OBJECTIVETo investigate the risk factors of pinhole infection in the fractured lower limbs after external fixation.

METHODSThe case-control study was designed. From May 2009 to May 2014, the clinical data of 272 patients with lower limb fracture treated by external fixation device were collected. All the patients were divided into two groups according to post-operative pinhole infection. There were 29 cases in the case group including 23 males and 6 females. The age of patients in case group ranged from 25 to 77 years old,with the average age of (53.41 ± 12.77) years old. There were 243 cases in control group including 217 males and 26 females. The age of patients in the control group ranged from 27 to 78 years old, with the average age of (48.71 ± 11.87) years old. There were nine risk factors observed in our study including age, gender, fixed time by external fixation device, diabetes, time in bed, smoking, operation condition of other parts in the body, infection condition of other parts in the body.

RESULTSThe results of univariate analysis showed that there were statistically significant differences among age (χ² = 15.708, P < 0.001), fixed time by external fixation device (χ² = 11.940, P < 0.001), severity of the lower limb fracture (χ² =15.438, P < 0.001), diabetes (χ² = 8.519, P = 0.004) and time in bed (χ² = 7.165, P = 0.007) between case group and control group. The results of Logistic regression analysis showed that the risk factors of pinhole infection after fixed by external fixation device in the lower limb fracture were the advanced age (OR = 8.327, P < 0.001), fixed time by external fixation device (OR = 6.795, P < 0.001), diabetes (OR = 4.965, P = 0.001) and time in bed (OR = 4.864, P = 0.008).

CONCLUSIONThe advanced age, long fixed time, diabetes and long time in bed could increase the risk of pinhole infection after external fixation in the lower limbs with fracture.

Adult ; Aged ; Case-Control Studies ; External Fixators ; adverse effects ; Female ; Humans ; Lower Extremity ; injuries ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Risk Factors

AIM: To better reveal the changing process of macula area after photodynamic therapy (PDT), the changes of tomographic imaging on macular fovea optical coherence tomography ( OCT ) scan at different follow- up time points after treating age-related macular degeneration ( AMD) by PDT were investigated.
METHODS: This cohort study included 30 eyes of 26 patients diagnosed as AMD. The dosage of verteporfin was calculated according to manufacturer's instruction. All participants got FFA, ICG, OCT scan and best corrected visual acuity before and followed up for 2wk, 1, 2, 3mo after PDT. The standard five lines combined with 6 lines OCT scan covered key parts of lesion and the scan locations before and after were kept the same. The bilaminar foveal thickness (BFT), outer high reflectivity band thickness ( OHRBT ) , and the total area of intraretinal fluid ( IRF ) and subretinal fluid ( SRF ) were measured at different time points. The relationship between the changes and follow up time was analyzed. Statistical analysis of the data was performed using SPSS for windows version 13. 0.
RESULTS: There months after treatment, an improvement of 2 lines or better on the Snellen chart was achieved on 22 eyes, visual acuity of 3 eyes without significant change, 3 eyes got decreased, 2 cases lost follow up. The average macular thickness of improved 22 eyes before treatment was 722. 5±55. 6μm, 2wk after treatment, 708. 3±45. 3μm, 1mo, 584. 4±49. 3μm, 2mo, 430. 7±50. 2μm and 180. 6 ±36. 3μm at 3mo. The OHRBT before and after treatment respectively were 302. 3 ±50-2μm, 277. 5±42. 3μm, 202. 7±40. 1μm, 180. 6±35. 7μm, 100. 8±22. 9μm. The total area of both IRF and SRF was estimated as 0. 34±0. 12mm2 , 0. 25±0. 07mm2 , 0. 10±0-05mm2 , 0. 08±0. 04mm2 , 0. 05±0. 01mm2 .
CONCLUSION:SRF and retinal edema of patients with AMD were absorbed 1mo after PDT, and the BFT, OHRBT were significantly tend to be thin.

The purpose of this study is to prepare T7 and TAT dual modified liposomes (T7-TAT-LIP) to penetrate through blood brain barrier and target to brain tumor cells. The liposomes were prepared with CFPE, T7 modified PEG-DSPE, TAT modified PEG-DSPE, soybean phospholipid, PEG-DSPE and cholesterol. The CFPE was used to track the cellular uptake efficiency. The density of T7 and TAT and the length of PEG were optimized, and then the liposomes were characterized by particle size, zeta potential, morphology and stability. Afterwards, the cellular uptake by bEnd.3 and C6 cells were evaluated. The results showed that the optimized parameters were 6% of T7, 0.5% of TAT, the molecular weight of PEG for T7 was 2000 and the molecular weight of PEG for TAT was 1000. After optimization, the particle size of T7-TAT-LIP was 118 nm, the zeta potential was -6.32 mV and the particles were spherical. The turbidity and particle size of liposomes were not obviously changed after 24 h incubation in PBS at 37 °C. The particle size and polydispersity index were also stable during 1 month incubation at 4-8 °C. The cellular uptake by both bEnd.3 and C6 cells of T7-TAT-LIP was higher than that of T7 or TAT modified liposomes, suggesting dual modified liposomes possessed better blood brain barrier targeting ability and brain tumor targeting ability than the single ligand modified liposomes.
Biological Transport ; Blood-Brain Barrier ; Brain Neoplasms ; drug therapy ; Cell-Penetrating Peptides ; pharmacology ; Cholesterol ; Liposomes ; Particle Size ; Phosphatidylethanolamines ; Polyethylene Glycols

Objective To monitor ventilator-associated event (VAE) for the first time in an intensive care unit (ICU) in China,understand the applicability,incidence,and clinical significance of VAE in China.Methods Targeted monitoring on VAE was performed among patients ≥18 years and with mechanical ventilation (MV)＞2 days in the ICU of a hospital between January 2014 and September 2015,incidence of VAE was calculated,and patients were grouped according to whether or not they had VAE,prognostic factors were analyzed statistically.Results A total of 1 004 patients were monitored,the total hospital stay was 13 795 days in patients who used ventilator,307 (30.58％) cases of VAE occurred,incidence of VAE per 1 000 ventilator-days was 22.25.Univariate analysis showed that patients with VAE had longer length of ICU stay and MV,and higher mortality rate than patients without VAE when they moved out of ICU (all P＜0.05).Multivariate logistic regression analysis showed that VAE was independent risk factor for length of ICU stay,duration of MV,as well as mortality when patients moved out of ICU(all P＜0.05).Conclusion Judgment of VAE is based on MV parameters,it is more objective and accurate.There is a high incidence of VAE among ICU patients,it may lead to poor clinical outcomes,and has good values for the targeted monitoring on ICU patients in large comprehensive hospitals of China.

Objective To explore strategies and measures to improve hand hygiene (HH)compliance and correctness of health care workers (HCWs)in a large hospital.Methods The WHO multimodal hand hygiene improvement strategy was adopted by healthcare-associated infection(HAI)management department of a hospital,measures consisted of five key com-ponents,including:system change,education and training,evaluation and feedback,reminders in the workplace,and insti-tutional safety climate.HH compliance and correctness of HCWs were observed by infection control practitioners,HH compliance and correctness in January-June of 2012 (pre-intervention)and January-June of 2014 (post-intervention)were compared,effectiveness of intervention strategies were evaluated.Results HH compliance rate and correctness rate of post-intervention were both higher than pre-intervention (75.92% [8 369/11 023]vs 53.67% [5 127/9 553],P <0.001;94.11%[7 782/8 269]vs 83.88%[3 642/4 342],P <0.001).Of different occupations,HH compliance rates of doctors and nurses were significantly different before and after intervention (both P <0.001),while workers and staff of other oc-cupations before and after intervention were not significantly different(both P >0.05).Except ‘after body fluid exposure’, HH compliance rates of the other four indications for HH before and after intervention were significantly different(all P <0.001).Conclusion HH compliance and correctness of HCWs can be improved after adopting WHO multimodal hand hy-giene improvement strategy.

Purpose To investigate the expression of tumor buds and its relationship with clinicopathological characteristics in endome-trial carcinoma. Methods 47 cases of endometrial carcinoma were observed and analyzed by means of clinicopathologic data and im-munohistochemical staining. The connections between tumor buds and clinicopathologic parameters were studied by statistics. Results Of the 47 endometrial carcinoma cases, tumor buds were seen in 18 cases. Tumor buds were correlated with histological grade, lymph node metastases, vascular invasion, Ki-67 index and survival. There were no associations between tumor buds with age, tumor size, pTNM stage or myometrial invasion depth. Immunohistochemistry demonstrated that the level of N-cadherin, vimentin in bud cells was higher than normal carcinoma cells while the level of CK(AE1/AE3),β-catenin and E-cadherin got the opposite results. Conclu-sion Tumor buds may play an important role in the progression of endometrial carcinoma. The immunohistochemical features of bud cells indicated that tumor buds may be a key step in epithelial-mesenchymal transition.

To prove the influence of protein isoaspartyl-methyltransferase ( PIMT ) on the cell apoptosis of fibroblast-like synoviocytes of RA.Methods: The expression vector of PIMT was constructed and transfected in to the RA-FLS, the impact of PIMT on the cell apoptosis of RA-FLS was observed by overexpressing the vector of PIMT.Results:The mRNA and protein level of PIMT in RA-FLS was increased after transfected the vector of PIMT into RA-FLS;compared with the normal cultured RA-FLS and the RA-FLS transfected with the empty vectors ,the cell apoptosis level was also increased.Conclusion:The decreased expression level of PIMT in RA-FLS is an important reason for reduce apoptosis of RA-FLS,and PIMT can affect the imbalance of proliferation/ap-optosis in the RA-FLS.

OBJECTIVETo explore the growth patterns and simple mathematic models of height and weight of Chinese children.

METHODSThe original data had been obtained from two national representative cross-sectional surveys which were 2005 National Survey of Physical Development of Children (under 7 years of age) and 2005 Chinese National Survey on Students Constitution and Health (6 - 18 years). Reference curves of height and weight of children under 7 years of age was constructed by LMS method, and data of children from 6 to 18 years of age were smoothed by cubic spline function and transformed by modified LMS procedure. Growth velocity was calculated by smoothed values of height and weight. Simple linear model was fitted for children 1 to 10 years of age, for which smoothed height and weight values were used.

RESULTS(1) Birth length of Chinese children was about 50 cm, average length 61 cm, 67 cm, 76 cm and 88 cm at the 3rd, 6th, 12th and 24th month. Height gain was stable from 2 to 10 years of age, average 6 - 7 cm each year. Birth length doubles by 3.5 years, and triples by 12 years. The formula estimating average height of normal children aged 2 - 10 years was, height (cm) = age (yr) x 6.5 + 76 (cm). (2) Birth weight was about 3.3 kg. Growth velocity was at peak about 1.0 - 1.1 kg/mon in the first 3 months, decreased by half and was about 0.5 - 0.6 kg/mon in the second 3 months, and was reduced by a quarter, which was about 0.25 - 0.30 kg/mon, in the last 6 months of the first year. Body mass was up to doubles, triples and quadruple of birth weight at about the 3rd, 12th and 24th month. Average annual gain was about 2 kg and 3 kg from 1 - 6 years and 7 - 10 years, respectively. The estimated formula for children 1 to 6 years of age was weight (kg) = age (yr) x 2 + 8 (kg), but for those 7 - 10 years old, weight (kg) = age (yr) x 3 + 2 (kg).

CONCLUSIONSGrowth patterns of height and weight at the different age stages were summarized for Chinese children, and simple reference data of height and weight velocity from 0 to 18 years and approximate estimation formula from 1 - 10 years was presented for clinical practice.

Adolescent ; Asian Continental Ancestry Group ; Birth Weight ; Body Height ; Body Mass Index ; Body Weight ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Models, Statistical ; Reference Values

Objective To investigate the incidence of healthcare-associated infection (HAI)in patients in a respiratory in-tensive care unit (RICU)of a teaching hospital,and provide reference for HAI prevention and control.Methods All pa-tients admitted to this RICU from January to December 2014 were surveyed with prospective targeted monitoring method, surveyed data were analyzed statistically.Results A total of 561 patients were surveyed,43 patients developed 44 times HAI,HAI rate and HAI case rate were 7.66% and 7.84% respectively,incidence of HAI and adjusted incidence of HAI per 1 000 patient-days were 6.26‰ and 1.79‰ respectively.The main infection site was urinary tract (45.46%,n=20). Incidence of ventilator-associated pneumonia (VAP ),catheter-related bloodstream infection (CRBSI),and catheter-associat-ed urinary tract infection (CAUTI)per 1 000 catheter-days were 2.73‰(n=13),1.57‰(n=2),and 3.78‰(n=18)re-spectively.Incidence of HAI per 1 000 patient-days between the first and second half year of 2014 was significantly differ-ent(4.59‰ vs 7.89‰;u=-1.75,P =0.04).A total of 47 pathogenic strains were isolated,the main pathogens were gram-negative bacteria(n=26,55.32%).Conclusion The major HAI in RICU is device-associated infection,it is necessary to strengthen the management of invasive procedures;targeted monitoring can find the weak links of infection control prac-tice and helpful for taking effective prevention and control measures to reduce the incidence of HAI in ICU.

Objective To explore the gender difference in clinical features and outcomes of elderly patients with coronary true bifurcation lesions after percutaneous coronary intervention (PCI).Methods A total of 169 consecutive patients were included in the study, who were diagnosed coronary true bifurcation lesions by coronary angiography (CAG)and received PCI in our hospital from December 2013 to December 2015.All patients were divided into 2 groups according to their gender (71 femals and 98 males).Angiographic characteristics of the coronary lesions and clinical data were analyzed in both groups.Clinical outcomes during follow up were recorded and studied.Results The levels of total cholesterol (TC), triglyceride (TG),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) in the female group were significantly higher than in the male group (all P<0.05).The levels of BUN,Cr,UA,CyC and TBIL in the female group were significantly lower than in the male group (all P<0.05).Comorbidity rates of hypertension and diabetes were higher in female patients without significant differences (P>0.05).The median follow-up time was 17 months and the incidence rate of overall adverse events in women was higher than that of men (25.4% vs.11.2%, P<0.05).Conclusions The clinical outcomes of elderly patients with coronary true bifurcation lesions after PCI had gender differences.The rates of adverse events in female patients was found significantly higher than male patients.