The paper reported a case of brachial artery ligation treatment of arteriovenous graft infection with arteriovenous graft exposure and bleeding. Based on the experience of vascular access center and the review of relevant literature, the causes and treatment options of this complication were analyzed, and the feasibility and safety of brachial artery ligation were elaborated for the treatment of this complication, to provide references for clinical diagnosis and treatment.

Objective:To investigate the status quo of nursing capacity for chronic respiratory disease in community health service centers.Methods:A questionnaire survey on nursing capacity for chronic respiratory disease was conducted in November 2018 among nurses working in internal medicine, general practice and chronic disease management departments of 4 community health service centers in Beijing Miyun District. The questionnaire included the knowledge and work content of chronic respiratory diseases. At the same time semi-structured interviews was conducted on the role of nurses in the management of chronic respiratory diseases among nurses selected by purposive sampling method.Results:In the study 63 valid questionnaires were collected and 14 nurses were interviewed. The results showed that the total score of nurses′ knowledge about chronic respiratory diseases was (62.0±14.4), and the scores of knowledge of chronic obstructive pulmonary disease (COPD), bronchial asthma and obstructive sleep apnea were (55.5±19.3), (61.0±21.6), (69.5±25.1), respectively. The total knowledge score of nurses with middle-rank professional title or above was higher than that of those with primary title [(67.0±12.9) vs. (54.0±13.6), t=-3.07, P<0.01]. The work contents mainly involved were nursing procedures(22/63,34.9%), health education(18/63,28.6%) and nursing evaluation(8/63,12.7%).Three themes were extracted from the deep interviews: the main work contents for nurses should be nursing procedures, nurses should participate in the chronic respiratory disease management as a member of the integrated medical team; nurses expected practice-oriented trainings of chronic respiratory disease management. Conclusions:The knowledge of chronic respiratory diseases among nurses in community health center needs to be improved, and the nursing skills special for respiratory diseases are needed. It is suggested to develop training courses and nursing guidelines suitable for community health centers and for nurses to participate in chronic respiratory disease management as team members, so that nurses in primary care institutions can play a better role in the management of chronic respiratory diseases.

Objective:To investigate the current status of chronic respiratory disease (chronic obstructive pulmary disease, bronchial asthma and obstructive sleep apnea) management capacity in community health centers in Beijing Miyun district.Methods:From November 21 to 22,2018,nineteen community health centers and 65 general practitioners in Miyun district of Beijing were selected to participate in a questionnaire survey. The self-designed questionnaire was divided into two parts: the questionnaire for medical institutions(institution questionnaire)and questionnaire for general practitioners(doctor questionnaire). The institution questionnaires were distributed by the Miyun District Health Commission,and filled in by the person in charge of the institution; the knowledge questionnaires were sent to all general practitioners of 4 community health service centers. The two independent sample t test was used to compare the measurement data in accordance with normal distribution between the two groups, and analysis of variance was used for multi group comparison. Results:Nineteen institution questionnaires were sent to all centers in the district and all 19 valid questionnaires were recovered. Among them, 18 centers thought that chronic respiratory diseases should be included in the management of chronic non-communicable diseases, and health records should be established to achieve regular follow-up monitoring, but only one center had put asthma in the record. Nine centers purchased pulmonary function instrument; 8 centers were equipped with inhaled glucocorticoid, and 1 center was equipped with β 2-receptor agonists. The effective recovery rate of knowledge questionnaire was 100.0% (65/65). There was no significant difference in the knowledge scores of three kinds of chronic respiratory diseases (chronic obstructive pulmary disease, bronchial asthma, obstructive sleep apnea) among general practitioners [(63±19), (64±23), (62±21), F=0.087, P>0.05]. The scores of general practitioners with different ages and professional titles were (57±15), (66±13), (42±16) and (54±19), (67±12), (68±11) respectively. There were significant differences in the knowledge scores of general practitioners with different ages and professional titles ( F= 8.582 and 6.079, all P<0.05). The average scores of general practitioners with age>50 years or junior professional title were lower than others. Conclusions:The leaders of each center in Miyun district have a clear understanding of the necessity of diagnosis and treatment of chronic respiratory diseases, but there are still some problems, such as insufficient attention to chronic respiratory system, insufficient investment in disease management infrastructure, and lack of professional knowledge of chronic respiratory diseases among general practitioners. It is hoped that in the future, chronic respiratory diseases can be introduced into public health service projects, investment in related disease infrastructure will be strengthened, and comprehensive respiratory knowledge and ability training courses suitable for grass-roots general practitioners can be popularized as soon as possible.

Objective:To study the Epstein-Barr virus (EBV) activity and its clinical characteristics in patients with hemorrhagic fever with renal syndrome (HFRS). Methods:From January 2016 to August 2017, patients with HFRS who were hospitalized in the First Affiliated Hospital of Harbin Medical University were routinely tested by EBV serology, and were divided into two groups according to their presence or absence of EBV infection, namely EBV active group and non-EBV active group. The clinical data between the two groups were compared and analyzed by SPSS 18.0.Results:A total of 188 HFRS patients were enrolled, including 73 cases in EBV active group and 115 cases in non-EBV active group. The EBV active rate of HFRS patients was 38.83% (73/188). The incidences of lumbago [57.53% (42/73) vs 42.61% (49/115)], abdominal pain [42.47% (31/73) vs 20.00% (23/115)], skin and mucosa congestion [57.53% (42/73) vs 39.13% (45/115)], and conjunctiva edema [50.68% (37/73) vs 28.70% (33/115)] in EBV active group were significantly higher than those in non-EBV active group (χ 2 = 3.983, 11.008, 6.083, 9.239, P < 0.05). There were 10, 7 and 43 patients with acute kidney injury (AKI) stage 1, 2 and 3 in EBV active group and 5, 13 and 53 patients in non-EBV active group. Degree of AKI in EBV active group was higher than that in non-EBV active group, and the difference was statistically significant (χ 2 = 12.615, P < 0.05). In EBV active group, the proportion of patients whose renal function recovery over 15 days [23.29% (17/73)] and white blood cell count [11.26 (3.39 ~ 54.23) × 10 9/L] were significantly higher than those in non-EBV active group [6.96% (8/115), 10.03 (2.91 ~ 66.99) × 10 9/L], and the differences were statistically significant (χ 2 = 10.330, Z = - 2.003, P < 0.05). Conclusion:HFRS patients may cause latent EBV activity, complicate their clinical features, cause severe renal damage and prolong the recovery time of renal function.

Objective:To introduce the usefulness and advantages of needle-type choledochotomy in laparoscopic common bile duct exploration.Methods:A retrospective analysis for the data of 1 107 patients who successfully implemented laparoscopic common bile duct exploration in Subei People′s Hospital of Jiangsu Province from January 1, 2013 to December 31, 2020 were applied. All cases were divided into the study group 662 cases with needle-type choledochotomy) and the control group (445 cases with non-needle-type choledochotomy) according to the manipulation of common bile duct incision. The time-cost, incidences of bleeding and bile leakage, as well as the recurrence rate of bile duct stone and the incidence of bile duct stenosis were observed and compared between the two groups. Normally distributed data were expressed as mean±standard deviation ( Mean± SD) and compared by t test while count data were expressed as frequency or percentage and compared by chi-square test or Fisher′s exact test. Results:The bile duct incision time and bleeding rate were (14.45±2.46) s and 25.1% in the study group, (104.48±15.32) s and 68.1% in the control group, respectively. The differences between the two groups were statistically significant ( P<0.001). The incidence of stone recurrence, biliary leakage, and bile duct stricture were 3.0%, 3.6% and 0.3% in the study group, 4.9%, 5.6% and 0.4% in the control group, respectively. There were no statistically significant differences between the two groups ( P>0.05). Conclusion:Needle-type bile duct incision can be used as a routine manipulation in laparoscopic common bile duct exploration for its time-saving, less bleeding, safe and easy to handling.

Recent studies have shown that intervention in the early post-traumatic period can inhibit scar hyperplasia and promote scar maturation. Because of its definite therapeutic efficacy and few adverse reactions, it has become an important auxiliary method to prevent scar formation after trauma. This article reviews the research advances on the mechanism of pulsed dye laser in inhibiting the formation of early hypertrophic scar after trauma, the timing of intervention, and its complications and treatment methods, in order to provide a basis for the early prevention and treatment of clinical post-traumatic scars.

Objective:To investigate the clinical effect of minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar.Methods:From September 2015 to May 2019, a total of 11 patients who had facial depressed scar were treated with minimally invasive scar release combined with autologous microfat graft in Huaihe Hospital of Henan University. Needle scar separator or 10 ml syringe needle was inserted under skin to release scar adhesion thoroughly. Microfat was harvested from the abdomen, which was separated and purified, and then evenly transplanted into the stripped space (0.5 cm wider than the edge of scar) under the scar with a 1 ml syringe. The severity of scar was evaluated pre-operation, 3-month post-operation and 6-month post-operation, using Vancouver Scar Scale score and Stony Brook Scar Evaluation Scale score to evaluate the efficacy. Using Visual Analogue Scale score to evaluate patient satisfaction. Analyses were performed using SPSS Statistics 25.0, and measurement data were expressed as Mean±SD if they conformed to normality and homogeneity of variance. One-way ANOVA was used for multi-time point data, and the Bonferroni test was performed for pairwise comparison. P<0.05 was considered a statistically significant difference. Results:The depression of scars disappeared immediately after treatment. 6 months after treatment, the surface of the scars was flat, the color and elasticity were close to adjacent normal skin, and the texture of the scars was soft. All patients were followed up for 6 months without recurrence, and 11 patients were satisfied. In Vancouver Scar Scale score, the pre-operation score was 7.27±1.10, the 3-month post-operation score was 2.64±0.81 and the 6-month post-operation score was 0.91±0.54, showing a significant difference ( F=467.98, P<0.001). Pairwise comparison result show that comparing the pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P<0.001). In Stony Brook Scar Evaluation Scale score, the pre-operation score was (2.00±0.89), the 3-month post-operation score was 4.45±0.69 and the 6-month post-operation score was 4.45±0.69, showing a significant difference ( F=67.00, P<0.001). Pairwise comparison result show that comparing pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P=0.006). The 6-month post-operation Visual Analogue Scale score was 95.0±6.74. Conclusions:Minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar can avoid the post-surgery scar formation and adhesion, and improve the color and texture of the facial hypertrophic scar. This method can be carried out under local anesthesia, with simple procedure and exact effect.

Objective:To investigate the clinical effect of minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar.Methods:From September 2015 to May 2019, a total of 11 patients who had facial depressed scar were treated with minimally invasive scar release combined with autologous microfat graft in Huaihe Hospital of Henan University. Needle scar separator or 10 ml syringe needle was inserted under skin to release scar adhesion thoroughly. Microfat was harvested from the abdomen, which was separated and purified, and then evenly transplanted into the stripped space (0.5 cm wider than the edge of scar) under the scar with a 1 ml syringe. The severity of scar was evaluated pre-operation, 3-month post-operation and 6-month post-operation, using Vancouver Scar Scale score and Stony Brook Scar Evaluation Scale score to evaluate the efficacy. Using Visual Analogue Scale score to evaluate patient satisfaction. Analyses were performed using SPSS Statistics 25.0, and measurement data were expressed as Mean±SD if they conformed to normality and homogeneity of variance. One-way ANOVA was used for multi-time point data, and the Bonferroni test was performed for pairwise comparison. P<0.05 was considered a statistically significant difference. Results:The depression of scars disappeared immediately after treatment. 6 months after treatment, the surface of the scars was flat, the color and elasticity were close to adjacent normal skin, and the texture of the scars was soft. All patients were followed up for 6 months without recurrence, and 11 patients were satisfied. In Vancouver Scar Scale score, the pre-operation score was 7.27±1.10, the 3-month post-operation score was 2.64±0.81 and the 6-month post-operation score was 0.91±0.54, showing a significant difference ( F=467.98, P<0.001). Pairwise comparison result show that comparing the pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P<0.001). In Stony Brook Scar Evaluation Scale score, the pre-operation score was (2.00±0.89), the 3-month post-operation score was 4.45±0.69 and the 6-month post-operation score was 4.45±0.69, showing a significant difference ( F=67.00, P<0.001). Pairwise comparison result show that comparing pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P=0.006). The 6-month post-operation Visual Analogue Scale score was 95.0±6.74. Conclusions:Minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar can avoid the post-surgery scar formation and adhesion, and improve the color and texture of the facial hypertrophic scar. This method can be carried out under local anesthesia, with simple procedure and exact effect.

Objective:By building a patient safety oriented nursing-sensitive indicator system, this study aimed to help clinical evaluation and nursing for patients in prone position, to constantly optimize management of prone position and promote patient safety.Methods:First drew up initial indicators through literature search and personal interviews, then modified and finally formed the prone position nursing indicators within two rounds of experts consultation. Verified the indicators by evaluating nursing staff satisfaction after half-year′s implementation.Results:Finally, the indicator system included 9 first level, 13 second level and 71 third level indicators. The reliability of experts and the satisfaction of nurses were both high.Conclusions:With the purpose of patient safety, the nursing indicator system of prone position ventilation for critically ill patients are comprehensively covered ever aspect of key component. Specific effect needs to be further verified in the hospital management practice.

Objective: To understand the current situation of early childhood sexuality education among parents of leftbehind children in rural areas and associated factors, to provide the evidence to launch the sexuality education for left behind children in rural areas in the future. Methods: An anonymous questionnaire survey was conducted among 1 348 parents of left behind children in rural areas who were selected by multistage stratified sampling during Mar. to May. 2018. Results: The rate of early childhood sexuality education of rural areas in Sichuan was 48.4%(652). Multivariate analysis showed that parents whose child was in higher grade ( OR=1.32, 95% CI =1.12-1.55); total annual income <10 000 yuan( OR=1.48, 95%CI =1.02-2.14), children had asked sexrelated questions ( OR=1.44, 95%CI =1.11-1.87), reckoning it necessary( OR=3.78, 95%CI =2.57-5.58), considering children’s sexuality education should be held by parents ( OR=2.69, 95%CI =1.78-4.07), other family members had launched the early childhood sexuality education( OR=7.86, 95%CI =5.16-11.95), school had launched it ( OR=3.13, 95%CI =2.25-4.34) had a highter rate of early childhood sexuality education. Conclusion Early childhood sexuality education of parents of left behind children of rural areas in Sichuan is in low level. Sexual health education should be based in school, together with parental training towards positive attitude and increases in early childhood sexuality education.