Objective To investigate and analyze factors affecting depressive disorders in elderly stroke patients after rehabilitation treatment.Methods A total of 1 100 elderly stroke patients receiving rehabilitation treatment in the three hospitals(Beijing Electric Power Hospital of State Grid Corporation,Beijing Fengtai Hospital of Integrative Medicine and Beijing Daxing Hospital of Integrative Medicine)were selected as the study subjects.General data were collected,and patients were surveyed using the daily life ability scale(BI),family care scale and social support scale(SSRS),according to the Hamilton Depression Scale(HAMD)to determine whether patients developed depressive disorders.Multivariate Logistic regression analysis were used to analyze influencing factors of depressive disorders in elderly stroke patients after rehabilitation treatment.Results A total of 1 100 survey questionnaires were issued and 1 073 were retrieved,with an effective rate of 97.5%,and among them,386 cases(36.0%)were diagnosed with depressive disorder,and 687 cases(64.0%)without depressive disorder.There were significant differences in the incidence of depression between patients with different ages,complications,per capita family income,BI score,family caring degree and SSRS score(P＜0.05).Multivariate Logistic regression analysis showed that advanced age(OR=1.337,95%CI:1.014-1.763),complication(OR=3.214,95%CI:1.365-7.569),lower per capita monthly family income(OR=2.263,95%CI:1.137-4.503),lower BI score(OR=1.872,95%CI:1.158-3.026),average family caring degree(OR=2.639,95%CI:1.200-5.802)and lower SSRS score(OR=1.557,95%CI:1.044-2.322)were risk factors for depression in elderly stroke patients after rehabilitation treatment(P＜0.05).Conclusion More attention should be given to elderly stroke patients to improve family care and social support,thus reducing the risk of depressive disorders after rehabilitation.

Objective:To understand the molecular transmission characteristics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome(AIDS) patients in the mountainous area of southwest Zhejiang Province(Lishui city).Methods:A total of 147 blood samples were collected from newly-diagnosed HIV-1 infected who received no antiviral therapy, and pol gene was amplified, followed by sequencing. MEGA6.0 software was used to construct phylogenetic tree and determine gene subtypes. HIVDB online was used to analyze drug resistance mutation, then the pairwise genetic distance(GD) was calculated and the opitimal threshold of GD was selected, finally the molecular transmission network was constructed by Cytoscape3.7.0 software. Chi-square or Fisher′s exact probability method was used for statistical analysis. Results:A total of 134 sequences were obtained successfully, and nine subtypes were detected. The dominant subtypes were CRF08_BC (34.33%, 46/134), CRF01_AE (29.85%, 40/134) and CRF07_BC (23.88%, 32/134). It also found that age, registered residence, education level and transmission route had significant differences in distribution of subtypes ( P<0.05). Nineteen drug resistance individuals were found, and the total drug resistance rate was 14.18% (19/134). The HIV-1 molecular transmission network was plotted based on 1.2% GD threshold. A total of 15 transmission clusters (cluster size ranging from 2 to 29) were found. The network access rate was 49.25% (66/134), mainly including male (75.76%, 50/66), heterosexual (81.82%, 54/66) and patientsrinfected with CRF08_ BC (50.00%, 33/66). A transmission cluster including two cases of female sex workers and seven cases of drug resistance was identified, in which the average age of the patients was 57.21 years old and the average degree value was 22.7, and the cases were mainly infected through heterosexual contact (96.55%, 28/29). The highest homology of the sequences in the cluster was in Yunnan. Conclusions:The HIV-1 subtypes were diverse in the mountainous area of southwest Zhejiang Province(Lishui city). Drug resistant transmission had reached a moderate epidemic level. There were molecular transmission clusters with the aggregation characteristics of elderly clients in specific regions. It was urgent to formulate and implement precise intervention strategies to curb the spread of HIV.

Objective To evaluate the safety and feasibility of early feeding in children after orthopaedic surgery.Methods Totally 638 children with general anesthesia after orthopaedic surgery in a tertiary hospital in Beijing were recruited and divided into two groups.Children in the experimental group (n=315) started water drinking and feeding if they passed the postoperative assessment on consciousness and digestive function,while children in the control group (n=323) adhered to the conventional protocol of 6h fasting postoperatively.Results The average initial time of water drinking,liquid food feeding and general diet in the experimental group were 0.63 h,1.03 h and 3.07 h,while they were 6.42 h,6.88 h and 8.79 h in the control group,and the differences were statistically significant (P＜0.001).There were no significant differences in the incidence,severity and frequency of postoperative nausea and vomiting between two groups in 6h and 24h after returning to wards(P＞0.05).At 6h after returning to wards,the incidences of moderate-to-severe thirst and hunger in the experimental group were significantly lower than those in the control group(P＜0.001),and pain scored over 3 marks was lower than the control group(P=0.002).Conclusion Children after orthopaedic surgery with general anesthesia are likely to drink water 1 h after returning to wards and then take general diet 2h later while comprehensive prevention measures being adopted.Early teeding would not aggravate postoperative nausea and voniting and can alleviate the extent of postoperative thirst,hunger and pain.

Objective To explore the effect of 5M1E quality analysis tool-based hand hygiene(HH) comprehensive intervention measures on pediatric healthcare-associated infection(HAI).Methods HH status of 29 health care workers(HCWs) in the pediatric department of a hospital was monitored, April-June 2015 was baseline survey stage, 5M1E quality analysis tool was adopted to analyze various factors affecting the compliance rate of pediatric HH, intervention measures began to be taken in June 2015, and compared with HH in July 2015-March 2016.The occurrence of HAI between July 2014-March 2015 and July 2015-March 2016 was compared.Results HH compliance rate of HCWs increased from 30.86% in April-June 2015 to 81.94% in January-March 2016;HH correct rate increased from 68.14% to 93.75%;HH compliance rate and correct rate of HCWs gradually increased(X2=2 608.626, 630.798,respectively, both P<0.001).Qualified rate of detection of HCWs' HH sampling increased from 20.69% in April-June 2015 to 89.66% in January-March 2016(X2=31.957,P<0.001).Incidence of HAI decreased from 7.74% in July 2014-March 2015 to 3.62% in July 2015-March 2016(X2=46.717,P<0.001).Conclusion Application of 5M1E quality analysis tool in the investigation, analysis, and comprehensive intervention in HCWs' HH in pediatric department has greatly enhanced HCWs' HH compliance rate, and reduced the incidence of HAI in pediatric patients.

Objective To develop an effective nursing intervention for PICC local infection in pediatric patients with tumors based on the best evidence obtained by methods of evidence-based nursing. Methods Questions were raised regarding the diagnosis and grading of PICC local infection in pediatric patients with tumors and the implementation of corresponding clinical care. Relevant literature evidence was reviewed using both electronic and manual library search. Results Relevant literature evidence about the diagnosis and grading of PICC local infection in pediatric patients with tumors and corresponding clinical care was identified, followed by a critical appraisal process. The criteria, used in our department, for diagnosis and grading of PICC local infection in pediatric patients with tumors and corresponding clinical care measures were formulated according to relevant evidence, current clinical status of our department and willingness of patients. Thereafter, corresponding clinical care measures were applied to 32 tumor pediatric patients with PICC local infection in our department according to the grading of infection. Good therapeutic effect was achieved and PICC local infection did not lead to chemotherapy delay or unplanned extubation in any pediatric patient. Conclusions The approach of evidence-based nursing can be used to effectively resolve common nursing problems in clinical practice, promote the ability of nursing staff to obtain and apply the best evidence and promote the scientificity and validity of nursing practice.

Objective To investigate the immunological reaction mechanism of medicated serum in Zibai Gelatin for SiHa cells of the cervical cancer infected by high risk human papilloma virus (HPV). Methods Through immunohistochemical comparison and the cell culture, and after medicated serum was administrated to SiHa cells of cervical cancer for 24 h, 48 h, and 72 h, optical densities of IL-6, IL-10, CD83 and TNF-αin the same time but different concentrations and different times but the same concentration were observed. Relationships of dose-effect and time-effect between expressions of IL-6, IL-10, CD83 and TNF-α and medicine action were analyzed by calculating average optical density. Results With the increase of medicine concentration and administration time of Zibai Gelatin, the expressions of IL-6 and TNF-αgradually decreased, while the expressions of CD83 and IL-10 gradually increased (P<0.05). Conclusion Zibai Gelatin with medicated serum can inhibit local inflammatory reaction by improving local immunologic function of cervix, which is beneficial to reduce cervix high-risk HPV.

To introduce the experiences of nursing risk management in Children's Cancer Center in Hongkong from aspects of organization structure and responsibility,clinical application of the risk management measures so to give reference to the hospital's nursing risk management in our country.

Objective To investigate the application value of spatio-temporal image correlation (STIC) combined with tomographic ultrasound imaging(TUI) in the prenatal diagnosis of conotruncal defects(CTD).Methods Two-dimensional(2D) fetal echocardiography to screen and TUI-STIC volumes from 1508 cases of fetuses of high risk with congenital heart disease.Postnatal work-up and pathological results were available for all fetuses with CTD.Results Thirty nine cases with CTD were found by TUI-STIC while thirty five cases were found by 2D echocardiography,but TUI-STIC had new findings and corrected the diagnosis in 9 cases as compared with 2D echocardiography.The sensitivity,specificity,positivity predictive value,negative predictive value and accuracy of TUI-STIC in evaluating CTD were 97.5 ％,100％,100 ％,99.9 ％ and 99 ％.The Kappa value of consistency test between 2DE and TUI-SIC was 0.244(P ＜ 0.01),McNemar test showed that the difference was statistically significant (P ＜ 0.01).Conclusions TUI-STIC allows a complete sequential analysis of fetal conotruncal defects and supplying additional information over 2D fetal echocardiography,it could improve the prenatal diagnosis rate.TUI-STIC is helpful in diagnosis of prenatal conotruncal defects.

Objective To investigate the effects of sevoflurane delayed preconditioning on caspase recruitment domain (ARC) expression during myocardial ischemia-reperfusion (I/R) in rats. Methods Sixty-four adult male SD rats weighing 270-350 g were randomly divided into 4 groups ( n = 16 each): sham operation (group S); myocardial I/R group; sevoflurane + sham operation group (group S-S) and sevoflurane delayed preconditioning + myocardial I/R group (group S-I/R) . Myocardial I/R was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 2 h of reperfusion in groups I/R and S-I/R. Group S-S inhaled 33% oxygen for 2 h, and sham operation was performed 24 h later. Group S-I/R inhaled 2.5% sevoflurane for 2 h, and then myocardial I/R was induced 24 h later. Eight animals were sacrificed at the end of 2 h reperfusion in each group and the hearts removed for determination of myocardial infarct size (IS) as a percentage of area at risk (AAR) by triphenyl tetrazolium chloride staining (IS/AAR) . Myocardial apoptosis was detected using TUNEL and apoptosis index was calculated. Another 4 animals were sacrificed immediately before ischemia and at the end of 2 h reperfusion to determine the expression of ARC and Caspase-8 in myocardium by Western blot. Results Compared with group S, the infarct size and apoptosis index were significantly increased in groups I/R and S-I/R, and ARC expression was up-regulated immediately before ischemia in groups S-S and S-I/R, and Caspase-8 expression was up-regulated at 2 h of reperfusion in group I/R ( P ＜ 0.05) . Compared with group I/R, the infarct size and apoptosis index were significantly decreased in group S-I/R, and ARC expression was up-regulated, while Caspase-8 expression was down-regulated at 2 h of reperfusion in groups S-S and S-I/R ( P ＜ 0.05) . Conclusion Sevoflurane delayed preconditioning can attenuate myocardial I/R injury through up-regulating the ARC expression and decreasing the myocardial apoptosis.

Objective To study cervical HPV infection in female patients with vulvar condyloma acuminatum(CA)from Shanghai area.MethodsExfoliated cells were obtained from cervices and vulva lesions of CA of 194 patients.respectively.HPV genotyping was carried out in cell samples using capture-hybridization method and gene chip techniques.Results HPV was detected in vulva lesions of all the 194 patients.Among them,74.2%(144/194)were positive for low risk(LR)-HPV,and 25.8%(50/194)for high risk(HR)-HPV.A single HPV genotype(6 or 11)was detected in 136(94.4%)patients with LR-HPV.and mixed genotypes of LR-HPV and HR-HPV in 46(86%)patients with HR.HPV.Of the 194 patients.85.6%(166/194)were complicated by cervical HPV infection.including 119(61.4%)cases of LR-HPV and 46(23.7%)cases of HR-HPV,In the case of HPV genotype.the consistence between CA lesions and cervix was 95.8%(159/166).The prevalence of LR-HPV declined sequentially from subtype 11 to 6 and 53,and that of HR-HPV from subtype 16 to 18 followed by 52,31,45 and 58.Conclusions There is a high rate of infection with HR-HPV in female patients with CA.and nearly one quarter of these patients are complicated by cervical HR-HPV infection.