Objective:To explore the microbiological and disease distribution characteristics of multidrug-resistant bacteria in patients hospitalized in a critical care rehabilitation ward, and to analyze the risk factors leading to multidrug-resistant bacterial infections.Methods:Microbiology screening data describing 679 patients admitted to a critical care rehabilitation ward were retrospectively analyzed to divide the subjects into a multidrug-resistant group (positive for multidrug-resistant bacterial infections, n=166) and a non-multidrug-resistant group (negative for multidrug-resistant bacterial infections, n=513). The risk factors were then analyzed using logistic regression. Results:Among 369 strains of multidrug-resistant bacteria observed, 329 were gram-negative bacteria (89.2%), mainly Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli. They were distributed in sputum (56.9%) and mid-epidemic urine (28.2%) specimens. Patients whose primary disease was hemorrhagic or ischemic cerebrovascular disease accounted for 40.96% and 23.49% of the multidrug-resistant bacterial infections, respectively. Logistic regression analysis showed that albumin level, dependence on mechanical ventilation, central venous cannulation, or an indwelling urinary catheter or cystostomy tube were significant independent predictors of such infections.Conclusion:The multidrug-resistant bacterial infections of patients admitted to the critically ill rehabilitation unit are mainly caused by gram-negative bacteria. Their occurrence is closely related to low albumin levels and mechanical ventilation, as well as to bearing an indwelling central venous catheter, a urinary catheter or a cystostomy catheter.

Objective:To evaluate the efficacy and safety of discriminative application of Chinese patent medicines in female patients after percutaneous coronary intervention (PCI) due to acute coronary syndrome (ACS).Methods:The study population was from the Chinese Patent Medicine (CPM) trial. CPM trial was a multicenter prospective cohort study, which enrolled patients from 40 centers in mainland China between February 2012 and December 2015, with the discriminative use of Chinese patent medicines as the exposure factor. Female patients with ACS after PCI who completed 36-month follow-up were included in this analysis, and were divided into a conventional treatment group (using conventional western medicine recommended by the guidelines) and a group with the discriminative use of proprietary Chinese medicines (on the basis of conventional western medicine treatment, discriminative use of Qishen Yiqi dropping pills for Qi deficiency and blood stasis syndrome, Guanxin Danshen dropping pills for blood stasis syndrome, and Danlou tablets for phlegm and blood stasis syndrome combined with the conventional western medicine). The primary endpoint event was a composite endpoint event including cardiovascular death, nonfatal myocardial infarction, and emergency revascularization surgery. Secondary endpoint events were composite endpoint events including readmission for ACS, heart failure, stroke, and other thrombotic events. Adverse events were collected. Cox proportional risk model was used to assess the effect of discriminatory application of Chinese patent medicine on endpoint events, and sensitivity analysis was performed by comparing the results with propensity score matching analysis.Results:A total of 748 female ACS post-PCI patients were included in the analysis, aged (63.2±8.3) years. There were 370 patients in the group of discriminative application of Chinese patent medicines and 378 patients in the conventional treatment group. There were 37 cases (10.0%) and 58 cases (15.3%) of primary endpoint events in the discriminatory application of Chinese patent medicines group and the conventional treatment group, respectively. Cox analysis showed that the risk of primary endpoint in the discriminatory application of Chinese patent medicines group was lower than that in the conventional treatment group after adjusting for confounding factors (adjusted HR=0.62, 95% CI 0.40-0.96, P=0.031). There were 38 (10.3%) and 57 (15.1%) cases of secondary endpoint events in the two groups, respectively. Cox regression analysis showed that the risk of secondary endpoint events in the discriminatory application of Chinese patent medicine group was lower than that in the conventional treatment group after adjusting for confounders (adjusted HR=0.56, 95% CI 0.37-0.87, P=0.001). The results of propensity score matching analysis also showed that Chinese patent medicines based on discriminatory application could reduce the risk of primary endpoint ( HR=0.62,95% CI 0.40-0.97 ,P=0.033) and second endpoint ( HR=0.56, 95% CI 0.37-0.87, P=0.009) significantly. There was no significant difference in adverse events between the two groups (12.4% (46/370) vs. 10.3% (39/378), P=0.362). Conclusion:On the basis of conventional western medicine treatment, discriminatory application of Chinese patent medicines can reduce the risk of endpoints in female patients after PCI due to ACS without significant adverse effects.

Objective:To understand the incidence of sleep disorder in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients before antiviral therapy, and to explore its risk factors.Methods:200 newly treated HIV/AIDS patients who visited the Eighth Affiliated City Hospital of Guangzhou Medical University from January to June 2016 were randomly selected. According to the Pittsburgh Sleep Quality Index (PSQI), they were divided into a good sleep group and a Sleep disorder group; The influencing factors of sleep disorder in HIV/AIDS patients were analyzed by univariate analysis and multivariate logistic regression.Results:The incidence of Sleep disorder in 200 HIV/AIDS patients before antiviral therapy was 22.5%(45/200); CD4 + T cell count was (414.13±202.16)/μl; 29%(58/200) of patients had CD4 + T cell counts<200/μl. There were significant differences in CD4 + T cell count and the proportion of patients with syphilis infection, comorbidity anxiety and comorbidity depression between the good sleep group and the Sleep disorder group (all P<0.05). Multivariate logistic regression analysis showed that syphilis infection ( OR=4.606; 95% CI: 1.973-10.752; P<0.001), comorbidity anxiety ( OR=2.496; 95% CI: 1.086-5.737; P=0.031) and comorbidity depression ( OR=2.087; 95% CI: 0.915-4.760; P=0.040) were risk factors for sleep disorder in HIV/AIDS patients before antiviral treatment. Conclusions:The incidence of Sleep disorder in HIV/AIDS patients before antiviral therapy in Guangzhou is high, especially in patients with syphilis infection, comorbidity anxiety and comorbidity depression. The sleep disorder of HIV/AIDS patients should be assessed and detected early, and multiple interventions should be taken to improve sleep quality.

Objective:To investigate the characteristics and differences of anxiety, depression and sleep disorder among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in Guangzhou, then optimize the antiretroviral therapy and provide effective mental intervention.Methods:All HIV/AIDS patients from the outpatient department of Guangzhou Eighth People's Hospital were enrolled in the present study from January 2016 to December 2016. They were evaluated by the hospital anxiety and depression scale and Pittsburgh Sleep Quality Index, to analyze the levels of depression, anxiety and sleep disorder.Results:The incidences of anxiety, depression and sleep disorder were 30.5%(61/200), 31.0%(62/200) and 22.5%(45/200) respectively. 36.1%(22/61) of patients with anxiety and 35.5%(22/62) of patients with depression were accompanied by sleep disorder. The sleep disturbance index were significant higher in HIV/AIDS patients with anxiety ( t=4.065, P<0.001) or depression ( t=3.034, P=0.003) than those without anxiety or depression. Anxiety was mainly found in HIV/AIDS patients in aged 20 to 40 group ( F=7.998, P=0.018), while depression was mostly found in HIV/AIDS patients who didn't receive higher education ( F=13.55, P=0.001), and sleep disorder was more common in people with CD4 + count <200 cells/μl ( t=2.01, P=0.046). Conclusions:Anxiety and depression, which could aggravate sleep disorder, are very common in HIV/AIDS patients. Psychological care need to be strengthened to HIV positive patients in early phase, and screening questionnaires should be conducted before antiretroviral treatment began.

Synchronous multifocal osteosarcoma (SMOS) was analyzed for its predisposing age, sex, location, oncology characteristics, and survival time with different treatment. The key words about "multifocal osteosarcoma" had been used to search articles which includ Synchronous multifocal osteosarcoma patients databases from 1949 to 2020. The articles have been filtratedby title, abstract and full text. There were 80 articles used for thisstudy. All the patients were objects of thisstudy. Butthe same patients' data in different articles had not been used repeatedly. The patients' data had been collected as much aspossible, including age, location, treatment, survival timeand so on. All the patients' data had been used forsystematic analysis. All of the 80 articles and 264 patients had been studied. The mean onset age was 16.17 years old and the peak age of onset was 10-20 years old. The gender difference had been uncovered and the sex ratio was 1.76∶1. The incidence site of 188 patients (92.16%) was located in the extremities. Alkaline phosphatase was elevated in 135 patients (95.10%). The pathological type was osteoblastic osteosarcoma in 134 patients (76.14%). There were 3 patients with hypocalcemia and 2 patients with anemia. The mean survival time of 15 patients (15/58) who gave up treatment was 4.51 months. The mean survival time of 23 patients with chemotherapy was 8.97 months. The mean survival time was 16.17 months in 11 patients with preoperative chemotherapy and surgical treatment. Nine patients with neoadjuvant chemotherapy, surgery and postoperative chemotherapy had an average survival time of 23.28 months. Multiple osteosarcoma of the same type was rare, with high degree of malignancy and poor prognosis. The age of high incidence was 10-20 years old. Currently, the most effective treatment was neoadjuvant chemotherapy, surgery and postoperative chemotherapy.

Objective: To investigate the clinical, immunological and virological characteristics of HIV-1 infected patients in the acute phase, for the sake of improving the diagnosis of acute infection with HIV-1. Methods: We retrospectively analyzed the clinical manifestation and laboratory data of patients with acute HIV-1 infection who were admitted to the Center of Infectious Diseases, Guangzhou Eighth People’s Hospital from January 2012 to June 2017. Results: Forty-four patients were enrolled into the study, 86.4% of them were male. 59.1% patients were homosexually transmitted. Clinical symptoms and signs mostly consisted of fever (84.1%), lymphadenopathy (56.8%) and so on, while 15.9% patients had central nervous system symptoms. Most common opportunistic infection included lung infection (50.0%) and oropharyngeal candidiasis (22.7%). Leucopenia (10 patients, 22.7%), and decreased CD4⁺ T cell count (267.5 cells/μl), inverted CD4⁺ /CD8⁺ ratio (86.4%) was mostly seen. Compared to patients who had HIV RNA load less than 6 lg copies/ml, the group of patients who had HIV RNA load more than 6 lg copies/ml had lower levels of CD4⁺ T cells (t=-3.724, P=0.001). Conclusions Patients with acute HIV infection have many different kinds of clinical symptoms and can be accompanied by opportunistic infection, and with high viremia.

Objective To evaluate the efficacy of prosthetic replacement for bone tumors and devitalization and replantation after resection of tumor segment for the treatment of patients with extremity osteosarcoma. Methods A total of 54 patients with Enneking stage Ⅱ extremity osteosarcoma who underwent limb-salvaging surgery in the Second Hospital of Shanxi Medical University from December 2010 to June 2017 were analyzed. Kaplan-Meier survival analysis was performed on the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group, the 5-year survival rate and distant metastasis rate between the two groups were compared. The χ 2 test and t test were used to compare the local recurrence rate, occurrence of local infection, and postoperative functional recovery between the two groups. Results Forty-six patients were followed up with the period ranging from 3 to 84 months. The prosthetic replacement for bone tumors group had 35 cases and the devitalization and replantation after resection of tumor segment group had 11 cases. The postoperative 5-year survival rate and 5-year distant metastasis rate were compared between the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group by using the Kaplan-Meier method (52.5％ vs. 59.4％, 38.5％ vs. 35.7％), and the differences were not statistically significant (χ 2 values were 0.084 and 0.013, both P > 0.05). For local recurrence rate and the risk of postoperative infection, the patients in devitalization and replantation after resection of tumor segment group showed higher results than those in prostheticreplacement for bone tumors group [36.4％ (4/11) vs. 8.6％ (3/35), 36.4％ (4/11) vs. 11.4％ (4/35)], and the differences were statistically significant (χ 2 values were 4.181 and 5.020, both P < 0.05). For 6 months postoperative functional reconstruction score, the patients in devitalization and replantation after resection of tumor segment group showed worse result than that in prosthetic replacement for bone tumors group [(17.4± 2.5) points vs. (24.3±4.8) points], and the difference was statistically significant (t = -4.911, P < 0.05); but this index tended to show better result at 18 months after surgery as compared with prosthetic replacement for bone tumors group [(27.3±2.7) points vs.(24.8±4.6) points], but the difference was not statistically significant (t= 1.811, P > 0.05). Conclusion The efficacy of prosthetic replacement for bone tumors is considered better than that of devitalization and replantation after resection of tumor segment, and it could be used as the preferred surgical option for limb-salvaging treatment in patients with extremity osteosarcoma at present.

Objective To explore expression level of circulating microRNA (miR)-133a and Galectin-3 and their potential clinical application in differential diagnosis between patients with chronic Keshan disease and dilated cardiomyopathy.Methods Twenty-eight patients with chronic Keshan disease and 28 cases of age-and sex-matched healthy people as control from the same severe historical endemic areas of Keshan disease in Heilongjiang Province,and another 28 patients with dilated cardiomyopathy from non-affected areas were chosen for the study.All the subjects were asked for disease history and did physical examination,examined by Doppler echocardiography for left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD),and collected fasting venous blood specimen (elbow vein).The plasma miR-133a and the serum Galectin-3 were determined by Real-time PCR and enzyme-linked immunosorbent method,respectively.Meanwhile,the correlation was analyzed between miR-133a,galectin-3,LVEF and LVEDD.Results The miR-133a and Galectin-3 levels in different groups were statistically different (F =48.789,9.485,P ＜ 0.01).The plasma miR-133a level in chronic Keshan disease group and dilated cardiomyopathy group [median (quartile):0.394 (0.271,0.770),1.665 (0.943,2.713)] were both significantly lower than those in control group [2.382 (1.502,3.302],P ＜ 0.01 or ＜ 0.05],and the plasma miR-133a level in chronic Keshan disease group was lower than that in dilated cardiomyopathy group (P ＜ 0.01).There was no significant difference of serum Galectin-3 level between chronic Keshan disease group and dilated cardiomyopathy group [17.710 (9.624,27.799),12.692 (9.376,26.290) μg/L,P ＞ 0.05],but both were significantly higher than those in control group [8.070 (7.135,9.308) μg/L,P ＜ 0.01].The miR-133a was positively correlated with LVEF (rs =0.297,P ＜ 0.01),while negatively correlated with LVEDD,and Galectin-3 (rs =-0.271,-0.318,P ＜ 0.05 or ＜ 0.01);the serum Galectin-3 was negatively correlated with LVEF (rs =-0.392,P ＜ 0.01),and positively correlated with LVEDD (rs =0.385,P ＜ 0.01).Conclusion The combined application of miR-133a,Galectin-3,LVEF and LVEDD may provide assistance in clinical differential diagnosis of chronic Keshan disease and dilated cardiomyopathy.

Objective: To know the prevalence of hepatitis B virus (HBV) among women in child-bearing age in Shandong Province, China, providing references to the improvement of HBV control strategy. Methods: The participants were randomly selected by two-stage sampling method from 12 counties which were representative for the whole province. Firstly two townships were selected from each county by probability proportional to size sampling (PPS) method. Then participants aged 1-4 years, 5-14 years, 15-29 years and 30-59 years were selected by stratified random sampling method. The women in child-bearing age (20-49 years) were involved in this study. Questionnaire survey and 5 ml blood collection were conducted among all participants. Blood samples were detected for hepatitis B surface antigen (HBsAg), antibody against HBsAg (anti-HBs) and antibody against hepatitis B core antigen (anti-HBc). Those who were positive for HBsAg were further detected for hepatitis e antigen (HBeAg), antibody against HBeAg (anti-HBe) and the load of HBV DNA. The basic information of the participants including age, gender, occupation, nationality and residence place were collected. The prevalence of HBV infection indicators after weight adjustment were calculated and compared between participants with different demographic characteristics. Results: A total of 1 151 women in child-bearing age were involved in this study. Twenty-seven participants were positive for HBsAg and the prevalence rate was 2.10% (95% CI: 0.97%-3.23%). Five participants were positive for both HBsAg and HBeAg and the prevalence rate was 0.36% (95% CI: 0-0.84%). There were 567 and 291 participants who were positive for anti-HBs and anti-HBc respectively and the corresponding prevalence rates were 47.72% (95%CI: 41.68%-53.75%) and 24.40% (95% CI: 18.50%-30.30%). The number of participants susceptible for HBV was 527 and the percentage of HBV susceptible women was 47.55% (95% CI: 41.63%-53.47%). Conclusion HBV infection among women in child-bearing age has attained very low level in Shandong Province, China. However, the high proportion of women in child-bearing age were still susceptible for HBV and hepatitis B immunization should be improved among them.

Objective: To evaluate prevalence of hepatitis A antibody (anti-HAV IgG) among population covered by different hepatitis A vaccine immunization strategies in Shandong Province in 2015. Methods: In October 2015, according to the geographical location of Shandong Province, the stratified random sampling method was used to stratify the 17 municipal distrcts, and the random number table method was used for sampling, First, two eastern cites (Qingdao, Rizhao), two western cities (Liaocheng, Zaozhuang) and three central cities (Jinan, Zibo and Laiwu) were selected; secondly, one county was drawn from each city. Finally, the participants were divided into five age groups including ≤7 years (age group covered by free hepatitis A vaccination strategy), 8-11 years (age group who receive hepatitis A vaccination at their own charge), 12-24 years (age group covered by catch-up vaccination of hepatitis A), 25-34 years (age group born before hepatitis A vaccine was used) and ≥35 years (age group born before hepatitis A vaccine was used). After all the paticipants or their guardians asked and registered basic information such as age, gender, home address, blood samples were collected from them and anti-HAV IgG was detected by ELISA method. The positive rate of anti-HAV IgG and 95%CI were calculated. Results: A total of 1 654 participants were involved in the final analysis, including 856 males (51.75%) and 798 females (48.25%) whose mean age was (13.44±13.06) years. The crude positive rate of anti-HAV IgG was 91.41% (1 512/1 654, 95%CI: 89.96%-92.72%) and the age-adjusted rate was 90.93% (95%CI: 90.92%-90.94%). The positive rates of anti-HAV IgG was at the highest level in the age group of ≤7 years (95.90%, 95%CI: 95.88%-95.91%) and was at the lowest level in the age group of 25-34 years (83.23%, 95%CI: 83.21%-83.25%). The age-specific positive rates of anti-HAV IgG in eastern areas (96.79%, 95%CI: 96.78%-96.80%) were higher than those in both middle areas (86.66%, 95%CI: 86.65%-86.67%) and western areas (91.96%, 95%CI: 91.95%-91.97%). Conclusion The positive rate of anti-HAV IgG was high among the general population in Shandong Province, but relatively low among young and middle-aged adults. Besides the routine immunization of hepatitis A among the children, more efforts should be taken for the prevention and control of hepatitis A among young and middle-aged adults in Shandong Province, especially in central and western areas.