Objective:To explore the transition from hospital discharge to home care in heart transplant recipients based on the Meleis' transition theory, so as to provide a basis for improving the quality of life of recipients.Methods:In July 2021, purposeful sampling was used to select heart transplant recipients from the First Affiliated Hospital of Zhejiang University School of Medicine as the research subject. A total of 12 recipients of one year after heart transplantation were selected for semi-structured interviews by snowballing. The interview data were analyzed using the Colaizzi 7-step method.Results:Through reading, analysis, sorting and summarizing, 4 themes and 11 sub-themes were extracted, namely, relatively stable recovery of physical condition, lack of medication and emotional management (unmet needs for medication cognition and management, good physical condition, early emotional experience of vulnerability) , the support of family and social resources affected the transition (the communication and support of patients promoted the transition, the support of the family promoted the transition, the lack of community resources hindered the transition, and the reimbursement policy affected the transition) , a positive experience in the transition (confidence to deal with future life, return to society and self-realization) , and expecting to obtain comprehensive and continuous management of body and mind (the needs of nursing care centered on mental health, the needs of professional management teams and the communication platform among doctors, nurses and patients) .Conclusions:The experience of home self-care after discharge has many physical and psychological impacts on heart transplant recipients. It is necessary to pay attention to the recipients in the transition period, and to build a whole-of-society support system to give help to heart transplant recipients.

Objective:To investigate the epidemiology of human papillomavirus (HPV) infection and gene subtypes among women in Qingdao form 2015 to 2019, so as to provide scientific support for the prevention and treatment of HPV related cervical cancer in Qingdao.Methods:A total of 26396 female cervical exfoliated cell specimens were collected at the Affiliated Hospital of Qingdao University from January 2015 to October 2019, then 17 high-risk HPV genotypes and 6 low-risk HPV genotypes were detected by PCR and reverse dot blot in vitro, and prevalence and year, genotype and age distribution were analyzed.Results:The total prevalence of HPV was 18.17%. The prevalence of single infection, double infection and multiple infection were 13.41%, 3.40% and 1.35% respectively. The infection rate of 7 high-risk subtypes (HPV52, 16, 58, 53, 56, 51, 68) and 3 low-risk subtypes (HPV81, 42, 43) exceeded 1%. The HPV prevalence of different age groups was significantly different and the prevalence showed a bimodal pattern among different age groups. There were two peaks in the ≤25 years group and 46-50 years group, which were 23.61% and 19.63% respectively. There was no significant difference in genotype distribution among different age groups.Conclusions:The cervical HPV infection rate of women in Qingdao is at a medium level, and single infection is the main pattern in different genotypes and age groups. In addition to the vaccine coverage subtypes, the prevalence of other subtypes such as HPV 53, 56, 51 and 68 in this region is also high. Therefore, regular HPV screening is still needed after vaccination to find out HPV genotypes which are not covered by the vaccine. It is suggested that the government optimize the HPV vaccine coverage genotypes to prevent the occurrence of HPV infection associated with cervical cancer.

Objective:To understand the discovery of human brucellosis cases in new affected counties in Sichuan province, 2015-2017, and provide evidences for prevention and control of human brucellosis.Methods:The incidence data and outbreak data of human brucellosis in Sichuan were collected from Chinese Infectious Disease Surveillance Reporting System, and face to face interview, telephone interview and on-line survey were conducted to collect the case information, such as epidemiological characteristics, medical care seeking.Results:The incidence of human brucellosis in Sichuan has increased obviously since 2013, and 103 counties reported human brucellosis cases for the first time. A total of 23 cases of human brucellosis were investigated, and the common symptoms of the cases was fever, accounting for 91.30 % (21/23). The cases mainly sought medical care in hospitals under county-level for the first time, accounting for 73.91 % (17/23), and the misdiagnosis rate was 91.30 % at the first diagnosis (21/23). The median interval between onset and diagnosis was 52 days, and the longest one was 142 days. Only 4.35 % (1/23) cases knew human brucellosis, and when they contacted with suspected livestock, the use rate of protective clothing was 30.43 % (7/23), the use rate of gloves was 8.70 % (2/23), the use rate of mask was 4.35 % (1/23), and the rate of washing hands with disinfectant after contact with livestock was 4.35 % (1/23). Goat was suspected to be the infection source of all the cases, and 34.75 % (8/23) of the cases were from Gansu, Qinghai and other provinces. The overall awareness rate of human brucellosis in the doctors was 34.58 % (102/295), and the training rate was 58.31 % (172/295). Only 33.33 % (11/33) of the hospitals could perform laboratory diagnosis of human brucellosis and 34.78 % (8/23) of county CDCs could carry out laboratory test of human brucellosis. Conclusions:The prevention and control of human brucellosis is facing challenge in Sichuan. The misdiagnosis rate was very high in newly affected counties, and the diagnosis were delayed obviously. The awareness of human brucellosis was low in the cases, and their awareness of self-protection was poor. The awareness rate about human brucellosis in doctors was low and they need more training; the capacity of brucellosis laboratory diagnosis in hospitals and CDCs at county-level should be improved.

Objective: To explore the advantages and clinical efficacy of free chimeric perforator flap based on the descending branch of circumflex femoral artery applied to tongue reconstruction after advanced tongue cancer resection. Methods: From October 2013 to December 2018, 57 cases received tongue and oral base reconstruction surgeries using the descending branch of circumflex femoral artery chimeric perforator flap, including 39 males and 18 females, ranged from 20 to 76 years old. And all cases were with stage T3 and T4 tongue cancers, including 35 cases of squamous cell carcinoma, 7 cases of low differentiation cancer, 5 cases of oncosarcoma, and 10 cases of adenoid cystic carcinoma. The tongue was reconstructed by using perforator flap and muscle flap to fill the dead space at the oral floor. The artery anastomoses with the superior thyroid artery or facial artery in the receiving area, and the vein anastomoses with the internal jugular vein in the receiving area. The shape, function and local complications of the reconstructed tongue were observed after operation. Results: Of 57 cases, only one case had partial necrosis of flap, while other 56 cases with chimeric perforator flap survived. Postoperative gastric tube and tracheal cannula were removed in all patients, no cases with oral fistula. All donor sites were sutured in one stage. Postoperative radiotherapy was performed in 41 of the patients. All patients were followed up for 3 to 60 months (average of 20.7 months), with satisfactory esthetic and functional results in reconstructed tongues. Only linear scars were left in the donor areas of the legs, and no lower limb dysfunction was observed. Conclusions The descending branch of circumflex femoral artery chimeric perforator flap can used for repairing simultaneously the defects of both tongue and oral base. It is helpful to avoid the occurrence of oral fistula and to provide the reconstructed tongue with a good function. It is a good choice to use the descending branch of circumflex femoral artery chimeric perforator flap for tongue reconstruction after resection of advanced tongue cancer resection.

Objective? To investigate the level of self-management and identify the influencing factors in elderly patients in Inner Mongolia with chronic heart failure(CHF). Methods? By convenience sampling, a total of 1 051 elder patients with CHF from 9 Class Ⅱ & Ⅲ hospitals in 5 cities of Inner Mongolia Autonomous Region were recruited to participate in this study from December of 2015 to July of 2018. The elderly CHF patients were investigated with General Data Questionnaire and Self-management Scale for Heart Failure Patients. Results? The total score of Self-management Scale for Heart Failure Patientsof 1 051 elderly patients with CHF was (47.9±7.7) with a scoring rate of 59.9%. Multivariate linear regression analysis showed that ethnicity,work status and marital status were the influencing factors of self-management level of elderly CHF patients. Conclusions? The self-management status of elderly CHF patients in Inner Mongolia is not ideal. Corresponding intervention measures should be formulated according to the influencing factors of self-management level of elderly CHF patients in Inner Mongolia.

[Abstract]? Stroke patients' return to work(RTW) is of great economic, social and research significance. The young and middle-aged stroke patients have become the focus of attention because of their high need to RTW and the possibility of returning to work. This paper summarizes the influencing factors affecting the return of young and middle-aged stroke patients to work as well as the method to increase their RTW through literature review, so as to lay the foundation for the follow-up study.

Objective To investigate the clinical features of multiple primary malignancies ( MPM) in patients with kidney malignancy .Methods The clinical data of 111 patients suffered from MPM associated with kidney malignant tumor in Yantai Yuhuangding Hospital and Affiliated Yantai Hospital of Binzhou Medical College from April 1984 to December 2014 were retrospectively analyzed .Results Among the 111 cases,there were 100 cases with two primary malignancies ,9 with three cancers and 2 cases with four or five cancers.Synchronous MPM were 37 cases,and metachronous 74 cases.The interval between the first and the second primary malignancy was between 0 and 348 months,with average of 46 months and median of 16 months.One hundred and seventy-two cases were treated by operation , and 64 cases by conservative therapy.The proportion of operation from the first to the fifth cancers were 89.2%(99/111),59.5%(66/111),54.5%(6/11),50.0%(1/2),0%(0/1),respectively,with the trend of declining.Finally 95 cases (85.6%) were followed up ,with 53 cases survived and 42 cases died.From the diagnostic date of the first primary cancer,overall survival in 1 year,3 years,5 years,10 years were 97.2%,77.2%,67.8%,48.4%, respectively.Median survival time was 120 months.From the diagnostic date of the last primary cancer , overall survival in 1 year,3 years,5 years were 81.4%,53.4%,48.2%,respectively.Median survival was only 48 months.Univariate analysis showed that the cumulative survival rate was higher in patients with operation than conservative therapy ( P =0.000 ) , in metachronous group than synchronous group ( P =0.009).COX proportional hazard model showed metachronous MPM (OR=3.870,95%CI 1.702-8.801,P=0.001),aggressive operation of the first primary cancer (OR=0.107,95%CI 0.018-0.647,P=0.015) and the second cancer (OR=0.313,95%CI 0.131 -0.750, P=0.009) were independent prognostic factors. Conclusions The main treatment of MPM associated with kidney malignancy is aggressive operation, radiotherapy, chemotherapy and biological therapy are adjuvant .Early detection and early operation for MPM are beneficial for increasing the survival of the patients .

Objective To investigate the effect of granulesten on hs-CRP and lipid in patients with stroke.Methods 76 patients with acute ischemic stroke were selected and randomly divided into two groups.38 cases in the control group were treated by conventional therapy, 38 cases in the experiment group were treated on the basis of the control group with granulesten.hs-CRP, IL-6, Hcy, and lipid fat were detected and the clinic effect were compared after the treatment.ResuIt Compared with control group, hs-CRP, IL-6, and Hcy of the experiment group were lower(P<0.05), TC, TG and LDL-C were lower, HDL-C was higher ( P<0.05 ) , the clinic effect was higher ( P<0.05 ) , the rate of side effect was higher ( P<0.05 ) . ConcIusion Granulester can significantly reduce serum hs-CRP, IL-6 and Hcy levels, improve blood lipid metabolism, improve the clinical efficacy, and adverse reactions are mild, it has important significance for patients with acute ischemic stroke.

OBJECTIVE:To observe the clinical efficacy and safety of azithromycin combined with Reduning injection in the treatment of children with mycoplasma pneumoniae infection. METHODS:80 children with mycoplasma pneumoniae infection were randomly divided into control group and research group. All the children were given routine treatment,including oxygen inha-lation,defervescence,nutritional support,reducing sputum and relieving asthma,etc. Based on it,children in control group were orally treated by Azithromycin enteric coated tablets 10 mg/kg,once a day. Children in research group were treated by Reduning in-jection 10 ml and 5% glucose injection 100 ml by intravenous infusion,once a day,based on the treatment in control group. The course of both was 14 d. The clinical data was observed,including the clinical efficacy,interleukin-6 (IL-6),interleukin-8 (IL-8),tumor necrosis factor-α(TNF-α)and the incidence of adverse reactions(ADR)before and after treatment. RESULTS:The total effective rate in research group was significantly higher than control group,with significant difference(P<0.05). After treat-ment,the IL-6,IL-8 and TNF-α in 2 groups were significantly lower than before,and research group was lower than control group,with significant difference(P<0.05). There were no significant differences in the incidence of ADR in 2 groups(P>0.05). CONCLUSIONS:Based on the routine treatment,azithromycin combined with Reduning injection has more obvious efficacy than only azithromycin in the treatment of children with mycoplasma pneumoniae infection with similar safety.

Objective To study the gynecologic laparoscopic surgery sevoflurane inhalation anesthesia on hemodynamics. Methods All 87 cases of patients in our hospital from May 2012 to May 2014 in Department of Obstetrics and Gyne-cology with laparoscopic surgery, were randomly divided into the observation group and the control group, the obser-vation group treated with sevoflurane inhalation anesthesia for laparoscopic surgery (n=44), the control group using combined spinal and epidural anesthesia for laparoscopic surgery(n=43),hemodynamic changes during operation in two groups of patients were compared. Results The RR, SpO2, PETCO2 in the observation group were higher than those in the control group,the difference was statistically significant(P<0.05). T1 T0,the time of systolic blood pressure (SBP)and diastolic blood pressure (DBP)and heart rate did not change much after induction of anesthesia, and T2, T3 time point,the SBP,DBP,HR of control group were lower than those in the observation group, there was statistically sig-nificant difference between the two groups(P<0.05). Anesthesia was induced with T0,T1 time points,there was no sig-nificant difference in hormone levels in two groups of patients with NE,E,CORT,ATII in the blood(P>0.05);and T2 after induction of anesthesia, T3 time point, compared with the time point of T0, the difference was statistically signif icant(P<0.05). The observation group and the hormone levels were lower than the control group, the difference was statistically significant(P<0.05). Conclusion Laparoscopic surgery sevoflurane inhalation anesthesia, hemodynamics of patients with stable,safe and reliable means of anesthesia.