OBJECTIVE To provide references for clinical diagnosis of catheter-related bloodstream infections(CRBSIs) and focus on studying the spectras of pathogenic bacteria and the drug sensitiveness. METHODS A total of 137 patients enrolled from Jan 2005 to Dec 2007 in our hospital with positive catheter cultures were admitted to our retrospective analysis.Pathogenic bacteria,contaminant bacteria and the drug sensitiveness of main pathogenic bacteria were analyzed. RESULTS From them 80 patients were diagnosed CRBSIs.Among 92 strains of pathogenic bacteria,43(46.7%) strains were Gram-positives,31(33.7%) coagulase negative staphylococci(CNS) strains,31(33.7%) Gram-negative bacilli strains and 18(19.6%) were Candida strains. CONCLUSIONS CNS are the most common bacteria of CRBSIs,and the second are Candida.The common pathogen show multi-drug resistance.

Objective To systematically evaluate the effectiveness of delayed cord clamping (DCC) in term infants. Methods The data of the Cochrane library, PubMed, EMBASE, CNKI , VIP, Wanfang from 1 January 1970 to 30 April 2013 were searched. Randomized controlled trials (RCT) of DCC in term infants were included.RevMan 5.1.0 was used in the statis-tical analysis. Results Ten studies involving 1623 participants were included. Meta-analysis based on included studies showed that:compared with immediate cord clamping (ICC), DCC improved the hemoglobin levels at birth (MD=2.19, 95%CI:0.36, 4.02) and increased the incidence of polycythaemia (RR=2.87, 95%CI:1.24, 6.62). Compared with ICC, DCC showed no signi-ficant difference in the phototherapy for hyperbilirubinemia (RR=2.46, 95%CI: 0.93, 6.52), the hemoglobin levels within 6 months (MD=0.29, 95%CI:-0.17, 0.75), and the incidence of anemia (RR=0.71, 95%CI:0.45, 1.12). Conclusions DCC can improve the hemoglobin level in term infants after birth. However, the appropriate time of cord clamping has not been deter-mined. It is necessary to undertake further studies with higher quality and larger scale to evaluate the optimal time of cord clam-ping.

Objective To evaluate the predictive accuracy of several risk-assessment strategies to predict the risk of significant neonatal hyperbilirubinemia, and to establish the best prediction model.Methods The transcutancous bilirubin (TcB) levels of 4907 term and near-team infants were measured.Trace blood bilirubin levels of the infants whose TcB levels ≥250 μmol/L were detected. Clinical data of newborns and their mothers were collected and were analyzed with Logistic regression model to investigate its correlation with signifrcant hyperbilirubinemia. Clinical high risk factors of significant neonatal hyperbilirubinemia were determined. Accuracy of three prediction methods for significant hyperbilirubinemia was compared by receiver operating characteristic (ROC) curve. The three methods included: whether predischarge bilirubin level (within 72 hours after birth) expressed in risk zone on an hour-specific bilirubin nomogram; clinical risk factors other than predischarge bilirubin level; and combination of the predischarge bilirubin risk zone and other clinical risk factors. Results Two hundred and eighty-six newborns (5.8%) were found with significant hyperbilirubinemia. The risk factors of significant neonatal hyperbilirubinemia were divided into three groups according to OR: (1) Major risk factors:predischarge (within 72 hours after birth) bilirubin level in the high risk-zone (OR=96. 39, 95% CI:53.32-174.27, P = 0. 000), large cephalohematoma (OR = 36.45, 95% CI: 10. 02-132.56,P=0. 0076), gestational age 35-36+6 weeks (OR= 30. 72, 95% CI 14.47-65.23, P=0. 0001) and exclusive breast feeding and weight loss was ＞9% of birth-weight (OR=22.44, 95% CI: 4.42-114. 03, P=0. 0016). (2) Minor risk factors: gestational age 37-37+6 weeks (OR=3.26, 95% CI:1.92-5. 55, P=0. 0232), predischarge bilirubin level in P76-P95(OR=13. 64, 95% CI: 8. 10-22.97,P=0. 0001) and bruising (OR = 2.32, 95% CI: 1.14-4.71, P = 0. 0497). (3)Protective factors (those factors associated with decreased risk of hyperbilirubinemia): predischarge bilirubin level in low-risk zone (≤P40) (OR=0. 00), gestational age ≥40 weeks (OR=0.21, 95% CI: 0.09-0.44,P=0. 0402) and mixed breeding (OR=0. 75, 95% CI: 0. 58-0.95, P=0.0059). The area under the ROC curve of predischarge bilirubin level was 0. 8687 and 0. 7375 for clinical risk factors other than predischarge bilirubin level. The area under the ROC curve of a combination of the predischarge bilirubin risk zone and additional clinical risk factors was 0. 9367. Conclusions The risk of significant neonatal hyperbilirubinemia could be simply and accurately predicted by infant's predischarge bilirubin level and the combination of predischarge bilirubin level, and clinical risk factors might improve the accuracy of prediction significantly.

Objective To determine the concentrations of amphotericin B in serum and cerebrospinal fluid from patients with AIDS-associated cryptococcal meningitis.Methods Ten patients with AIDS-associated cryptococcal meningitis were enrolled in the study.Blood samples were collected before drug administrated at the 7th.14th and 21 th day after maintenance dose achieved.Cerebrospinal fluid samples were collected from lumbar puncture or taken before intrathecal drug administration at least one week after maintenance dose achieved.The concentrations of amphoteriein B in blood and cerebrospinal fluid samples were determined using RP-HPLC.Results When maintenance doses varied from 25 to 40 mg/d,the blood steady-state trough concentration range of amphotericin B was 1.34-2.27 ms/L,and that of cerebrospinal fluid was 44.0-9 1.7μg/L.Conclusions The concentrations of amphotericin B in the cerebrospinal fluid would be lower than the desired concentration if amphotericin B administrated only through intravenous or integrated with irregular intrathecal administration.It suggests that higher dosage of intravenous injection and regular intrathecal administration should be applied to achieve the desired concentration.

Objective:To explore the effect of enhanced recovery after surgery(ERAS)-based multidisciplinary collaboration model on shortening the time of forbidden eating before receiving surgery, provide the basis for the selection of the preoperative diet prohibition scheme.Methods:From January 2017 to February 2019, a total of 384 patients who received the operation in Qingdao Municipal Hospital were analyzed retrospectively. The patients who under the traditional preoperative diet prohibition scheme were taken as the control group(156 cases) while those who under the multidisciplinary cooperation mode nursing under the concept of eras were taken as the experimental group(228 cases). The experimental group formulated the perioperative diet prohibition process according to the guidelines of eras, and the experimental group carried out the perioperative diet management for the patients according to the procedure. The difference between the two groups in the time of fasting, hunger, thirst incidence, insulin resistance, temporary stop will be observed and compared.Results:The time of fasting was (4.01±1.55) h in the experimental group and (10.12±1.57) h in the control group,there was significant difference between the two groups( t value was -1.65, P < 0.01). The incidences of thirst,hunger were 13.2%(30/228), 11.8%(27/228) in the experimental group and 89.7%(140/156), 87.2%(136/156) in the control group, there were significant differences between the two groups(χ 2 values were 220.20, 215.20, P < 0.01). The levels of insulin resistance on the first and third day after operation were 1.85 ± 0.43,1.52±0.61 in the experimental group and 1.99±0.51, 1.67±0.49 in the control group, the differences were statistically significant ( t values were -2.90, -2.56, P < 0.05).The temporary stop rate was 1.75%(4/228) in the experimental group and 7.69%(12/156) in the control group, the difference was statistically significant( χ2 value was 8.19, P<0.01). Conclusions:The ERAS-based multidisciplinary collaboration model can effectively shorten the preoperative fasting time, reduce the level of insulin resistance, reduce the incidence of hunger and thirst, and improve the rate of temporary stop and adjustment.

Objective To investigate the dynamic changes of transcription profiles of mouse thymus gene expression in different times after 6 Gy γ-irradiation.Methods High-flux cDNA microarray technique was used irradiation,the numbers and types of differentially expressed genes were gradually decreased,for instance,the induced differential expression genes were involved in cell cycle,immunity and stress,apeptosis,signal transduction,transcription regulation,DNA synthesis and recombination,cystoskeleton,ion channel and transportation,metabolism,protein translation and synthesis,development and cell differentiation,etc.correlated cell cycle(3 up-regulating:Cyclin G,Anxal,Fgf1 and 2 down-regulating:Cdc2a,Cdc25b),5 genes correlated immune stress(4 up-regulating:IL-18,Casp1,IL-15,IL-7 and 1 down-regulating:Cd28),7 genes correlated apoptosis(4 up-regulating:Caspl,Anxal,Perp,IL-7 and 3 down-regulating:Pten,Api5 and Fas).Conclusions After 6 Gy irradiation,differentially expressed genes in mouse thymus is not only involved in many targets,levels and pathways,but also displayed an obvious difference in times.This reveals the regular pattern of differential expression genes in the process of injury and reconstitution in moderate dose irradiated mouse thymus.

Objective To observe the effect of γ-ray irradiation on CD4 + CD25 + regulatory T cells (Tregs),and to investigate the mechanism of immune injury induced by irradiation.Methods The thymus and spleen of C57BL/6 mice were taken and weighted 1-28 d after γ-ray irradiation,and the organ coefficients were calculated.The amount of mouse peripheral WBC measured,CD4 + T cells and Tregs in peripheral and splenic were analyzed by flow cytometry.Results Coefficients of mouse thymus and spleen decreased significantly 1 d post irradiation,and reached to the bottom at 7 d.Coefficients did not recover to control level 28 d after radiation.Peripheral WBC continuously decreased and reached the bottom at 7 d,and did not recover to control level up to 28 d postirradiation.Peripheral CD4 + T lymphocyte temporally reduced at 1 d,while it increased at 7 d,and it approached to control level at 28 d after radiation.Splenic CD4 + T cells slightly reduced at 7 d however,they basically maintained as the same level as control 14 d and 28 d after radiation.Peripheral Tregs ascended at 1 d and reached the peak at 7 d,and reduced at 14 d and 28 d postirradiation,although they still were significantly higher than those of control group.At the same time,splenic Tregs increased significantly and achieved peak value at 1 d,and then gradually decreased and reached the minimum at 28 d after irradiation,which were significantly lower than those of control group( t =2.731,P ＜ 0.05).Conclusions Mouse thymus and spleen were injured severely,and the number of immunocytes decreased after 6 Gy whole body γ-ray irradiation.However,Tregs with immunosuppressive action increased significantly postirradiation,revealing that Tregs were closely correlated with immune function depression and immunomodulation imbalance induced by ionizing radiation.

Objective:To investigate the analgesic efficacy of dexmedetomidine combined with dizosine after lumbar internal fixation and its effects on hyperalgesia.Methods:Seventy-two patients who underwent lumbar internal fixation in General Hospital of Armed Police and Marine Police between April 2018 and June 2019 were included in this study. They were randomly assigned to undergo either flurbiprofen axetil and dizosine administration (control group) or dexmedetomidine and dizosine (observation group) for postoperative analgesia. Mechanical pain, degree of postoperative pain, and incidence of complications were recorded in each group.Results:At 6, 24 and 48 hours after surgery, peri-wound pain threshold in the observation group was (119.52 ± 20.42) points, (120.19 ± 17.44) points, (120.94 ± 20.73) points, respectively, which were significantly higher than (108.42 ± 15.24) points, (107.63 ± 16.83) points, (108.47 ± 17.82) points in the control group ( t = 0.01, 0.00, 0.01, all P < 0.05). At 24 and 48 hours after surgery, forearm pain threshold in the observation group was (109.93 ± 15.87) points and (110.79 ± 22.85) points, respectively, which were significantly higher than (97.07 ± 16.49) points and (95.63 ± 24.06) points ( t = 3.37, 2.74, both P < 0.05). There was no significant difference in Ramsay Sedation Scale score between the two groups ( P > 0.05). There was no significant difference in the dose of dizosine used within 48 hours after surgery between the two groups ( P > 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group [8.33% (3/36) vs. 27.78% (10/36), χ2 = 4.60, P < 0.05]. Conclusion:Dexmedetomidine combined with dizosine exhibits obvious analgesic efficacy after lumbar internal fixation. The combined therapy can effectively prevent hyperalgesia with a low incidence of comphications.

Objective: To explore the improvement effect of hypnotherapy on dysmenorrhea symptoms of female college students with primary dysmenorrhea, in order to provide reference for the intervention and treatment of female college students with primary dysmenorrhea. Methods: From Septerber to December 2021, 90 female college students diagnosed with primary dysmenorrhea in Qinzhou First People s Hospital were randomly divided into hypnotic suggestion group( n =30), hypnotic relaxation group ( n =30) and control group( n =30). The 10 session hypnotic suggestion and 10 session hypnotic relaxation interventions were carried out while the control group received no intervention. Participants in the three groups were assessed by using the Visual Analogue Scale(VAS), Beck Depression Inventory Ⅱ(BDI Ⅱ), State Anxiety Inventory(SAI), Questionnaire of Quality of Life of College Students(QOLCS), Cox Dysmenorrhea Symptom Scale (CMSS) before and after intervention. Results: After intervention, the VAS, BDI Ⅱ and SAI scores of the hypnotic suggestion group and the hypnotic relaxation group significantly decreased compared to those before the intervention( t =7.04, 13.32, 3.58, 2.15, 2.52, 2.01, P <0.05). There were statistically significant differences in VAS, BDI Ⅱ and SAI scores among the three groups( F =24.71, 29.57, 6.60, P <0.01). After intervention, the QOLCS total score, physical, psychological and behavioral dimension scores in the hypnotic suggestion group and the hypnotic relaxation group significantly improved( t =-4.61, -3.36, -3.12, -2.81, -2.71, -2.19, -2.69, -2.28, P <0.05). There were statistically significant differences in QOLCS total score, physical, psychological, behavioral, environmental, and social support dimension scores among the three groups( F =10.36, 4.14, 5.14，4.81, 7.07, 5.53, P <0.05). After the intervention, the CMSS dysmenorrhea severity and dysmenorrhea duration scores in the hypnotic suggestion group and the hypnotic relaxation group were significantly lower than those before the intervention( t =5.66, 4.70, 3.09, 2.21, P <0.05). There were significant differences in CMSS dysmenorrhea severity and dysmenorrhea duration scores among the three groups( F=15.33, 12.33, P <0.05). Conclusion Hypnotherapy can help relieve pain of female college students with primary dysmenorrhea，improve depression and anxiety.

Objective To understand patient pathway and clinical characteristics of chronic diseases in urban areas of Shanghai. Methods A total of 10 002 residents were enrolled and assigned to the chronic disease group (including hypertension, diabetes, coronary heart disease, myocardial infarction, and ischemic stroke) and the non-chronic disease group. Body mass index,fasting blood glucose, triglyceride,total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were tested.Difference of patient pathway and clinical characteristics of those chronic diseases was compared. Results Above chronic diseases were observed in 37.7% participants. About 2/3 diseases were confirmed and 80% patients were followed up in healthcare units not far away from home. Patients with coronary heart disease and myocardial infarction showed more outpatient visit to tertiary hospitals (P＜0. 05 ). However, patients with ischemic stroke had health check, rehabilitation and pharmacy done mainly in local healthcare centers (P＜0. 05 ). Diastolic blood pressure of patients visiting local doctors was significantly decreased (P＜0. 05). Conclusion Some differences in patient pathway were found in this study. Communication and cooperation between medical institutions should be intensified for effective chronic disease control.