Objective To review the distribution and shifting trends of cultured bacteria from the aqueous humor and the vitreous body. Methods A retrospective analysis on distribution of Gram′s stain, the distribution and change of isolates was performed in 522 specimens (aqueous humor,261 and vitreous body,261) of patients with suspected endophthalmitis during a 10 year period (1989 1998). Results The positive cultures were 119 (aqueous humor,44 and vitreous body,75) of 522 specimens. The average positive rate was 22.8%. Gram positive cocci constituting 45.4%(54) of total isolates followed by Gram negative bacilli,34.5%(41);Gram positive bacilli, 20.2%(24). In the positive bacterial cultures, enterobacteriaceae was the most common isolate, 18.5%, and the next was micrococcus, 16.0%; coagulase negative staphylococcus,12.6%; and pseudomonas,10.9%.Comparing the data from 1989 through 1993 with the data from 1994 through 1998, the frequency of Gram positive cocci had no significant change, while the frequency of Gram positive bacilli was decreased and the percentage of Gram′s negative bacilli was increased. Conclusions Gram positive cocci and Gram negative bacilli are the predominant pathogens of bacterial endophthalmitis. The percentage of Gram′s negative bacilli has increased for 5 years. It is very important to comprehend the distribution and shifting trends of these pathogenic bacteria for diagnosis, prevention and treatment of bacterial endophthalmitis.

Objective To investigate the changes of carotid, lipidemia and fibrinogen in type 2 diabetes mellitus patients complicated with cerebral infarction (DCI). Methods 58 cases of DCI (DCI group) were enrolled in this study, and 36 cases of cerebral infarction without diabetes mellitus served as control group. The location, number and nature of carotid atherosclerotic plaque and inner diameter of carotid artery were assessed by Doppler ultrasonography in all the patients, as well as blood lipid, blood glucose and fibrinogen were evaluated. Results In DCI group, the rate of carotid atherosclerotic plaque was 79.3%, the IMT and inner diameter of common carotid artery in DCI group were significantly different from control group (all (P

Objective To survey the career identity and satisfaction of family doctors in Pndong New Area of Shanghai municipality.Methods Two hundred and thirty four family doctors were selected with random sampling method from 6 community health centers in Pudong New Area of Shanghai.The survey on career identity and satisfaction was conducted using a self-designed questionnaire.Results The results showed that 37.2％ of participants were very satisfied (8.1％,19/234) or satisfied (29.1％,68/234) with their current career situation.The three lowest satisfaction factors were salary (14.1％,33/234),benefit and social insurance (27.3 ％,64/234),professional reputation and social status (20.9％ 49/234).Meanwhile,the three highest factors were quality of their leadeship (79.5％,186/234),interpersonal relationship(74.4％,174/234) and the institutional management (63.3％,148/234).The survey also showed that 44.5％ and 30.6％ of participants expected their monthly pay as 8 001-10 000 and 5 000-8 000 RMB; 39.1％ thought the current performance evaluation mechanism as effective,while 25.7％ thought the opposite.Conclusion The social status and salary level of family doctors need to be improved; there is also an urgent need to improve the performance evaluation mechanism and other supporting measures.

Background Allergic conjunctivitis is common in clinical practice.But some patients,especially pediatric patients,are not diagnosed and treated correctly because of different classifications and other associated symptoms.A comprehensive understanding of the clinical characteristics of allergic conjunctivitis helps to correct diagnosis and management.Objective This study tried to analyze the clinical characteristics of allergic conjunctivitis.Methods A descriptive study was carried out.The clinical data of 745 cases of various classifications of allergic conjunctivitis who received treatment in Beijing Tongren Eye Center from April 2011 to March 2015 were retrospectively analyzed.The general status,disease history,family medical history,personal allergy history,medication history,disease course,attacked duration,affecting factors of symptoms,other non-ocular allergic diseases,other associated eye disease,the findings of the anterior ocular segment,treating outcomes were summarized and the correlation of age with symptoms was evaluated.Results In the 745 cases,75.44％ cases (562/745 were seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC),21.88％ cases (163/745 were vernal keratoconjunctivitis (VKC),2.42％ cases (18/745) were giant papillary conjunctivitis (GPC),and 0.27％ cases (2/745) were atopic keratoconjunctivitis (AKC).The number of patients was most in July (180,24.16％) and least in December (26,3.49％).The itching was found in 53.02％ patients,redness in 36.64％ patients,blinking in 21.88％ patients.In the patients,58.26％ patients were ≤ 14 years,34.09％ patients were 15-39 years and 7.65％ patients were ≥40 years,and a significant difference in gender was found in various age groups (x2 =89.431,P =0.000).The co-morbidities appeared to be allergic rhinitis,eczema,urticaria,allergic purpura and asthma,and the ocular coexisting conditions included dry eye,refractive error,blepharitis and meibomian gland dysfunction,corneal epithelial disorders,triehiasis and anterior uveitis.Logistic regression analysis revealed that blinking patients were more and dry eye,foreign body sensation and pain were less in ≤ 14 years patients than those in the ＞14 patiens (3=-2.039,P =0.000;3 =1.585,P=0.001;3=1.174,P=0.003;3=1.218,P =0.037).The symptoms of allergic conjunctivitis were relieved by the administration of dual-acting antiallergic agent/antihistamine drug,glucocorticoid or immunosuppressor agents.Conclusions SAC and PAC are more common classifications of allergic conjunctivitis,followed by VKC.July is a high-occurrence duration and clinical symptoms are diverse and often accompanied by other allergic diseases.The administration of dual-acting antiallergic agent/antihistamine drug,glucocorticoid or immunosuppressor agents is an effective approach to the management of allergic conjunctivitis.

Objective To explore the function and mechanism of estrogen receptor α (ERα) in bladder cancer cell proliferation and aggressivity.Methods The ERα expression bladder cancer cell line T24ERα model was established.The cell growth was detected by MTT assay,apoptosis by flow cytometry,cell invasion by matrigel transwell.Western blot was used to check signals by ERα regulation in bladder cancer cells related to the proliferation and metastatic ability.Results Compared to the control group,the cell inhibition rates of experimental group in 96 h and 144 h were 18.85％ and 37.21％,respectively.The difference was significant compared with the control group (P ＜ 0.05).The apoptosis rates of the experimental group and control group were (18.93 ±1.41)％ and (9.91 ±1.08)％ (P＜0.05).The experimental group through matrix adhesive cell proportion was (10.00 ± 2.00)％,significantly lower than that of the control group (26.00 ± 3.61) ％ (P ＜ 0.05).Western blot showed integrin-β1,p-FAK,p-Src and Scr expression were reduced compared to control group (P ＜ 0.05).Conclusion ERα could inhibit bladder cancer cell growth and metastasis through down-regulating integrin-β1-FAK/Src signal pathway,while promote the apoptosis of bladder cancer cells.

Objective To discuss the success rate of external cephalic version (ECV) for breech presentation in singleton pregnancies and the factors influencing ECV,and complications induced by ECV.Methods A prospective study was conducted which included 204 pregnant women who underwent regular prenatal examinations and delivered in Nanjing Drum Tower Hospital between March 1,2011 and February 29,2012.The 204 cases were single pregnancy with breech presentation identified by ultrasound during 32-37+6 weeks of gestation,and without other indications for cesarean section (CS).According to willingness of the participants,204 cases were divided into two groups.The 101 pregnant women who refused EVC (control group) were asked to practice knee-chest position twice a day; and 103 pregnant women volunteered to undergo EVC (ECV group) during 32-37+6 weeks of gestation.The proportion of cephalic presentation at delivery,CS rate and the incidence of PROM,premature delivery and cord around the neck were compared between the two groups.Factors influencing the success rate of ECV were analyzed.Chi-square or adjusted Chi-square test were used for statistical analysis.Results The proportion of cephalic presentation at delivery in the ECV group was higher than that in the control group [68.9％ (71/103) vs 29.7％ (30/101),x2=31.39]; the CS rate in the ECV group was lower than that in the control group [49.5％ (51/103) vs 78.2％ (79/101),x2=18.18],as was the rate of CS due to breech presentation [62.7％ (32/51) vs 89.9％ (71/79),x2=13.86],all P＜0.05.The success rates in frank breech presentation,complete breech presentation and incomplete breech presentation were 77.1％ (37/48),72.7％ (24/33) and 45.5％ (10/22),respectively (x2=7.37,P＜0.05),and the success rate in frank breech presentation was higher than that in incomplete breech presentation (x2=6.84,P＜0.017).No significant differences were observed in the success rates between primiparas and multiparas [67.7％ (63/93) vs 8/10,x2=0.19],placenta attached at front wall of uterus and other attachment sites [61.0％ (25/41) vs 74.2％ (46/62),x2=2.01],and EVC performed at 32-35+6weeks of gestation and 36-37+6 weeks [70.5％ (62/88) vs 9/15,x2=0.65],allP＞0.05.No significant differences were observed for the incidence of PROM [7.8％ (8/103) vs 6.9％ (7/101)],premature delivery [2.9％ (3/103) vs 2.0％ (2/101)] and cord around the neck [17.5％ (18/103) vs 21.8％ (22/101)] between the ECV and control group (x2=0.05,0.19 and 0.60,all P＞0.05).Conclusions ECV for breech presentation in singleton pregnancies can effectively correct the fetal position and reduce the CS rate.ECV performed after 32 weeks of gestation does not increase the risk of PROM and premature delivery.

Objective To study the clinical features of acute limited neck motion in children and its differential diagnosis, and to improve doctors' awareness and the early diagnosis of the disease.Methods A total of 420 patients with acute limited neck motion as the chief complaint and atlantoaxial rotary subluxation as the first diagnosis between January 2005 and January 2014 in Nanjing Children's Hospital Affiliated to Nanjing Medical University were enrolled.The clinical manifestations, imaging and consultation data of the 420 patients were retrospectively analyzed.Results There were totally 248 male patients and 172 female patients.The ages ranged from 2 to 14 years old(the mean age was 7.2 years old) ,the course ranged from 2 hours to 2 days.Among 420 patients,353 patients were diagnosed as atlantoaxial rotatory subluxation.Forty-two patients were diagnosed as cervical intervertebral disc calcification.Seven patients were diagnosed as Tourette syndrome.Four patients were diagnosed as intracranial tumors.Three patients were diagnosed as cervical eosinophilic granuloma.Two patients were diagnosed as cervical spinal tuberculosis.Two patients were diagnosed as viral encephalitis.Two patients were diagnosed as benign paroxysmal torticollis.Two patients were diagnosed as Kawasaki disease.One patient was diagnosed as neuroblastoma.One patient was diagnosed as hemophilia A.One patient was diagnosed as drug adverse reaction of metoclopramide.According to Fielding clinical classification,204 patients were type Ⅰ, 122 patients were type Ⅱ,21 patients were type Ⅲ, and 6 patients were type Ⅳ.Conclusions Based on disease distribution of acute limited neck motion in children, atlantoaxial rotatory subluxation seems to be the predominant while non-atlantoaxial rotatory subluxation is not uncommon.Differential diagnoses should be considered to avoid misdiagnosis.For atlantoaxial rotatory subluxation, conservative treatment including continuous mandible occipital belt traction and brace has been proved to be very effective methods.

Objective:To investigate the knowledge level of hospice care and the related influencing factors among health providers in Shanghai.Methods:From November to December 2019,a questionnaire survey on the hospice care knowledge was conducted among 7 074 health providers from 223 registered hospice care clinics or institutions in 16 districts of Shanghai.Results:A total of 7 027 valid questionnaires were recovered, with an effective recovery rate of 99.3%. Among the 7 027 responders, there were 1 460 males (20.8%) and 5 567 females (79.2%) with an mean age of (36.9±9.3) years; 2 682 nurses (38.2%) and 2 442 doctors (34.8%); 5 065 (72.1%) from community health service centers; 2 982 (42.4%) involving in hospice care services and 4 039 (57.5%) willing to work in hospice care. The average score of hospice care knowledge was (8.9±2.6), and the average accuracy for questions was 59.0%. Health providers had the highest awareness rate for the composition of hospice care professional team (93.9%, 6 597/7 027) and the lowest awareness rate for the emotional commitment in hospice care service (16.6%, 1 165/7 027). Health providers with junior colleges degree ( B=-0.429), vocational college degree and below ( B=-0.544), nurses ( B=-0.652), working in suburban areas ( B=-0.278), social office ( B=-0.891), without witness of dying process of end-of-life patients ( B=-0.329), not involving in hospice care services ( B=-0.283), and not willing to participating in hospice care ( B=-0.820) had low knowledge scores ( P<0.05). Conclusions:The overall level of hospice care knowledge of health providers in Shanghai is generally at a medium level, and the training of hospice care knowledge should be strengthened for the better development of hospice care.

The provision of hospice care can improve the quality of life for terminal patients. Currently the measurement tools for knowledge, attitudes and practices(KAP)of hospice care providers have been developed and widely used internationally. This article reviews the measurement scales and relevant factors for KAP of hospice care to provide reference for further studies. The databases of CNKI, Wanfang data, PubMed, Web of Science databases, Google and Baidu search engines were systematically searched. According to the retrieval strategy, 42 literatures were finally included for analysis. The development of measurement scales and influencing factors about KAP of medical staff were reviewed from the included studies. It appeared some mature scales have been applied in different extent, or available for interpretation into different language versions. Most of researches adopted quantitative tools to measure medical staff's KAP on hospice care. The current researches conducted in China mainland showed a change on target population from nurses to specialized doctors and from a single group to multidisciplinary medical team. In the future, it would be more focusing on multidisciplinary team mainly comprised of general practitioners, nurses and social workers. Till recently, there is little literature evidence for study of the characteristics of localization.

Objective:To investigate the attitude of health providers towards hospice care in Shanghai,and analyze the related influencing factors.Methods:From November to December 2019,a questionnaire survey on the attitude towards hospice care was conducted among 7 074 health providers from 223 medical institutions in 16 districts of Shanghai.Results:A total of 7 027 valid questionnaires were recovered, with an effective recovery rate of 99.3%. The total score of attitude to hospice care was (91.9±11.6),the average score of items was (3.7±0.5). The highest score rate was "perception of the benefits for the quality of life promotion" (87.08%),and the lowest score rate was "perception of the threats from the worsening conditions of advanced patients" (60.88%).Health providers who were doctors ( B=-1.207), nurses ( B=-0.912), those without witness of dying or end-of-life patients ( B=-1.417), those without involving in hospice care services ( B=-1.203), and not willing to participating in hospice care ( B=-7.849) had lower attitude scores (all P<0.05). Conclusions:The survey indicates that health providers in Shanghai have a positive attitude towards hospice care,but the initiative to engage in hospice care service is not high. It is necessary to conduct targeted training of relevant professional knowledge to enhance the attitude and enthusiasm to hospice care among health providers.