Objective:To investigate the knowledge of hand-cleaning in student nurses,cultivate their awareness of washing hands,improve their submitting of washing hands and standardize their washing procedure,so as to reduce the hospital-acquired infection via hands.Methods: A self-designed questionnaire on hand-cleaning-related knowledge was used to survey 100 student nurses in their clinical practice in our hospital.Results:In the 100 questionnaires,some student nurses have poor-mastering of the signs of hand-cleaning,and have indefinite concepts of the time,position and frequency of hand-cleaning.The most frequently forgotten part of hands cleaning is finger(42%),the second is wrist(29%).Lots of student nurses(92%) mistakingly thought that washing hands with warm water was much better.Conclusion:The student nurses had relatively poor knowledge on hand-cleaning,much more attention should be paid on the education of this aspect by nursing department,in order to improve self-protection and control of hospital-acquired infection effectively.

Objective To evaluate the safety and feasibility of total laparoscopic hepatectomy for liver neoplasms.Methods Laparoscopic hepatectomy in 15 patients with liver neoplasms were completed by combined application of ultrasound scalpel,Ligasure and vascular clip without blockage of liver blood flow,including 9 cases of hepatic cavernous hemangioma,whose diameters were from 5.0 cm to 15.0 cm,3 cases of hepatic cyst with fibrosis,located in left lateral hepatic lobe,3 cases of primary hepatic carcinoma,whose diameters were from 1.0 cm to 5.0 cm and the hepatic functions were all Child A.Results Laparoscopic hepatectomy was completed successfully in all 15 cases with no conversion to open laparotomy,including 6 cases of left lateral hepatectomy,9 cases of irregular hepatectomy.The mean operative time was 110 min,blood loss during operation was from 30 ml to 500 ml,the average was 251 ml.The mean postoperative hospital stay was 6.5 d.The mortality rate was 0%.No severe complications occurred except 1 case of small amount bleeding which stopped itself.Conclusion Total laparoscopic hepatectomy is a feasible,safe and minimal invasive approach for patients with liver neoplasms within segment Ⅱ、Ⅲ、Ⅳa、Ⅴ、 and Ⅵ.

Objective:To compare acquired immune deficiency syndrome (AIDS) related knowledge, attitudes, behaviors and their influencing factors among college students in different years in Beijing, and to provide evidence for targeted health education among college students in future.Methods: College students were selected by the stratified cluster sampling method, and a questionnaire survey was conducted among college students in year 2006 and 2016 in Beijing.The sample sizes were 1 800 and 3 001 college students, respectively.The contents of the questionnaire included: socio-demographic characteristics, AIDS related knowledge, AIDS related attitude, sex intercourse and its related risk behaviors, condom use intension, and AIDS related health education.Results: Compared with the year 2006, the average AIDS knowledge scores of college students in year 2016 dropped from 12.78±1.95 to 11.90±2.56 (t=12.91, P<0.05), and the correct answer rates of questions in the knowledge part were decreased, too.Except for belief on condom use, the college students were more negative on AIDS related attitude and self-efficacy in year 2016 than in year 2006.Among the students who had sex experience, the rates of commercial sex [17.65% (33/187) vs.6.53% (16/245), χ2=13.003, P<0.001] and the rates of homo-sexual intercourse [15.43% (29/188) vs.4.13% (10/242), χ2=16.356, P<0.001] were higher in year 2016 than in year 2006.The main way for the students seeking pornographic information was changed from books to internet (41.15%) in 2016 compared with the year 2016.In 2016, the influencing factors of intention on condom use were male (OR=0.713), self-efficacy of condom purchase (OR=0.876), never received sex education before college (OR=0.752), self-efficacy of condom use (OR=1.135), belief of condom use (OR=1.775), and attitude towards AIDS patients (OR=1.136).Conclusion: AIDS related knowledge, attitudes and behaviors among college students have been changed, AIDS related health education should be designed and improved based on new characteristics of college students.AIDS health education in colleges should pay more attention to sex attitude and sex responsibility and self-protection awareness among college students as well.

Objective To explore the effect of treating posterolateral tibial plateau fractures via the fibular osteotomy approach.Methods From August 2009 to August 2011,17 patients with posterolateral tibial plateau fractures,including 12 males and 5 females,aged from 24 to 76 years (average,37.8 years),were treated via the fibular osteotomy approach in our hospital.According to the Schatzker classification,8 cases were type Ⅱ,3 cases were type Ⅲ,6 cases were type V.After operation,X-rays were taken in all patients,and Rasmussen's radiological and functional gradings were used to evaluate radiological and functional outcomes of knees.Results All patients obtained follow-up,ranged from 9 to 35 months (average,18months).The healing time of the fracture ranged from 10.0 to 18.0 weeks (average,13.5 weeks).During the period of followed-up,there was no loss of reduction; one case presented with symptoms of common peroneal nerve injury,such as local hypesthesia in distal lateral lower leg and dorsi pedis,which recovered two weeks postoperatively.According to Rasmussen's radiological grading,the mean score of the knee joint was 17.5(range,14.0 to 18.0).The range of motion of the knee joint ranged from -5°to 135°(average,123.5o).According to Rasmussen's functional grading,the mean score of the knee joint was 26.9 (range,22 to 30).Conclusion Treating posterolateral tibial plateau fractures via the fibular osteotomy approach can obtain sufficient exposure,good reduction and fixation,and avoid flexion contracture of the knee and peripheral vascular nerve injury.Moreover,postoperative function and stability of the knee joint recover well.

Objective:To explore the impact of the clinic-pharmacy separation reform in Beijing on the outpatients with medical insurance.Methods:A segmented regression model of interrupted time series(ITS)data was used, to analyze the changes from April 2017 to May 2019 in outpatient visits, average cost per visit, out-of-pocket burden, with a tertiary hospital in Beijing as an example before and after the reform.Results:Segmental regression analysis showed that since the reform, the out-of-pocket burden of outpatients fell by 5.2% in the first month. After the reform, the medicine expenses decreased 0.50 yuan monthly instead of increasing 0.24 yuan before, and the surgery expenses, examination and laboratory fees, and materials expenses have increased from an average monthly increase of 0.14 yuan, 0.64 yuan and 0.36 yuan to 0.15 yuan, 0.70 yuan and 0.17 yuan respectively. Meanwhile, the growth rate of outpatient services slowed down, with an increase number dropping from 855 visits/month to 523 visits/month.Conclusions:The reform had reduced the out-of-pocket expenses of outpatients.

Objective To evaluate the objective sleep status of patients with chronic insomnia by cardiopulmonary coupling (CPC) technique, and evaluate the characteristics of cognitive dysfunction to explore the correlation between objective sleep and cognitive dysfunction in patients with chronic insomnia. Methods Forty-three patients with chronic insomnia, admitted to our hospital from October 2017 to April 2019, were enrolled in our study;15 age-, gender-and education-matched healthy volunteers were recruited as control group. All subjects followed their daily routine at home and completed CPC examination. Montreal Cognitive Assessment (MoCA), Auditory Vocabulary Learning Test (AVLT), Trail Making Test (TMT) and Stroop Color Word Test were used to evaluate the general and single cognitive functions, respectively. The correlation of objective sleep with cognitive function was analyzed. Results (1) As compared with those in the control group, high frequency coupling (stable sleep) ratio was significantly decreased, low frequency coupling (un-stable sleep) ratio and extremely low frequency coupling (rapid-eye-movement sleep/waking) ratio were significantly increased, and latency of high frequency coupling was significantly prolonged in chronic insomnia group (P<0.05). (2) Chronic insomnia group had significantly lower MoCA total scores than control group (P<0.05), specifically manifested as decrement of visuospatial ability and execution and attention abilities; specific cognitive test showed that chronic insomnia group performed worse in immediate recall, and had delayed recall of AVLT, longer time consumption in TMT-B, smaller number of wired arrival numbers, and longer time consumption in Stroop color word test than the control group, with significant differences (P<0.05). (3) There was a correlation between CPC sleep structure and Cognitive Function Scale scores in patients with chronic insomnia. Conclusion In patients with chronic insomnia, stable sleep is reduced, un-stable sleep and rapid-eye-movement sleep/waking are increased; the impaired cognition domains are visual space and executive function, attention and memory; disturbed sleep structure aggravates the memory and execution impairment of patients with chronic insomnia.

Objective:To explore the relationship between hematocrit, early fluid therapy, and clinical outcomes in patients with septic shock, and to provide evidence for fluid resuscitation therapy and prognosis assessment in these patients.Methods:The clinical information of patients with septic shock who were diagnosed and treated in the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 1, 2018 to December 31, 2020 were collected. Taking the survival or death of patients 28 days after admission as the end point of clinical research, the patients were divided into the survival and death groups. After analyzing the basic data of the two groups, the univariate and multivariate COX regression analyses were used to analyze the evaluation value of Δ Hematocrit (HCT) d2-d1 and ΔHCT d3-d1 on the prognosis of patients with septic shock. At the same time, the Kaplan-Meier survival curve was used to analyze the overall survival rate of patients with septic shock, and the smooth curve fitting graph was used to verify its relationship with net fluid intake and death. Results:There were 241 cases in the survival group and 67 cases in the death group. Univariate COX analysis showed statistically significant differences between the survival and death groups in acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) ( P=0.0006), red cell volume distribution width (RDW) ( P=0.0043), age ( P=0.0184), ΔHCT d2-d1 ( P=0.0136), ΔHCT d3-d1 ( P=0.0204), and white blood cell (WBC) ( P=0.0444). Multivariate COX analysis showed that ΔHCT d2-d1 ( P=0.0115) and ΔHCT d3-d1 ( P=0.0029) were independent risk factors for death in EICU patients with septic shock. ΔHCT d2-d1 and ΔHCT d3-d1 were divided into three groups according to the three-digit method. The Kaplan-Meier survival curve showed no significant difference among the three groups in the overall survival rate related to ΔHCT d2-d1 ( P=0.16), but there was a statistically significant difference in the overall survival rate among the three groups related to ΔHCT d3-d1 ( P=0.025). The smooth fitting curve of ΔHCT d3-d1, net fluid intake, and prognosis showed that ΔHCT d3-d1 was negatively correlated with net fluid intake, and the middle ΔHCT d3-d1 group had the best prognosis. Conclusions:The value of ΔHCT d3-d1 is related to the net fluid intake of patients with septic shock. An appropriate decrease in HCT on the third day can improve the prognosis of patients with septic shock. The dynamic changes of hematocrit can provide a certain basis for fluid resuscitation and prognosis evaluation in patients with septic shock.

Objective:To retrospectively analyze clinical efficacy and safety of omalizumab in the treatment of chronic urticaria (CU) in southern Zhejiang, China.Methods:A retrospective observational study was conducted on CU patients who received omalizumab treatment at the First Affiliated Hospital of Wenzhou Medical University from January 1st, 2018 to August 1st, 2021. Through the outpatient follow-up visits, the disease activity, condition control, and quality of life were evaluated using the 7-day urticaria activity score (UAS7) , urticaria control test (UCT) , and dermatology life quality index (DLQI) . In addition, changes in disease condition, recurrence after withdrawal, and adverse events were assessed. Independent-sample t test was used for intergroup comparisons of normally distributed measurement data, Wilcoxon signed-rank sum test or Kruskal-Wallis H test was used for comparisons of non-normally distributed measurement data, and chi-square test or Fisher′s exact test was used for comparisons of enumeration data. Results:A total of 252 CU patients with poor response to antihistamines were included, with a baseline UCT score of 5.0 ± 2.4 points, a UAS7 score of 25.6 ± 6.2 points, and a DLQI score of 17.5 ± 4.7 points; among them, 204 (81.0%) were treated with omalizumab at an initial dose of 300 mg, and 48 (19.0%) with omalizumab at an initial dose of 150 mg. At the end points (12.0 ± 1.4 months after the start of treatment) , an overall control rate of 90.3% (224/248) was achieved after the omalizumab treatment; concretely, 137 (55.2%) patients achieved complete control (UCT = 16 points) , 87 (35.1%) achieved partial control (12 points ≤ UCT < 16 points) , and 24 (9.7%) showed no response (UCT < 12 points) , while 10 with partial response shifted to complete control after dose increase. During the treatment period, recurrence occurred in 50 patients (36.5%) , of whom 32 patients opted for retreatment with omalizumab, and then 30 (93.8%) achieved partial or complete control. Adverse events were reported in 8 patients (3.2%) , and all were mild or moderate.Conclusion:Omalizumab was effective in the real-world treatment of CU, and could improve patients′ quality of life, with a favorable safety profile.

Objective:To explore the clinical characteristics of patients with paraquat mixed with diquat poisoning.Methods:The clinical data of 145 patients with paraquat mixed with diquat poisoning admitted to the Department of Emergency of the First Affiliated Hospital of Wenzhou Medical University from January 20, 2016 to March 31, 2022 were retrospectively analyzed. According to the detection results of plasma toxicants in patients with poisoning, the patients were divided into the paraquat diquat mixed group (mixed group), paraquat group (PQ group) and diquat group (DQ group). The clinical indexes, organ dysfunction, different poisoning doses and prognosis of the three groups were compared. Patients in the mixed group were divided into the survival group and death group according to their 90-day survival, and the differences of each index between the two groups were compared. Kaplan-Meier survival analysis was conducted for each index. After Log-rank test, multivariate Cox regression was used to analyze the risk factors of death in the mixed group.Results:A total of 31 patients were included in the mixed group, 92 patients in the PQ group, and 22 patients in the DQ group. There were significant differences in age, toxic dose, number of organ dysfunction, PSS score and APACHE II score among the three groups ( P<0.05). The main injured organs of the mixed group were gastrointestinal tract, kidney, liver, lung and nervous system. The proportion of organ damage in the mixed group was higher than that in the PQ group and DQ group. The white blood cell count, neutrophil count, HB, creatinine, AST, lactic acid, PT and APTT were statistically significant among the three groups ( P<0.05). In the mixed group, patients taking oral administration of < 20 mL all survived; 8 patients taking oral administration of 20 -50 mL died; 11 patients took oral administration of 51-100 mL and 8 (72.7%) died; and 10 patients took oral administration of more than 100 mL and 9 patients (90%) died. In the mixed group, patients with the concentration of diquat > 5000 ng/mL died. Among 31 patients with mixed poisoning, 30 patients (96.78%) had significantly higher concentrations of diquat than paraquat. There were no significant differences in sex, age, time from poisoning to hospitalization, ingestion amount, lymphocyte count, Hb, BNU, CK, total bilirubin, PH, and PT between the survival group and the death group ( P>0.05). Multivariate Cox regression analysis showed that the ingestion amount, plasma PQ concentration at admission, plasma DQ concentration at admission, and lactic acid were independent risk factors for death ( P<0.05). Conclusions:Paraquat mixed with diquat can cause multiple organ function damage. The main damaged organs are gastrointestinal tract, kidney, liver, lung and nervous system. Compared with PQ or DQ poisoning, mixed poisoning has a higher incidence of organ damage, a more serious condition, and a higher mortality rate. Ingestion amount, plasma PQ concentration at admission, plasma DQ concentration at admission and lactic acid were independent factors influencing the prognosis of mixed poisoning.

Platycodon grandiflorus polysaccharide (PGP) is one of the main components of P. grandiflorus, but the mechanism of its anti-inflammatory effect has not been fully elucidated. The aim of this study was to evaluate the therapeutic effect of PGP on mice with dextran sodium sulfate (DSS)-induced ulcerative colitis (UC) and explore the underlying mechanisms. The results showed that PGP treatment inhibited the weight loss of DSS-induced UC mice, increased colon length, and reduced DAI, spleen index, and pathological damage within the colon. PGP also reduced the levels of pro-inflammatory cytokines and inhibited the enhancement of oxidative stress and MPO activity. Meanwhile, PGP restored the levels of Th1, Th2, Th17, and Treg cell-related cytokines and transcription factors in the colon to regulate colonic immunity. Further studies revealed that PGP regulated the balance of colonic immune cells through mesenteric lymphatic circulation. Taken together, PGP exerts anti-inflammatory and anti-oxidant effect and regulates colonic immunity to attenuate DSS-induced UC through mesenteric lymphatic circulation.
Animals ; Mice ; Colitis, Ulcerative/drug therapy* ; Platycodon ; Colon/pathology* ; Cytokines ; Anti-Inflammatory Agents/therapeutic use* ; Polysaccharides/therapeutic use* ; Dextran Sulfate ; Disease Models, Animal ; Colitis/chemically induced* ; Mice, Inbred C57BL