To explore the current status of children receiving primary health services at a community health service center in Shenzhen so as to provide references for the formulation of children health care policies.According to the patient electronic data in 2011,the clinical profiles were analyzed for children aged under 7 years seeking the advice of general practitioners (GPs) at Niuhu Community Health Service Center.Children aged under 7 years accounted for 12.4％ of all subjects.The causes of seeing the GPs were as follows:acute upper respiratory.infection(58.2％),acute bronchitis(14.9％),gastroenteritis(5.6％),trauma(3.3％)and dermatitis(3.2％).And no difference existed in the workload between pediatrists and surgeons,internists or herbalists.The common and frequent community diseases may be diagnosed and managed at a community health service center.

Objective To analyze the clinical characteristics of two patients with 3β-hydroxysteroid dehydrogenase deficiency and to explore their molecular genetic defects.Methods The clinical features and laboratory data of two patients were collected.The exons of HSD3B2 gene were amplified by PCR and sequenced by Sanger sequencing.Results Patient 1, aged 5 yrs old, was raised as a girl with 46, XY karyotype, presented with hyperpigmentation, female infant vulva, clitoral hypertrophy, and bilateral cryptorchidism;Patient 2, aged 11 yrs old, was raised as a girl at birth but as a boy after 1 yr old for known 46, XY karyotype, presented with hyperpigmentation, micropenis and severe hypospadias.Both patients had markedly elevated adrenocorticotropin and decreased cortisol.Two homozygous missense mutations in HSD3B2 gene were identified:conversions of codon Pro155 toLeu(p.P155L)inpatient1,andcodonAla82toThr(p.A82T)inpatient2,bothofwhichwerereportedforthe first time in China.Conclusion The patients with 3β-hydroxysteroid dehydrogenase deficiency in 46,XY karyotype mainly present with male pseudohermaphroditism and adrenocortical deficiency, and the diagnosis should rely on the steroids detection and HSD3B2 gene screening.

Objective To study the predisposing factors of postoperative complications of esophageal cancer,and analyze the different genetic expression of mRNA,DNA methylation and mutations with different esophageal cancer staging.Methods A total of 706 patients with esophageal cancer from the First Affiliated Hospital of Nanjing Medical University and Jiangsu People's Hospital from 2010 to 2013 and 2015 to 2016 were involved in this study.Data of genetic information from 107 patients with esophageal cancer were obtained from the Cancer Genome Atlas (TCGA) database.Results The analysis showed that age was correlated with SEP (P =0.011),and pTNM staging was correlated with the occurrence of AF (P =0.010) and CL (P =0.030).The postoperative nutritional pattern was also significantly associated with the occurrence of AF (P =0.041).There was a significant difference in the expression of EPHA3 mRNA in patients with esophageal cancer in different TNM stage (P =0.006),DNA methylation level of NOTCH1 (P =0.027),and mutations genes such as ZNF750 (P =0.037) and MALAT1 (P =0.044).Conclusion Postoperative complications of esophageal cancer could be associated with patients'age,TNM staging and postoperative nutritional patterns.The expression of EPHA 3 mRNA and the DNA methylation of NOTCH 1 show significant difference in different TNM stages of esophageal cancer,and both of them have higher expression in advanced patients.Mutation of ZNF750 and MALAT1 are negatively correlated with the staging of esophageal carcinoma.

Objective To study the predisposing factors of postoperative complications of esophageal cancer,and analyze the different genetic expression of mRNA,DNA methylation and mutations with different esophageal cancer staging.Methods A total of 706 patients with esophageal cancer from the First Affiliated Hospital of Nanjing Medical University and Jiangsu People's Hospital from 2010 to 2013 and 2015 to 2016 were involved in this study.Data of genetic information from 107 patients with esophageal cancer were obtained from the Cancer Genome Atlas (TCGA) database.Results The analysis showed that age was correlated with SEP (P =0.011),and pTNM staging was correlated with the occurrence of AF (P =0.010) and CL (P =0.030).The postoperative nutritional pattern was also significantly associated with the occurrence of AF (P =0.041).There was a significant difference in the expression of EPHA3 mRNA in patients with esophageal cancer in different TNM stage (P =0.006),DNA methylation level of NOTCH1 (P =0.027),and mutations genes such as ZNF750 (P =0.037) and MALAT1 (P =0.044).Conclusion Postoperative complications of esophageal cancer could be associated with patients'age,TNM staging and postoperative nutritional patterns.The expression of EPHA 3 mRNA and the DNA methylation of NOTCH 1 show significant difference in different TNM stages of esophageal cancer,and both of them have higher expression in advanced patients.Mutation of ZNF750 and MALAT1 are negatively correlated with the staging of esophageal carcinoma.

Objective: To investigate the effects of "Q" nose paste on fixing nasogastric tube. Methods: Totally 167 patients with nasogastric tube were divided into the observation group(80 cases) and the control group(87 cases) by random digits table method.The observation group fixed nasogastric tube using "Q" nose paste,while the control group using "π" nose paste. The occurrence rate of pressure injury of nasal mucosa and nasogastric tube dislocation, nurses′ operation time of pasting, removing nose paste, the time intervals of exchanging nose paste were observed and compared between the two groups. Results: The occurrence rate of pressure injury of nasal mucosa in the observation group was 0,and it was significantly lower than the control group 6.897% (6/87), the difference was statistic between the two groups (χ²=5.523, P<0.05). The nurses′ operation time of pasting and removing nose paste in the observation group was (18.99 ± 1.13), (10.20 ± 0.96) s, and they were significantly shorter than the control group (38.97 ± 1.28), (20.38 ± 1.30) s, the difference was statistic between the two groups (t=-106.521, -57.266, P<0.01). The time intervals of exchanging nose paste in the observation group was (3.78 ± 0.98) d, and it was significantly lower than the control group (2.07 ± 0.91) d, the difference was statistic between the two groups(t=11.628, P<0.05). There was no statistical difference in the rate of nasogastric tube dislocation between the two groups (P>0.05). Conclusions Application of "Q" nose paste in fixation of nasogastric tube can decrease the incidence of nasal mucosa pressure ulcers, it is conducive to extend the interval of nasal sticker replacement and improve work efficiency, thus is worthy of clinical application.

Objective To evaluate the efficacy of healthcare failure mode and effect analysis in enhanced recovery after surgery(ERAS) in thoracic surgery. Methods Establish the healthcare failure mode and effect analysis group and evaluate the possible healthcare failure modes in implementation of ERAS.Calculate the odds ratio and make a decision tree in order to find out the failure modes and make safe schemes for bowel preparation, peri-operative pain monitoring and evaluation, vein thrombosis screening and management, early mobilization and food-taking after surgery and catheter removal for patients with benign prostate hyperplasia. Results Before and after the implementation of ERAS, 237 patients were selected.The risk priority number after the implementation of ERAS had been reduced,all less than 8 points. After the implementation of ERAS, the rate of initial pain score greater than 4 was 53.2%(126/237),the incidence of nausea and vomiting was 13.5%(32/237),and incidences of thrombosis and constipation were all 6.8%(16/237),the urinating patency rate after pulling-out the tube was 100.0%(237/237). Before the implementation of ERAS, the indicators was 96.6%(229/237), 43.0%(102/237), 30.0%(71/237), 36.7%(87/237),79.7%(189/237).There was significant difference before and after the implementation of ERAS (χ2=5.455-15.022, P<0.05). Conclusions The application of healthcare failure mode and effect analysis can reduce the incidence of adverse reaction and complications after thoracic surgery and ensure a secure and high-quality implementation of ERAS,which is worth using widely.

Objective:To construct the exercise rehabilitation index system and exercise program for cardiac surgery patients after cardiopulmonary bypass, in order to provide basis for exercise rehabilitation.Methods:By literature analysis and group discussion, initial expert consultation letters were drawn up, and the Delphi method was used to conduct two rounds of consultation with 20 experts in the field of cardiac rehabilitation, and the exercise rehabilitation program was constructed on the basis of index system.Results:Response rate of two rounds of consultation was 100%, respectively. Experts ′ authority coefficients of the two rounds of consultation were 0.882 5 and 0.935 0 respectively. The Kendall coordination coefficients of the first and second level indexes were all statistically significant. The index system included 10 first-class indicators and 48 second-class indicators, forming a three-level exercise rehabilitation program. Conclusions:The index system and exercise rehabilitation program are scientific and practical, which provide reference for the implementation of exercise rehabilitation.

Objective:To evaluate the global and segmental myocardial work in patients with cardiac amyloidosis (CA) by left ventricular pressure-strain loop (PSL) noninvasively.Methods:Eighteen patients with CA in Beijing Chao-Yang Hospital from March 2018 to December 2020 were included as CA group, 20 healthy subjects were selected as control group. The global longitudinal strain (GLS) and mechanical dispersion (MD) of left ventricle were analyzed by two-dimensional speckle tracking imaging. The left ventricular PSL was used to assess global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE). The mean value of left ventricular basal, mid and apical myocardial work index (MWI), constructive work (CW), waste work (WW) and work efficiency (WE) were calculated and compared between the two groups.Results:①Compared with the control group, GLS was decreased and MD was increased in CA group (all P<0.05). ②GWI, GCW, GWW and GWE were decreased in CA group compared with the control group (all P<0.05). ③In CA group, the MWI, CW and WE of the basal, mid and apical segments were lower than those of control group (all P<0.05), WW of the basal and mid segments were lower than those of apical segment(all P<0.05). The impairment of MWI, WW and WE in basal and mid segment were more significant than those of apical segment (all P<0.05). ④GWI, GCW and GWE were positively correlated with GLS ( r=0.854, 0.816, 0.748; all P<0.001) and LVEF ( r=0.674, 0.634, 0.650; all P<0.01), and negatively correlated with MD ( r=-0.657, -0.672, -0.710, all P<0.01). GWI and GCW were negatively correlated with E/e′ ( r=-0.493, -0.539; all P<0.05). Conclusions:The global, basal, mid and apical left ventricular myocardial work indices are decreased in CA patients. MWI, CW and WE show an apical sparing pattern. Quantitative assessment of myocardial work by PSL may provide more valuable information for CA patients.

Objective To evaluate the efficacy and safety of Qingpeng ointment for the treatment of localized eczema in children.Methods A multicenter,randomized,open-labeled,tacrolimus 0.03％ ointment-controlled clinical trial was conducted.A total of 442 children with localized eczema were enrolled into this study,and divided into 2 groups to topically apply Qingpeng ointment (Qingpeng group) and tacrolimus 0.03％ ointment (tacrolimus group) respectively twice a day for 2 weeks.The children were followed up before the treatment and 1,2 weeks after the treatment,and the efficacy and safety were evaluated at the same time.Results Clinical data from 426 children were included in the efficacy analysis.At 1,2 weeks after the treatment,there were no significant differences in the response rate between the Qingpeng group and tacrolimus group (1 week after the treatment:78.92％ vs.81.77％,x2 =0.545,P =0.460;2 weeks after the treatment:98.65％ vs.97.54％,x2 =0.721,P =0.396).However,the pruritus scores at 1,2 weeks after the treatment were both significantly lower in the Qingpeng group than in the tacrolimus group (1 week:F =14.001,P =0.000;2 weeks:F =11.252,P =0.001).At 1 week after the treatment,the incidence rate of adverse reactions was significantly lower in the Qingpeng group than in the tacrolimus group (P ＜ 0.05).Mild itching,burning sensation and other local irritant sensations were the most common adverse reactions.Conclusion Qingpeng ointment is safe and effective for the treatment of localized eczema in children with good tolerability.

Objective:To evaluate the effects of dexmedetomidine on the content of glutamate and expression of NR1 in hippocampus of mice with endotoxemia and the role of cholinergic anti-inflammatory pathway.Methods:Eighty clean-grade male C57BL/6 mice, aged 8 weeks, weighing 24-28 g, were divided into 4 groups ( n=20 each) using a random number table method: control group (group C), endotoxemia group (group LPS), dexmedetomidine group (group DEX) and alpha-bungarotoxin (α-BGT) group.Lipopolysaccharide 20 mg/kg was intraperitoneally injected to establish the model of endotoxemia in LPS, DEX and α-BGT groups. Dexmedetomidine 40 μg/kg was intraperitoneally at 15 min before establishing the model in DEX and α-BGT groups.In group α-BGT, alpha-7 nicotinic acetylcholine receptors specific agonist α-BGT 1 μg/kg was intraperitoneally injected at 15 min before injecting dexmedetomidine.Ten mice taken in each group were selected to collect the blood samples from the eyeball and then sacrificed, and hippocampi were isolated.Enzyme-linked immunosorbent assay was used to measure the concentration of serum S100β protein and NSE, and high-performance liquid chromatography was used to determine the content of glutamate in hippocampus.Ten mice in each group were sacrificed at 6 h after establishing the model to detect the expression of NR1 in hippocampus by immumofluorescence method. Results:Compared with group C, the concentrations of serum S100β protein and NSE concentrations and hippocampal glutamate content were significantly increased, and NR1 expression was up-regulated in LPS, DEX and α-BGT groups ( P<0.01). Compared with group LPS, the concentrations of serum S100β protein and NSE concentrations and hippocampal glutamate content were significantly decreased, and NR1 expression was down-regulated in DEX and α-BGT groups ( P<0.01). Compared with group DEX, the concentrations of serum S100β protein and NSE concentrations and hippocampal glutamate content were significantly increased, and NR1 expression was up-regulated in group α-BGT ( P<0.01). Conclusion:The mechanism by which dexmedetomidine alleviates cerebral injury is associated with activating cholinergic anti-inflammatory pathway, decreasing glutamate content and down-regulating NR1 expression in mice with endotoxemia.