Objective To explore the impact of pre positioned nasopharyngeal airway combined with high head pre inhalation of oxygen on lung oxygenation and blood gas analysis indicators in morbid obese patients undergoing laparoscopic weight loss surgery.Methods 100 morbid obesity patients from January 2020 to April 2022 planned to undergo elective laparoscopic weight loss surgery were selected as the study subjects.All the patients were divided into two groups according to the random number table method:group A with a head height of 25° and a pre installed nasopharyngeal airway;group B with a head height of 25° and no pre installed nasopharyngeal airway,with 50 patients in each group.Two groups were pre oxygenated for 3 min before undergoing intravenous anesthesia to induce tracheal intubation.Observe and record the pH value,partial pressure of oxygen in arterial blood(PaO2),partial pressure of carbon dioxide(PCO2),partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen(PaO2/FiO2)as well as the ratio of arterial pressure to alveolar oxygen partial pressure(a/APO2)of the two groups of patients who breathed air(T0)after entering the room,ventilated with mask positive pressure for 3 min(T1),and intubated with trachea for 3 min(T2).Record plateau pressure(Pplat),peak airway pressure(Ppeak),and dynamic lung compliance(Cdyn)at T1,T2,and 5 min after pneumoperitoneum(T3).Record the time for percutaneous arterial oxygen saturation(SpO2)to decrease to 92.0%under different artificial ventilation after tracheal intubation,the time for SpO2 to recover to 96.0%after resumption of ventilation,and the occurrence of adverse reactions.Results Compared with Group B,at time point T1,Group A showed a decrease in PCO2 and an increase in PaO2,with statistically significant differences(all P<0.05);Compared with T0,at time points T1 and T2,PaO2/FiO2 and PCO2 in the two groups were increased,while a/APO2 decreased(all P<0.05).At T1 time point,Pplat and Ppeak in Group A were lower than those in Group B,while Cdyn was higher than that in Group B,with statistical significance(P<0.05);Compared with T1 time point,at T2 and T3 time point,Pplat and Ppeak in Group A increased,while Cdyn decreased,with statistically significant differences(all P<0.05);Compared with T1,Ppeak increased in B groups at T2 time point(P<0.05),while Pplat and Ppeak increased in T3 time point,and Cdyn decreased in B group,with statistical significance(all P<0.05).Compared with Group B,Group A had a longer time for SpO2 to decrease to 92.0%and a shorter time for SpO2 to recover to 96.0%(P<0.01).Conclusion The combination of pre positioned nasopharyngeal airway and high head pre inhalation of oxygen can effectively improve acute respiratory obstruction during induction of general anesthesia insertion in morbid obesity patients,and extend the duration of no ventilation.

Purpose: Models for predicting perforation during endoscopic resection (ER) of gastric submucosal tumors (SMTs) originating from the muscularis propria (MP) are rare. Therefore, this study was conducted to determine important parameters in endoscopic ultrasonography (EUS) images to predict perforation and to build predictive models. Methods: Consecutive patients with gastric SMTs originating from the MP who received ER from May 1, 2013 to January 15, 2021 were retrospectively reviewed. They were classified into case and control groups based on the presence of perforation. Logistic multivariate analysis was used to identify potential variables and build predictive models (models 1 and 2: with and without information on tumor pathology, respectively). Results: In total, 199 EUS procedures (194 patients) were finally chosen, with 99 procedures in the case group and 100 in the control group. The ratio of the inner distance to the outer distance (I/O ratio) was significantly larger in the case group than in the control group (median ratio, 2.20 vs. 1.53; P<0.001). Multivariate analysis showed that age (odds ratio [OR], 1.036 in model 1; OR, 1.046 in model 2), the I/O ratio (OR, 2.731 in model 1; OR, 2.372 in model 2), and the pathology of the tumors (OR, 10.977 for gastrointestinal stromal tumors; OR, 15.051 for others in model 1) were risk factors for perforation. The two models to predict perforation had areas under the curve of 0.836 (model 1) and 0.755 (model 2). Conclusion EUS was useful in predicting perforation in ER for gastric SMTs originating from the MP. Two predictive models were developed.

Objective To investigate the allergen profiles of dust mite-sensitive allergic rhinitis patients in Dalian,and to lay the foun-dation for precise prevention and control of allergic rhinitis.Methods Clinical data of allergic rhinitis patients treated at Affiliated Zhongshan Hospital of Dalian University from January 2015 to December 2022 were collected.The allergen distribution spectrums were compared between different groups designated according to sex,age,allergen reaction level,combination of other allergens,and testing time.Results A total of 1 330 allergic rhinitis patients were included,among whom the total detection rate of dust mite allergy was 60.83%(n= 809),with 330(40.79%)of these having dust mite sensitization alone and 479(59.21%)having multiple sensitization.There were many kinds of allergens in multiple sensitization.Among those with dust mite allergy,all 20 combined allergens detected in this group were analyzed,and mugwort,cat hair,and common rinea grass were the top three allergens in combined sensitization,accounting for 64.52%.The number of other allergens combined with dust mite was mainly 1-3 species(88.73%),and a maximum of 10 allergens were simultaneously present.Patients with 1-3 other combined sensitivities were mainly reactive to respiratory allergens,and those with 4 or more allergens essentially had joint sensitization to respiratory and food allergens.As for the allergen reaction level,the dust mite sensitivity reaction was relatively strong,with grade 3 or above accounting for 61.19%.Except for mugwort,the other combined allergens elicited mainly grade 1 and grade 2 reactions.The detection rates of dust mite allergy were 61.84%in male patients and 59.94%in female patients,with no statistical difference between the sexes(χ2=4.000,P= 0.261).The detection rate of dust mite sensitization was highest in the group aged<20 years and decreased with age(χ2=69.984,P<0.001).Dust mite-sensitive allergic rhinitis mainly occurred from August to October,and the detection rate of dust mite sensitization was the highest in October,reaching 80.16%.Conclusion The dust mite sensitization rate in patients with allergic rhinitis in the Dalian area is relatively high,and multiple sensitization is more common.Combinations of respiratory allergens mainly involve 1-3 types,and mugwort,cat hair,and common ragweed are the most common aller-gens combined with dust mite.Therefore,prevention and control of allergic rhinitis should focus on the characteristics of dust mite allergy in this region.

Objective To design and develop intelligent rehabilitation equipment for administering continuous passive motion (CPM) of a rabbit's knee joint after tibial plateau fracture.Methods The equipment constructed had three main parts:the core machinery,electronic control and a control program designed based on bionics principles.Twenty six-month-old New Zealand White male rabbits were randomly divided into sedentary (SED) and CPM groups after their knees had been fractured.The rabbits in the CPM group were given 30 min of early joint rehabilitation once a day for 4 weeks using the CPM equipment,while those in the SED group were kept in their cages and allowed free activity without any special exercise program.The body weight,range of motion and swelling of the affected knee joint were measured before the fracture and on the 3rd,7th,14th,21st and 28th days after the fracture.On the 28th day after the fracture the pathological structure of the articular cartilage on the operative side was observed under a light microscope.Results The equipment ran safely and reliably,and drove the rabbits to move synchronously.It could accurately and conveniently adjust the knee flexion angle,movement speed and movement time.The intelligence of the equipment met the experimental requirements.On the 3rd day after the operation the average range of motion in the joints of both groups had changed significantly compared to that before the fracture.On the 28th day after the fracture the average degree of swelling and range of motion in the CPM group were significantly different from those of the SED group.On the 28th day,deformity and the smoothness of the fracture line in the CPM group were superior to those in the SED group.Moreover,the dominant tissues in the defect area of the CPM group were mainly hyaline cartilage while those in the SED group were mainly repair fibrocartilage.The defect area and its adjacent articular cartilages,chondrocyte regeneration and arrangement,layers of cells and subchondral tidal line recovery of the CPM group were better than in the SED group on average.Conclusion The equipment for knee joint manipulation is convenient to use,reliable and effective for the early rehabilitation of tibial plateau fracture,at least in rabbits.It promotes remodeling of the fracture and cartilage repair after tibial plateau fracture,and also improves range of motion in the knee and reduces swelling.

Objective Mitochondrial DNA depletion syndrome is a rare autosomal recessive disorder characterized by complex genetic and clinical manifestations.This study aimed to investigate the clinical and laboratory features of a boy with mitochondrial encephalomyopathy caused by SUCLG1 mutation.Methods The clinical data and genetic test of a patient with mitochondrial DNA depletion syndrome were retrospectively analyzed.Result The proband presented with limb weakness at the 4th month after birth,and presented dystrophic appearance,muscular hypotonia,psychomotor retardation,failure to thrive,hearing impairment,scoliosis,thoracocyllosis and facial features at 9 months old.Laboratory tests showed blood lactic acid and pymvate increased,liver damage and abnormal myocardial enzymes.Plasma camitine ester profiling showed that amino acids decreased and C4-dicarboxylic-carnitine increased.Urinary organic acid analysis showed increased concentration of methylmalonic acid and its metabolites indicating methyl malonic aciduria.MRI showed bilateral T2 hyperintensities in bilateral caudate nuelei and lenticular and brain atrophy-like changes.Brainstem auditory evoked potential showed severe hearing loss.His development quotient was 35.Genetic sequencing of MUT,,MMAA,MMAB and other classic mitochondrial disease related genes of the proband revealed no mutation.Two heterozygous mutations,c.961C＞G and c.713T＞C,inherited from the phenotype of normal parents were detected in his SUCLG1 gene.The copy number of mitochondrial DNA was 244/cell in peripheral blood leukocytes,equivalent to 68.4％ of that in normal control.Conclusion In this study,an infant with muscular hypotonia,psychomotor retardation,deafness and slightly increased urine methyl malonic acid was diagnosed by genetic test.For patients with unexplained hypotonia,mental retardation,abnormal movements,hearing disorder together with increased blood pyruvic acid and lactic acid,mild methylmalonic acidemia and abnormal acylcarnitine,mitochondrial DNA depletion syndrome should be considered.Gene analysis is important for diagnosis and prenatal diagnosis of the next pregnancy.

Objective To investigate the symptoms and the needs of transitional care for the patients with lung cancer at the intermission of chemotherapy and provide references for the symptom management and carrying out transitional care. Methods Totally 156 patients with lung cancer were investigated by questionnaire survey. Results With the increase of chemotherapy, symptoms such as cough, sputum, dyspnea were relieved after chemotherapy(F=18.266, 20.463, 17.371, P < 0.05), but symptoms like fatigue, nausea, vomiting, loss of appetite, sleep uncomfortable were worse than before(F=15.821, 20.116, 16.439, 13.541, 9.528, P<0.05,<0.01). Negative emotions like bitterness and sadness had no obvious change. Symptoms affected the patients′mood, the incidence and severity were higher after chemotherapy(χ2=43.162, F=11.683, P < 0.05), as for general activity and walking, the incidence and severity were higher after the first cycle chemotherapy and the second cycle(χ2=42.589, 37.689, 39.125, F=9.148, 15.325, 14.758, P < 0.05), but after 4 cycles of chemotherapy, it did not change significantly (P>0.05). 79.49%(124/156)patients did not know the content and function of transitional care, 98.72%(154/156)patients hope to get transitional care through the hospital. Conclusions Symptoms by side effects were getting worse for patients with lung cancer and influenced their daily life. Patients got to know less about transitional care, however they had a strong need for transitional care. We should
reinforce the management of symptoms and transitional care to improve their quality of life.

Objective To investigate cognitive status and influencing factors for hand hygiene(HH)among health care workers(HCWs),and provide basis for scientific management of HH.Methods In April 2013,HCWs in a general hospital were selected by randomly sampling method,questionnaires were used to survey the implementation of HH in recent one month and HCWs’cognition on knowledge about HH.Results A total of 750 HCWs were in-vestigated,652 available questionnaires were collected.The frequency of hand washing and hand disinfection per day among most HCWs were 10 - 19 times,accounting for 46.62% and 47.85% respectively;30.52% of HCWs washed their hands for ≥30 seconds each time,60.58% of HCWs dried hands with paper towel after washing hands,57.21 % of HCWs abided by six-step hand washing method.The overall correct rate of cognition on ten op-portunities that requiring HH in clinical practice was 68.68%.The main factors influencing the implementation of HH were as follows:skin irritation of hand sanitizer and hand disinfectant subjectively considered by HCWs (63.34%),inadequate hand washing facilities(41 .10%);high cost of hand sanitizer ,hand disinfectant,and dry paper towel (38.96%),et al.Conclusion In addition to intensifying education on HH,installing rational HH facili-ties and improving HH standard are key points in strengthening HH in general hospital.

Objective:To understand general hospital medical staff status quo and characteristics of blood -borne occupational exposure , analysis its ethics factor , to make the prevention countermeasures of blood -borne oc-cupational exposure to provide scientific basis .Methods:From January 2013 to December floor all the medical staff of blood -borne occupational exposure cases were retrospectively analyzed .Results:A total of 101 medical staff blood-borne occupational exposure , which is given priority to with the nurse , accounted for 60 .40%;More con-centrated in under 30 employees, accounted for 70.29%;Occupational exposure personnel distribution in the ma-jority with surgical department (42.57%), followed by the physician (36.63%);Wards (60.40%), the operat-ing room (15.84%) and therapy (11.88%) are the sites of occupational exposure often happen;Sharp injury in the composition of the ratio of 87.12%, in the first place, in which a proportion (23.76%), pull out the needle (18.81%) and blood (15.84%), surgical suture (14.85%) and transfusion injection (13.86%) as the sharp injury of frequent occurrence of occupational exposure;Exposure is given priority to with hepatitis b ( 61 .38%) . Conclusion:Medical staff blood-borne occupational exposure risk is high , the hospital infection control personnel must pay attention to occupational exposure of the whole education , strengthen the administration of the occupation-al exposure of ethics , reduce the risk of occupational exposure and injury .

OBJECTIVE: To observe the clinical treatment effectiveness of Clarithromycin combined with nasal glucocorticoids for chronic rhinosinusitis (CRS). METHOD: Clarithromycin was 0.25 g a day (the first two weeks was 0.25 g twice a day) and topical Triamcinolone Acetonide Acetate nasal spray was (220 microg/d) once a day. Fifty-six patients were enrolled in our research. Twenty-six patients of CRS without nasal polyps was treated for 12 to 28 weeks (average 16.62 weeks). Thirty patients of CRS with nasal polyps was treated for 12 to 33 weeks (average 20.03 weeks) after polypectomy. The patients' symptom were evaluated through Sino-Nasal Outcome Test 20 (SNOT-20) scale. Meanwhile sinus CT were evaluated by Lund-Mackey system before and after operation. RESULT: The score of CT scan was significantly decreased to 2.83 +/- 1.86 (t = 11.41, P < 0.01) in the CRS with nasal polyps group and to 2.43 +/- 1.91 (t = 12.86, P < 0.01) in the CRS without nasal polyps group after treatment. Recovery rate of CRS with nasal polyps group was 43.3% and of CRS without nasal polyps group was 50.0% with CT images. The self assessments of treatment efficiency was coincident with CT image in the two groups. CONCLUSION The treatment with Long term use of low dosage oral macrolide Clarithromycin combined with nasal steroid on CRS was efficacy. Polypectomy ,large dose antibiotic and steroid used in intraoperative period could significant improve the treatment efficiency of CRS with nasal polyps.
Adolescent ; Adult ; Aged ; Chronic Disease ; Clarithromycin ; administration & dosage ; therapeutic use ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Nasal Polyps ; drug therapy ; Rhinitis ; drug therapy ; Sinusitis ; drug therapy ; Treatment Outcome ; Triamcinolone Acetonide ; administration & dosage ; therapeutic use ; Young Adult

Objective To study the bystander effects and associated mechanisms through irradiated conditioned medium(1CM). Methods Natural kilhr(NK) cells were obtained from peripheral blood samples. ICM irradiated with different doses of 60Coγ-rays was used for culturing K562 cell strain. The degree of injury of K562cells by activated NK cells was observed, as well as the apoptosis frequency of K562 cell was investigated. Results Severe injury was induced in K562 cells cultured in ICM than the control (sham-irradiated) as shown by increased sensitivity to NK cells (P < 0.05). The apoptosis frequency of K562 cell was increased significantly compared with the control cells (P < 0.05). Conclusions The bystander effect induced by irradiation is existent. ICM can trigger the bystander effect on K562 cell strains.