Objective To propose a family-centred health education program for family caregivers of Autistic children and investigate its clinical value.Methods Delphi method was used to establish a family-centred Autistic children care program for family caregivers looking after the Autistic children,which involved two rounds of expert consultation.The pre-and post-control method for different cases was employed in the study.Forty Autistic caregivers in our hospital from January 2022 to October 2022 were assigned to the control group and another 40 in our hospital from November 2022 to January 2023 were assigned to the observation group.The family caregivers of Autistic children in the control group received traditional care education,while those in the observation group was managed with the family-centred Autistic children health education program.The two groups were compared in terms of care burden,knowledge of health education,and evaluation of clinical symptom of Autistic children.Results The expert authority coefficient of the first round of expert consultation was 0.875 respectively and those in the second round was 0.900,respectively.The coefficient of variation of the coordination degree of each index was 0.04-0.20.Kendalls W scores of the two rounds were 0.794 and 0.786,respectively.A health education program for family-centred Autistic children caregiver was established to consist of three subjects:caregiver training,family-centred parental care and activation of positive emotions of autistic caregivers.Autism caregivers in both groups had completed the study.In comparison with the control group,the care burden of the observation group was significantly lower,the knowledge of health education was significantly higher,and the evaluation of children's clinical symptoms was better among the family caregivers of autistic children in the observation group(all P<0.05).Conclusions The family-centred autistic children care program for family caregivers is scientific and applicable.It is conducive to providing health education guidance for family caregivers of Autistic children,effectively reducing the care burden and enhancing the knowledge of health education.

ObjectiveTo study the bioactive secondary metabolites of Talaromyces sp. TP21 and their bioactivities. MethodThe secondary metabolites of Talaromyces sp. TP21 were isolated by high performance liquid chromatography （HPLC）， normal phase and reversed phase column chromatography combined with molecular networking and bioassay-guided fractionation， and their structures were determined by nuclear magnetic resonance （NMR） and high resolution mass spectrometry （HR MS）. The inhibitory effects of the compounds on the growth of the lung cancer cell line A549 and the liver cancer cell line Hep G2 were measured by themethyl thiazolyl tetrazolium （MTT） method. The antimicrobial activities of the compounds were measured with Staphylococcus aureus and human oral cavity-derived Saccharomyces cerevisiae as the indicator microorganisms. ResultSeventeen compounds were isolated from the secondary metabolites of Talaromyces sp. TP21 and identified as ergochrome C （1）， daldiniaeschsone A （2）， seco-blennolide B （3）， penitholabene （4）， penicichrysogene A （5）， orsellinic acid （6）， griseofulvin （7）， isorhodoptilometrin （8）， （+）-5-chloromitorubrinic acid （9）， penicillixanthone A （10）， pentacecilide B （11）， pentacecilide C （12）， chrodrimanin C （13）， chrodrimanin E （14）， chrodrimanin H （15）， chrodrimanin F （16）， and 3-hydroxypentacecilide A （17）. ConclusionCompounds 1-5， 11-12， and 17 were isolated from Talaromyces for the first time. Among them， compounds 4， 7， and 10-12 exhibited inhibitory activities against the growth of A549 and Hep G2 cells， with the median inhibitory concentration below 50 μmol·L^-1. Furthermore， compounds 9 and 10 showed inhibitory activities against S. aureus and human oral cavity-derived S. cerevisiae， with the minimum inhibitory concentration of 8-128 mg·L^-1.

The family readiness for discharge of premature infants in the Neonatal Intensive Care Unit (NICU) is an important index to evaluate the safe discharge of premature infants, and a good family discharge readiness is the basic guarantee for the smooth recovery and healthy growth of premature infants. This article summarizes the concept, influencing factors, and intervention strategies of family discharge readiness for premature infants in NICU, in order to provide reference for the formulation and improvement of discharge readiness measures for premature infants in NICU.

Multi-disciplinary team(MDT)mode is regarded as the key to standardized diagnosis and treatment of malignant tumors. The model, however, encounters such roadblocks in the current form of MDT organization, as costly clinical resources and time consumption, low efficiency, poor management of participating experts in MDT, and lack of enforceability of the therapeutic decisions made. This paper summarized the practical MDT experiences of the Affiliated Cancer Hospital of Shandong First Medical University. It introduced the construction of an intranet-based MDT system covering a large proportion of newly diagnosed malignant tumor patients, and the practices and achievements of such MDT management system under hospital administrative guidance. The authors proposed to use reporting ratio as the main assessment indicator in promoting MDT, and that to define the performance, responsibilities and rights in MDT practice. These measures aim at to upgrading individual behaviors of doctors to organizational behaviors of hospitals, and providing cancer patients with more standardized, comprehensive and personalized diagnosis and treatment decisions.

Objective:To assess the bacterial profiles and antimicrobial susceptibility patterns in uropathogens, and help to inform the empiric treatment decisions for urinary tract infection in outpatient settings.Methods:A single institutional retrospective analysis was performed on positive urine cultures from outpatient settings between January 1998 and December 2018. To analyze changes over time, trends analysis were undertaken on bacterial profiles, antimicrobial susceptibility and resistance.Results:A total of 1.172 pathogenic bacteria were isolated after exclusion of duplicate strains originated from the same patient, including 991(84.6%) Gram-negative bacterial strains and 181(15.4%) Gram-positive strains. The most common Gram-negative uropathogens were Escherichia coli (60.8%) and Klebsiella pneumonia (8.1%). Enterococcus faecalis (4.6%) was the predominant Gram-positive strain. The detection rate of Escherichia coli increased significantly, from 50.8% to 63.2% ( χ2=7.978, P=0.046), and no significant difference was observed in the distribution of major uropathogenic bacteria over the 20 years (all P>0.05). The proportion of extended-spectrum β-lactamase (ESBLs) producing strains increased significantly across the 20 years ( P<0.05). The resistance rates of Escherichia coli to amoxicillin and clavulanate potassium, aztreonam, ceftazidime, ciprofloxacin and sulbactam + cefoperazone increased significantly (all P<0.05). All the isolates sustained high susceptibility to tazobactam + piperacillin, amikacin, imipenem and nitrofurantoin (95.0%, 95.7%, 97.9% and 91.1%). Similar to those of Escherichia coli, Klebsiella pneumoniae remained a high and stable sensitivity to tazobactam+piperacillin, amikacin and imipenem during the 20 years (79.1%, 88.0% and 80.3%). However, the proportion of ESBLs producing strains increased significantly ( P<0.05). Among Gram-positive bacteria isolates, the sensitivity rates of Enterococcus faecalis to ampicillin, nitrofurantoin and penicillin G were 100.0%. No vancomycin resistant strain was detected in Gram-positive bacteria. Conclusions:From 1998 to 2018, Escherichia coli and Klebsiella pneumoniae are the most common Gram-negative bacteria uropathogens obtained in outpatient settings. Significant increases of resistance to some antimicrobial agents such as second- and third-generation cephalosporins and fluoroquinolones are observed during the 20 years and high susceptibilities to tazobactam+piperacillin, amikacin, imipenem and nitrofurantoin sustain over time. Local treatment strategies of urinary tract infections on outpatient basis should be made according to epidemiology of drug resistance and individual characteristics to control the spread and curb the prevalence of drug resistant.

Intertrochanteric fracture of femur (IFF) is a common fracture type in traumatic orthopedics,which seriously affects patients' quality of life and health.Studies have shown that the fibrinolytic system can be activated in the invasive operation of IFF,which leads to massive blood loss during and after operation,especially hidden blood loss.Tranexamic acid,as an anti-fibrinolytic drug,can effectively reduce fibrinolytic activity by inhibiting fibrinolysis induced by fibrinolytic enzymes in order to stop bleeding.In recent years,with the diversified development of surgical hemostasis methods and the continuous exploration of hemostatic drugs,the application of anti-fibrinolytic drugs represented by tranexamic acid in perioperative period of IFF has gradually increased.Based on literatures at home and abroad,this paper aims to summarize the research progress of the application of tranexamic acid to reduce the perioperative hidden blood loss in intertrochanteric fracture,providing reference for clinical treatment decision.

Objective To observe the clinical effect of platelet-rich fibrin (PRF) on prevention of postoperative hemorrhage and facial traumatic swelling in patients with mandibular angle osteotomy.Methods Twenty-five patients with mandibular angle hypertrophy were included in this study from January 2014 to November 2015.Split face comparative study was carried out to use the left and right sides as the experimental side and the control side,respectively.The PRF in the experimental side was placed in the mandibular osteotomy,while the control side was placed in platelet-poor plasma (PPP).After operation,the drainage volume and facial swelling degree were measured.Results The drainage volume of the experimental group (PRF group) was (20.35 ±7.40) ml,the control group (PPP group) was (43.23±11.96) ml,and the difference was statistically significant (P＜0.05).There was no such case without swelling in postoperative third day.The facial swelling score on the experimental side was (1.19±0.40),the control side was (2.62±0.64),and two groups of postoperative facial swelling scores were significantly different (P＜0.05).Conclusions The PRF can reduce postoperative bleeding and facial swelling after mandibular angle osteotomy.

BACKGROUND: Non-small cell lung cancer (NSCLC) with neuroendocrine differentiation (NED) was a new pathologic type and uncommon in clinics. The aim of this study is to observe the relationship between clinical pathologic characteristics, imagination, biological behavior and prognosis in NSCLC-NED. METHODS: The clinical data of 47 patients with NSCLC-NED admitted from January 2009 to November 2017 in the Fifth Medical Center of General Hospital of People's Liberation Army were collected. The demographic data and imaging characteristics were summarized. Pathological features, treatment and prognosis, analysis of the correlation between different factors and prognosis. RESULTS: Of the 47 patients with NSCLC-NED, the median age was 61 years (45 years-78 years), 38 males and 9 females; 37 were poorly differentiated cancer with NED, and 10 were middle differentiated cancer with NED; 2 cases of driving gene positive (1 case of EGFR sensitive mutation, 1 case of ALK fusion), objective response rate (ORR) of first-line chemotherapy was 34.5%, and median progression-free survival (PFS) was 4 months; the median overall survival (OS) was 11 months, and only 2 cases (4.2%, 2/47) of OS were over 2 years. CONCLUSIONS NSCLC-NED is different from simple NSCLC or pulmonary neuroendocrine tumors. Males, ≤70 years old, severely smoking, and patients with lower tumor differentiation often have NED, and most of them are stage IV. This type of patient-driven gene positive proportion is lower than the general adenocarcinoma population, less sensitive to chemotherapy, and the overall survival is shorter, indicating a poor prognosis.

BACKGROUND: Anaplastic lymphoma kinase (ALK) positive in non-small cell lung cancer (NSCLC) was about 5%-7% and ALK tyrosine kinase inhibitor (TKI) was the standard treatment in NSCLC. The aim of this study is to evaluate the efficacy and safety of crizotinib in patients with advanced ALK gene-positive or recurrent NSCLC. METHODS: Three methods were used to screen patients with advanced or recurrent NSCLC harboring ALK gene fusion/translocation. The patients with ALK positive tested by flourescence in situ hybridization (FISH) was given orally crizotinib, 250 mg, bid. The objective response rate (ORR), progression-free survival (PFS) and safety were evaluated. RESULTS: A total of 226 patients were screened, 39 of whom had ALK fusion or translocation, and 37 were enrolled in the study. 35 patients were evaluated for objective response, ORR was 70.3%, and disease control rate (DCR) was 94.6%, and median PFS was 11.8 mon. The main adverse reactions were elevated transaminase (Grade 1, 91.7%), elevated transaminases (Grade 2, 23.4%), nausea (Grade 1, 75.6%), anemia (Grade 1-2, 62.3%), visual impairment (Grade 1, 21.8%), weight loss (Grade 1, 31.4%), pneumonia (Grade 2, 3.5%). CONCLUSIONS Crizotinib can be used for the treatment of advanced NSCLC with ALK fusion/translocation. It is highly effective and well tolerated.

Objective Aged facial contour presents changing facial skeleton and sagging soft tissue.We performed reshaping the facial skeleton simultaneouly during the rhytidectomy to achieve a youthful facial contour.Methods It was a retrospective observational study based on 26 elderly women (42-60 years) that complained of aged face and boosing of the orbital rim,prominent zygoma and mandibular angle.All of them had undergone reduction boosing,malar and mandible combined with rhytidectomy from January 2010 to December 2015.Results The facial skeleton was reshaped with face-lift successfully.No fatal bleeding,respiratory obstruction,cardiovascular accident,severe facial edema,permanent facial nerve injury and other major complications occurred.All of the patients recovered safely.Follow-up for 3-24 months showed that the facial contour and aging were improved,and the youthful face form was preserved.Conclusions The face contour correction combined with face-lift is an effective technique to restore the youthful for elderly patients.