Objective To summarize the experience of nursing cancer patients with anal fistula treated with blood stem cells transplantation (BSCT). Method 8 critical cancer patients with anal fistula treated with BSCT from August 2013 to November 2014 were intervened by nursing measures such as prevention of constipation and diarrhea , protecting the anus from infection and health education . Results Two patients of them contracted with mild crissum infection , 1 moderate , 0 severe . With the pertinent nursing intervention , no serious complications occurred . The hospital stay was 20~30 d , with an average of ( 24 . 75 ± 2 . 30 ) . Conclusion The nursing measures including preventing constipation and diarrhea, keeping the anus from infection and health education can be effective in avoiding anal fistula infection and its related complications and reducing patients′pain , which are worth clinical promotion .

ld have an improved outcome after reasonable treatments. The gene mutation detection suggests that 609G>A (W203X) may be the hot spot mutation of MMACHC gene in Chinese patients.

Objective:To explore the effect of Traditional Chinese Medicine (TCM) syndrome differentiation and nursing on quality of life and immune function of elderly patients with middle and advanced non-small cell lung cancer.Methods:A total of 95 elderly patients with non-small cell lung cancer who were admitted to Taizhou Hospital of Zhejiang Province from March to April 2019 were selected by convenience sampling. Among them, 46 patients admitted from March to September 2018 were selected as the control group and 49 patients admitted from October 2018 to April 2019 were selected as the observation group. Patients in the control group were given routine nursing, while patients in the observation group were given TCM syndrome differentiation and nursing on the basis of control group. The the MOS Item Short from Health Survey (SF-36) score, T lymphocyte subsets and nursing satisfaction of patients before and after intervention were compared between the two groups.Results:After the intervention, SF-36 scores of patients of the two groups were lower than those before the intervention ( P<0.05) , and the SF-36 scores of the observation group after the intervention were significantly higher than those of the control group, the differences were statistically significant ( P<0.05) . After the intervention, levels of CD3 +, CD4 + and CD4 +/CD8 + in the two groups were lower than before the intervention ( P<0.05) , and the levels of CD3 +, CD4 + and CD4 +/CD8 + in the observation group after intervention were higher than those in the control group, the differences were statistically significant ( P<0.05) . The nursing satisfaction of the observation group was significantly higher than that of the control group, the difference was statistically significant ( P<0.05) . Conclusions:TCM syndrome differentiation and nursing is helpful to protect the quality of life and immune function of elderly patients with middle and advanced non-small cell lung cancer undergoing chemotherapy and improve nursing satisfaction of patients, which is worthy of clinical promotion.

Influenza is one of the respiratory infectious diseases threatening human health, which has been widely concerned by researchers for its high morbidity and mortality. The immune function is compromised in patients receiving cancer chemotherapy, patients receiving hemopoietic stem cell transplantation or solid organ transplantation, patients on maintenance hemodialysis, and patients receiving systemic corticosteroids. Compared with immunocompetent patients, immunosuppressed patients have a longer duration of viral shedding and more antiviral resistance during influenza infections. This article reviews the antiviral therapy and related drug resistance in immunosuppressed patients with influenza, and also discusses the management of resistance to neuraminidase inhibitors and post-exposure prophylaxis in this population.

Background: Data on the efficacy and incidence of adverse effects associated with dexmedetomidine (DEX) as a local anesthetic adjuvant for patient-controlled epidural analgesia (PCEA) are inconclusive. This meta-analysis assessed the efficacy and risks of DEX for PCEA using opioids as a reference. Methods: Two researchers independently searched PubMed, Embase, Cochrane Library, and China Biology Medicine for randomized controlled trials comparing DEX and opioids as local anesthetic adjuvants in PCEA. Results: In total, 636 patients from seven studies were included in this meta-analysis. Postoperative patients who received DEX had lower visual analog scale (VAS) scores than those who received opioids at 4–8 h (mean difference [MD]: 0.61, 95% CI [0.45, 0.76], P < 0.001, I2 = 0%), 12 h (MD: 0.85, 95% CI [0.61, 1.09], P < 0.001, I2 = 0%), 24 h (MD: 0.59, 95% CI [0.06, 1.12], P = 0.030, I2 = 82%), and 48 h (MD: 0.54, 95% CI [0.05, 1.02], P = 0.030, I2 = 91%). Additionally, patients who received DEX had a lower incidence of itching (odds ratio [OR]: 2.86, 95% CI [1.18, 6.95], P = 0.020, I2 = 0%) and nausea and vomiting (OR: 6.83, 95% CI [3.63, 12.84], P < 0.001, I2 = 24%). In labor analgesia, no significant differences in neonatal (pH and PaO2 of cord blood, fetal heart rate) or maternal outcomes (duration of labor stage, mode of delivery) were found between the DEX and opioid groups. Conclusions Compared with opioids, using DEX as a local anesthetic adjuvant in PCEA improved postoperative analgesia and reduced the incidence of itching and nausea and vomiting without increasing the incidence of adverse events.

Objective? To investigate the risks of malnutrition in patients with lung cancer during chemotherapy and to analyze their influencing factors. Methods? The inpatients with lung cancer receiving chemotherapy in the Department of Respiratory Medicine, Enze Medical Center from September 2017 to August 2018 were selected by convenient sampling. The 112 patients were divided into groups according to Nutrition Risk Screen (NRS) 2002. Their general information, diet and malnutrition risks were investigated successively. Logistic regression analysis was used to identify the influencing factors to malnutrition risks of the patients during chemotherapy. Results? Totally 112 patients completed the study. 28 of them showed no risk of malnutrition, while 84 had risks of malnutrition. There were statistically significant differences in age, place of residency, household monthly income, nutritional management, tumor staging, intake of protein and fat, nausea, emesis and diarrhea between two groups with different nutrition conditions(P＜ 0.01). Logistic regression analysis revealed that age, place of residency,monthly income, nutritional management, tumor staging, intake of protein, nausea, emesis and diarrhea were the risk factors of malnutrition in patients with lung cancer during chemotherapy. Conclusions? Patients with lung cancer are at high risk of malnutrition during chemotherapy. Age, nutritional management, tumor staging, intake of protein, nausea, emesis and diarrhea are the risk factors of malnutrition in patients during chemotherapy. Effective nutritional management intervention shall be made for patients as early as possible, so as to reduce the incidence and worsening of malnutrition and improve patients' effects and quality of life.

Objective To investigate the hospital work environment management, nurses' self-efficacy and work engagement and to explore the correlations among them. MethodsFrom March 2017 to March 2018, we selected 310 clinical nurses of three hospitals in Jinhua by convenience sampling. The investigation was carried out with the self-designed general information questionnaire, Chinese version of Practice Environment Scale (PES), General Self-Efficacy Scale (GSES) and Utrecht Work Engagement Scale (UWES). Correlation analysis was used to related data after being organized. In this study, 310 questionnaires were issued and 306 valid questionnaires were collected, with an effective recovery rate of 98.71%. ResultsAmong 306 nurses, the scores of PES, GSES and UWES were (95.25±12.17), (25.58±5.13) and (52.38±8.81) respectively. Pearson correlation analysis showed that the dimension scores of PES had positive correlations with the dimension scores of self-efficacy and work engagement (P＜0.05);nurses' self-efficacy was positively correlated with the dimension scores of work engagement (P＜0.05). Stepwise regression analysis used to explore the influence of work environment management between nurses' work engagement and self-efficacy showed that self-efficacy had a partial mediating effect between work environment and work engagement accounting for 37.64% of the total effect. ConclusionsNurses' work engagement has correlations with self-efficacy and work environment, and plays a mediating effect between them. Improving work environment management and nurses' self-efficacy can improve nurses' work engagement so as to provide the good nursing care for patients.

OBJECTIVETo investigate the MUT gene mutations in patients with methylmalonic acidemia (MMA), and analyze the genotype-phenotype correlation in patients with methylmalonyl-CoA mutase deficiency.

METHODSThe diagnosis of the disease mainly depends on the measurement of C3 (acylcarnitine), C3/C0 (free carnitine) and C3/C2 (acetylcarnitine) in the blood by tandem mass spectrometry, the detection of methylmalonic acid in the urine by gas-chromatography mass spectrometry, the determination of total homocysteine in the serum, and the loading test of vitamin B(12). The entire coding region of the MUT gene was screened by PCR combined with direct DNA sequencing in 21 isolated MMA patients. Novel mutations were identified by restriction fragment length polymorphism (RFLP) and sequence analysis in 100 controls.

RESULTSSeventeen MUT gene mutations were detected in 14 of the 21 patients, among them 8 mutations were novel, and R108H, D244LfsX39 and G544X were more frequent, with the frequencies of 9.5%, 7.1% and 9.5%, respectively. Most mutations were missense mutations (64.7%), and majority of them were in exons 2 and 3 (55.6%). Ten out of the 14 patients with MUT gene mutations had early-onset disease, while one case had late-onset disease, and the remaining 3 cases were detected by newborn screening. In addition, 11 of these 14 patients did not respond to vitamin B(12).

CONCLUSIONThis study revealed partial MUT gene mutation spectrum in Chinese patients with isolated MMA. The patients carrying MUT mutations often had early-onset disease, and most of them were VitB(12)- non-responsive.

Amino Acid Metabolism, Inborn Errors ; genetics ; Base Sequence ; China ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Methylmalonic Acid ; metabolism ; Methylmalonyl-CoA Mutase ; genetics ; Molecular Sequence Data ; Mutation

Objective:To analyse the clinical characteristics and antiviral therapy in immunosuppressed hospitalized patients with influenza.Methods:The clinical data of 273 patients with positive influenza A or B virus nucleic acid admitted in Peking University People’s Hospital from November 2015 to March 2022 were retrospectively analyzed. Among them, 123 were immunosuppressed and 150 were non-immunosuppressed. The clinical characteristics and antiviral therapy in immunosuppressed patients with influenza were analyzed. SPSS 22.0 software was used to analyze the data.Results:Chemotherapy for malignancies was the most common cause of immunosuppression (61.8%, 76/123), followed by haemopoietic stem cell transplantation (24.4%, 30/123). The common symptoms were fever (93.5%, 115/123) and cough (41.5%, 51/123). The proportions of co-infections (22.8%, 28/123) and complications (43.9%, 54/123) in immunosuppressed hospitalized patients were higher than those in non-immunosuppressed patients ( χ2=9.365 and 7.496, both P<0.01). Compared with single drug therapy, combination of antiviral drugs did not shorten the fever time, negative conversion time of virus nucleic acid and the length of hospital stay, and reduce the death ( U/ χ2=312.5, 356.0, 749.5 and 0.185, all P>0.05). Compared to patients without corticosteroids use, the use of corticosteroids did not increase mortality in immunosuppressed patients ( χ2=2.508, P=0.113). Conclusions:Classical symptoms may be absent in immunosuppressed patients with influenza, and early detection of influenza virus is still an important means of early diagnosis. Co-infections and complications are more common in immunosuppressed influenza patients. Immunosuppressed influenza patients did not benefit from the combination of antiviral therapy.

Objective To investigate the risk factors for postoperative prolonged mechanical ventilation in neonates and young infants with complicated congenital heart disease. Methods A retrospective analysis of 150 children (80 males and 70 females, aged ≤ 6 months, RACHS-1 grade ≥ 3) with complex congenital heart disease who were admitted to Children's Heart Surgery Department of Anzhen Hospital from January 2016 to December 2017 was conducted. These data were collected: the demographic data, history of cardicvascular-related diseases, type of surgery, preoperative complications, CPB, CPB time, deep hypothermia, blood gas index, delayed chest closure (DCC), pacemaker; minimum oxygenation index in the first 24 h after operation, maximum vasoactive-inotropic score (VIS), failed extubation and postoperative complications. Logistic regression model was used to analyze the risk factors of prolonged mechanical ventilation within neonates and young infants after complicated congenital heart surgery. Results Forty-two patients (28％) required PMV with mechanical ventilation ≥ 72 h. Univariate analysis showed age, weight, RACHS-1 grade, previous history of cyanosis, history of pneumonia, emergency surgery, preoperative mechanical ventilation, preoperative EF, deep hypothermia, CPB time＞ 132 min, intraoperative minmum pH value, intraoperative maximum blood glucose and lactic acid concentrations, DCC, application of pacemakers, maximum VIS within 24 h after surgery, minimal OI and postoperative complications may be the risk factors of prolonged postoperative mechanical ventilation in neonates and young infants with complicated congenital heart disease (P ＜ 0.05). Multivariate Logistic regression analysis showed that the CPB time＞132 min (OR = 11.04, 95％ CI 2.07-58.96, P = 0.005), intraoperative maximum lactate (OR = 1.53, 95％ CI 1.07-2.20, P = 0.021) and failed extubation (OR = 17.28, 95％ CI 2.46-121.20, P = 0.004) were independent risk factors for prolonged postoperative mechanical ventilation in neonates and young infauts with complicated congenital heart disease. Conclusion CPB time＞132 min, intraoperative maximum lactic acid concentration and failure of extubation can be used as predictors of prolonged postoperative mechanical ventilation in neonates and young infants with complicated congenital heart disease.