Objective:To explore the psychological experience and demand of parents of children with delayed recovery after congenital heart disease surgery.Methods:This study adopted phenomenological research methods from qualitative research. Using the purposive sampling method, parents of postoperative delayed recovery children with congenital heart disease who met the inclusion criteria were selected as the research objects from October to November 2019 at Fuwai Hospital, Chinese Academy of Medical Sciences. Semi-structured interviews were conducted with the parents of the children, and the data were analyzed by Colaizzi 7-step analysis method.Results:Finally, 13 parents of children with delayed recovery after congenital heart disease surgery were included. According to the interview results, four themes were extracted, which were negative psychological experience of parents of children with delayed recovery, positive psychological experience and expectation change of parents, heavy economic burden of parents and diversified needs of parents.Conclusions:During the delayed recovery period, psychological experience of parents is complex and their needs are diverse. The nursing staff should identify and pay attention to the causes of the negative psychological experience of the parents of the children, timely channel their negative emotions and strengthen the positive psychological experience in many aspects. They can assist parents to seek social help to reduce physical and mental pressure and meet the diverse needs of parents by providing high-quality nursing services and multi-channel information support.

Objective:To investigate the application value of donor liver autologous portal venous blood rinse in orthotopic liver transplantation (OLT).Methods:The retrospective cohort study was conducted. The clinicopathological data of 35 pairs of donors and recipients who underwent OLT in the First Affiliated Hospital of University of Science and Technology of China from May 2018 to June 2019 were collected. Of the 35 donors, there were 31 males and 4 females, aged (48±9)years. Of the 35 recipients, there were 25 males and 10 females, aged (47±9)years. Of the 35 recipients, 16 recipients undergoing donor liver autologous portal venous blood rinse were allocated into the portal vein group, and 19 recipients undergoing donor liver albumin water rinse were allocated into the albumin group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data of skewed distribution were represented as M(range). Count data were descried as absolute numbers, and comparison between groups was analyzed using the Fisher exact probability. Results:(1) Surgical situations. The anhepatic phase time and arterial blood Ca 2+ concentration within 5 minutes after reperfusion of the recipients were (52±12)minutes and (0.99±0.10)mmol/L in the portal vein group, versus (64±12)minutes and (1.05±0.07)mmol/L in the albumin group, showing significant differences in the above indicators between the two groups ( t=2.94, 2.22, P<0.05). The mean arterial pressure, arterial blood K +concentration and arterial blood pH within 5 minutes after reperfusion of the recipients were (70±24)mmHg (1 mmHg=0.133 kPa), (4.7±1.3)mmol/L and 7.27±0.06 in the portal vein group, versus (71±28)mmHg, (4.6±1.1)mmol/L and 7.30±0.07 in the albumin group, showing no significant difference in the above indicators between the two groups ( t=0.14, 0.30, 1.22, P>0.05). (2) Post-operative situations. Cases with post-reperfusion syndrome (PRS), cases with severe PRS of cardiac arrest, cases with primary graft nonfunction of the recipients were 6, 0, 2 in the portal vein group, versus 8, 1, 1 in the albumin group, showing no significant difference in the above indicators between the two groups ( P>0.05). Total bilirubin on postoperative day 7 of the recipients was (90±52)μmol/L in the portal vein group, versus (166±112)μmol/L in the albumin group, showing a significant difference between the two groups ( t=2.66, P<0.05). International normalized ratio on postoperative day 7, the highest alanine aminotransferase and aspartate aminotransferase within 7 days after operation of the recipients were 2.1±2.0, (1 952±2 813)IU/L and (3 944±6 673)IU/L in the portal vein group, versus 1.8±0.6, (1 023±1 014) IU/L and (2 005±2 910)IU/L in the albumin group, showing no significant difference in the above indicators between the two groups ( t=0.66, 1.23, 1.08, P>0.05). Recipients with hepatic artery complication and biliary complication were 1 and 2 in the portal vein group, versus 0 and 4 in the albumin group, showing no significant difference in the above indicators between the two groups ( P>0.05). There were 3 cases and 2 cases died during the perioperative period in the portal vein group and the albumin group, respectively. (3) Follow-up. Of the 35 recipients, 30 recipients were followed up for 534(range, 28?776)days after operation. During the follow-up, there were 3 patients with postoperative complications in the portal vein group including 2 cases died and 1 case recovered after sympto-matic treatment. There were 5 patients with postoperative complications in the albumin group including 1 case died and 4 cases recovered after symptomatic treatment. Up to the follow-up date, 11 patients in the portal vein group and 16 patients in the albumin group were in good condition. Conclusion:Rinse of the donor liver with autologous portal venous blood during liver transplantation can shorten the time of anhepatic phase, without increasing the occurrence of post-reperfusion syndrome, ischemia re-perfusion injury and biliary tract complications.

Caroli disease is a relatively rare genetic disease, also known as congenital intrahepatic cystic cholangiectasis, which is mainly manifested as non-obstructive segmental dilation of large, intrahepatic bile ducts, which is manifested as cysts in imaging and histopathological examination. The pathogenesis of Caroli disease is still unclear, and it is mainly believed to be related to PKHD1 gene mutation. Mutations in this gene often lead to autosomal recessive polycystic kidney disease (ARPKD), so Caroli disease is commonly associated with polycystic kidney disease. Caroli disease usually develops during adolescence and is characterized by recurrent cholangitis, which is diagnosed mainly by imaging. This article reviews the progress of diagnosis and treatment of Caroli disease by reading related literature.

Objective:To explore the relationship between disease uncertainty, coping style, and self-perceived burden (SPB) in patients with lower extremity deep vein thrombosis (DVT) .Methods:Totally 280 patients with lower extremity DVT who were hospitalized in the Department of Vascular Surgery of three ClassⅢ Grade A hospitals in Cangzhou from September 2020 to April 2021 were selected by convenience sampling and investigated with the general information questionnaire, Medical Coping Style Questionnaire, Self-Perceived Burden Scale (SPBS) , Medical Coping Modes Questionnaire (MCMQ) , and Mishel's Uncertainty in Illness Scale (MUIS-A) . Pearson correlation was used to analyze the correlation between variables. A total of 280 questionnaires were distributed in this study, and 262 valid questionnaires were recovered, with an effective recovery rate of 93.6%.Results:The SPB score of the 262 patients with lower extremity DVT was (28.83±7.43) ; disease uncertainty, avoidance, and yielding were positively correlated with the patients' SPB ( r=0.651, 0.477, 0.469; P<0.01) , while facing was negatively correlated with SPB ( r=-0.485, P<0.01) . The path analysis revealed that avoidance and yielding played a partial mediating effect between disease uncertainty and SPB, accounting for 14.6% of the total path effect. Conclusions:Disease uncertainty can indirectly affect SPB in patients with lower extremity DVT through avoidance and yielding. Clinical medical staff should formulate targeted intervention and health guidance strategies to improve patients' disease cognition and coping ability, and reduce their SPB.

Objective:To investigate the value of logistic regression model based on the features of cone-beam breast CT (CBBCT) for the identification of benign and malignant masses in dense breast.Methods:The data of 106 patients (130 masses) with dense breast who underwent contrast-enhanced CBBCT examination and obtained pathological results from May 2011 to August 2020 were retrospectively analyzed as the training set. From August 2020, the data of 49 patients (54 masses) who met the same criteria were prospectively and consecutively collected and used as the validation set. Taking pathological results as the gold standard, the training set was divided into benign and malignant groups. The t-test, χ 2 test and Fisher′s exact test were used to compare the differences in CBBCT image characteristics between the two groups in the training set. A binary logistic regression model was established by multivariate analysis. ROC curves were used to assess the diagnostic efficacy of the model as a whole in the training and validation sets and the diagnostic efficacy of each feature in the model, and the cut-off value of the intensity (ΔCT) value was determined. The H-L method was used to test the goodness of fit of the model. Decision curve analysis (DCA) was drawn to validate the clinical power of the model. Results:Univariate analysis showed that the breast parenchymal background enhancement (BPE), shape, margin, lobulation, spiculation, density, calcifications, ΔCT value, enhancement pattern, non-mass enhancement, ipsilateral increased vascularity (IIV), and peripheral vascular signs had statistical difference between benign group and malignant group ( P<0.05). BPE, margin, ΔCT value and IIV were included in the multivariate analysis, the equation was logit( P′)=-8.510+0.830×BPE+0.822×margin+1.919× ΔCT+1.896 × IIV. The are a under curve of the model in the training set was 0.879 ( P<0.001) and in the validation set was 0.851 ( P=0.001). The are a under curve of BPE, margin, ΔCT value, and IIV in the diagnosis of malignant mass were 0.645, 0.711, 0.712, 0.775 (all P<0.05); the best cut-off value of ΔCT was 50.38 HU. The fit of this model was good ( P = 0.776). The DCA curve showed that when the risk threshold was 0.05-0.97, the net benefit rate was>0, and this model had some clinical value. Conclusion:The logistic regression model based on the features of CBBCT is helpful to distinguish benign and malignant masses in dense breasts.

Objective To understand the clinical distribution situation of streptococcus penumoniae (SP) and drug susceptibility test results to provide a basis for the clinical diagnosis,treatment and prevention of SP infection.Methods Totally 416 nonrepeat strains of SP were isolated during 2010 to 2015.Their identification and drug susceptibility test were performed by using the ATB Express bacterial identification system.The results were interpreted according to the standard of CLSI 2014 edition.Results In these 6 years,SP showed the isolation peak in spring and winter;the detection rate of respiratory tract specimens reached more than 90 ％;the young children and elderly people were predominant;SP maintained high sensitivity to penicillin,amoxicillin,etc.,the difference in the sensitivity rate and non-sensitivity rate had statistical significance(P＜0.05);but SP showed high level non-sensitivity to clindamycin,erythromycin,etc.,the difference in the sensitivity rate and non-sensitivity rate had no statistical significance (P＞0.05).Conclusion Although β-lactam antibiotics such as penicillin can still be used as the first choice of therapy,but PISP and PRSP show the increasing trend year by year;therefore the antibacterial drugs should be selected according to the drug susceptibility test results.

Objective To learn drug resistance of bacteria isolated from a hospital of Chengdu from 2012 to 2013 .Methods From 2012 to 2013 ,39 732 clinical specimens were collected ,ATB Express half‐automatic bacteria identification system were used to identify the bacteria ,and paper diffusion(K‐B) method was used to do drug sensitive test ,results were judged according to Clini‐cal and Laboratory Standards Institute 2012 standard interpretation ,Whonet5 .6 was used to do statistical analysis .Results In the bacteria isolated from this hospital in 2012 and 2013 ,gram‐positive bacteria accounted for 27 .7% and 37 .4% respectively ,gram negative bacteria accounted for 72 .3% and 62 .6% .The top five pathogenic bacteria were E .coli(16 .3% ,20 .3% ) ,Pseudomonas aeruginosa(11 .5% ,11 .7% ) ,Staphylococcus aureus (11 .3% ,11 .4% ) ,Acinetobacter baumannii(10 .6% ,9 .3% ) ,Klebsiella pneu‐moniae(14 .7% ,12 .0% ) .The detection rates of Methicillin‐Resistant Staphylococcus(MRSA) were 56 .2% ,47 .7% .The positive rates of producing extended spectrum βlactamases(ESBLs) of E .coli and Klebsiella pneumonia accounted for 41 .0% ,32 .2% and 21 .0% ,10 .8% ,which were high sensitive to carbon penicillium alkene antibiotics and amikacin .Susceptibility monitoring results showed that the drug resistance of Acinetobacter baumannii was rising ,and the drug resistant of Pseudomonas aeruginosa to most antibiotic were decline .Conclusion The top five bacteria isolated from this hospital in 2012 and 2013 are given priority to gram‐negative bacteria ,in addition to the drug resistant trend of Acinetobacter baumannii increased slightly ,the drug resistant of other four common bacteria were decline .Clinical attention should focus on positive ESBLs ,E .coli ,Klebsiella pneumoniae ,MRSA and M ulti‐resistant bacteria .

Objective To investigate the changes of serum miR-21 expression level in patients with HCC before and after transcatheter arterial chemoembolization (TACE) and to discuss its clinical significance. Methods Before and after TACE the levels of serum miR-21 in 42 patients with HCC and 42 healthy subjects were determined by reverse transcriptase quantitative PCR (RT-PCR), and the levels of serum AFP were also estimated by enzyme-linked immunosorbent assay (ELISA). The results were analyzed. Results The serum miR-21 level in patients with HCC was (12.9 ± 3.5) times of that in normal subjects(t=19.430 7, P < 0.01). One month after TACE, the serum miR-21 level became (7.2 ± 1.7) times of that of normal reference value, which was remarkably lower than that obtained before the treatment (t=9.493 7, P<0.01). The serum miR-21 level was closely correlated with the tumor size, the presence of tumor thrombus and HBV infection. One month after TACE the serum miR-21 levels in patient groups showing partial response, stable disease and progressive disease were (4.0 ± 0.3), (6.0 ± 1.5) and (8.6 ± 1.5) times, respectively, of that of normal reference value, and statistically significant difference existed between each other among the three groups (F=38.168, P=0.000). ROC-AUC value of MiR-21 in diagnosing HCC was 0.910 ± 0.041, which was significantly higher than that of AFP (0.860 ± 0.037, t=6.3042, P<0.01). The specificity of miR-21 in detecting HCC was 88.1%, which was remarkably higher than that of AFP (69%, χ2= 4.5253, P = 0.033).Conclusion After TACE the serum MiR-21 level in HCC patients is significantly decreased, which is very helpful in predicting the therapeutic efficacy of TACE. Therefore, MiR- 21 can be regarded as a potential molecular marker of HCC.

OBJECTIVETo investigate the acquaintance to orthodontics and possible factors that obstruct orthodontic treatment in middle school students in zones with different economic levels in Jiangjin, Chongqing.

METHODSThe students were randomly divided into four groups: A class from a junior high school in town (group 1), a class from a senior high school in town (group 2), a class from a junior high school in the countryside (group 3), a class from a senior high school in the countryside (group 4). The information was collected by questionnaire, and the statistical analysis of results was carried out by SPSS 17.0 software.

RESULTSSex made difference in the acquaintance to orthodontics treatment. Girls worried more about teeth extraction and pain that may occur during treatment than the boys. Students in the city had more access to related consultations compared to those in the countryside. Different economic conditions made much contribution to the proportion to go for orthodontics treatment in cities and rural areas. The evaluation from families and friends may affect patients' subjective estimation to themselves.

CONCLUSIONOrthodontists should learn more about student patiens from various aspects, and make different therapies according to their sexes, economic conditions of family, education levels, etc. Only so can orthodontists get better compliance from their patients.