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The development of information technology in the medical industry is accelerating the construction of 3-level rehabilitation networks centering on community-based rehabilitation, which is based on the Internet and in combination with the Internet of things(IOT). A municipal rehabilitation hospital cooperated with the health centers of sub-district communities in the city to build a remote rehabilitation network based on IOT technology, for rehabilitation training of community stroke patients. The two sides worked out a cooperation scheme on project management, designed and built a remote community rehabilitation management model. Under the remote monitoring and equipment data IOT, the medical team of the municipal rehabilitation hospital could formulate the therapeutic plan according to the immediately obtained relevant functional evaluation data, and the medical team of the community health service center was responsible for the implementation of the plan. Fifty-three patients in the experimental group received the training of remote lower limb intelligent feedback system based on IOT together with routine rehabilitation training. After 8 weeks of treatment, the functional evaluation data of the two groups were improved in varying degrees( P< 0.05), but the improvement of the experimental group was significantly better than that of the control group( P < 0.05). Remote rehabilitation under the construction path of remote rehabilitation network based on IOT technology could significantly promote the improvement of post-functional rehabilitation of community stroke patients. This study can provide reference for the construction of three-level remote rehabilitation networks based on IOT and the implementation of home-based remote rehabilitation therapy in the future.
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Objective:To evaluate the efficacy of somatosensory evoked potential (SEP) monitoring for prevention of deep venous thrombosis (DVT) in lower extremity of patients undergoing spinal surgery.Methods:A total of 120 patients of both sexes, aged 40-70 yr, of American Society of Anesthesiologists physical status ⅠorⅡ, without impairment of coagulation function, undergoing posterior lumbar interbody fusion, were selected and divided into 3 groups ( n=40 each) using the random number table method and envelope method: basic preventive measure group (group A), compression stocking group (group B) and SEP monitoring group (group C). In group B, elastic stockings were worn at 1 h before surgery.SEP monitoring was performed during surgery, and the intensity of current stimulation was 25 mA in group C. The flow velocity of popliteal vein in both lower extremities was measured using color Doppler ultrasound apparatus during surgery.Venous blood samples were taken to measure plasma D-dimer concentrations at 1 day before surgery, at the end of surgery and at 24 h after surgery.The DVT developed in lower extremities was diagnosed by ultrasound method during surgery and within 24 h after surgery. Results:Compared with A and B groups, the blood flow velocity of popliteal vein was significantly increased, and the plasma D-dimer concentration and incidence of DVT developed in lower extremity during surgery were decreased in group C ( P<0.05). Conclusion:SEP monitoring can effectively prevent the occurrence of DVT in lower extremity while it is used as an electrophysiological monitoring of the spinal cord in patients undergoing spinal surgery.
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Objective@#To investigate the clinicopathological features of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract.@*Methods@#Five cases of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract from the Affiliated Hospital of Qingdao University from 2016 to 2019 were retrospectively reviewed. The clinical and pathological parameters were analyzed by combining clinical data and reviewing the available literature of 35 cases (34 cases abroad and 1 case in China).@*Results@#There were 4 males and 1 female with a median age of 47 years (18-66 years). All patients had abdominal pain and constitutional symptoms including diarrhea, emaciation, intermittent mucous stool or oral and epiglottic ulcers. Endoscopic manifestations included multiple punctate congestion, erosion and ulcer at the terminal ileum and colorectum. Two cases had congestion and erosion of antrum and angle of stomach, and the lesions did not fuse and form tumors. Histologically, the lamina propria was expanded by a dense, medium to small lymphocyte infiltration, which was monomorphic, with slightly irregular nuclei without prominent nucleolus or lymphoepithelial lesions. There were admixed small amount of plasma cells and eosinophils. In 4 cases, immunohistochemistry showed the lesional cells were positive for CD3, CD8, TIA1, and negative for CD4, CD56, granzyme B and Ki-67 index was ≤10%. In situ hybridization showed that EBER was negative and clonal TCR gene rearrangement was detected. One consultation case was CD3+, CD5- and Ki-67 index of 10%, although other indicators were not done. All five patients were treated with symptomatic support. In follow-up observation for 2 to 25 months, all patients were alive with the disease.@*Conclusions@#Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract is a newly classified monoclonal T-cell proliferative disease, with low incidence, clinical inertia and long-term survival. It has unique clinicopathological features but pathologically it is easily misdiagnosed as inflammatory bowel disease or T-cell lymphoma. Correct diagnosis is of great important clinical significance.
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Objective To investigate the current status and influencing factors of compassion fatigue in clinical nurses,and to provide theoretical references for prevention of nurse burnout and promotion of nurse retention.Methods Totally 992 clinical nurses from ten tertiary hospitals were enrolled through random cluster sampling to complete general information questionnaire,the Professional Quality of Life Scale (Pro-QOL-V),the Resilience Scale for Adults(RSA) and the Jefferson Scale of Empathy·Health Professionals(JSE-HP).Results The prevalence of moderate and high risk of secondary stress and burnout were 71.1％,73.2％,respectively;clinical nurses with work experience of 6 to 10 years presented the highest level of burnout(P＜0.01);lower empathy and resilience,as well as adverse work environment were risk factors of compassion fatigue.Multiple regression analysis showed that the influencing factors of nurse burnout were compassion satisfaction,secondary stress,resilience,workload,recognition,empathy,and payment,which explained 70.5％ of the total variance.Conclusion Secondary stress,burnout and compassion satisfaction in clinical nurses are influenced by nurses' empathy,resilience and work environment,and nursing administrators should pay attention to receiving recognition as positive predictors of burnout,except for workload and payment.
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Objective To investigate the improvement role of aspirin combined with statins on carotid plaque of patients with cerebral thrombosis.Methods80 cases of patients with cerebral thrombosis in our hospital from May 2014 to May 2016 were selected, these patients were divided into aspirin combined with statins treatment group (combined treatment group, 40 cases) and single aspirin treatment group (single treatment group, 40 cases) two groups according to the treatment methods, the NIHSS scores, Barthel indexes, clinical curative effects, IMT, plaque areas of the two groups were statistically analyzed.ResultsThe NIHSS score of the combined treatment group was significantly lower (P<0.05), the Barthel index was significantly higher (P<0.05), the total treatment efficiency 95.0% (38/40) was significantly higher than the single treatment group 80.0% (32/40) (P<0.05), the IMT was significantly shorter (P<0.05), the plaque area was significantly smaller than the single treatment group (P<0.05).ConclusionAspirin combined with statins can more effectively improve the carotid plaque of patients with cerebral thrombosis than aspirin alone, so is worthy of promotion and use in the clinical.
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Background and purpose:Increasing thyroid cancer (TC) incidence has caused wide public concern. It is typically interpreted as an increase in the true occurrence of TC but may also relfect changing life style or aging of population or increased diagnostic scrutiny. This study describes the temporal trend for incidence of TC and survival rate of patients by summarizing the 41 years TC incidences and follow-up data in Xuhui District, Shanghai.. Methods:Annual TC incidence data of Xuhui District from 1973 to 2013 were provided by Shanghai Cancer Registry System. The calculation of age-standardized incidence rates (ASIR) was based on the population of the year 1973. Temporal trends in TC incidence were analyzed based on the natural spline regression model. Annual percentage change (APC) was estimated by Jointpoint software from US National Cancer Institute, as well as survival rates were estimated using Kaplan-Meier method by Stata software.Results:During the period from 1973 to 2013, papillary cancer was the dominant type with proportion 69.8%. The ASIRs for female TC were 2.51-2.70 times as high as those for male TC. The average age of TC incidence for male was 50.04±14.71 while for female was 48.57±13.65. When aging factors were removed, incidence rate of TC was on the rise since 1981 with the APC of 8.46% (95%CI: 5.9%-11.1%), and on a rapid growth from 2004 to 2013 with the APC of 20.30% (95%CI: 9.8%-31.7%). The study showed that the 5-year TC survival rate was 95.21%, and the 10-year TC survival rate was 89.09%. In addition, survival rate of female was higher than that of male (χ2=15.43,P=0.000 1).Conclusion:The rising trend of TC in Xuhui District is similar to those in Shanghai and some developed countries. Although the mortality rate of TC is low, it has a rapid increase in incidence. Studies on factors associated with TC will help to clarify the epidemiological features about TC and promote more eff-cient prevention and control strategies.
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Objective To investigate the clinical data of Mycoplasma pneumoniae pneumonia(MPP)compli-cated with embolism in children,and to improve the understanding of the clinical features,diagnosis and treatment of the disease.Methods Six cases of MPP complicated with embolization,who were treated at Nanjing Children′s Hospital Affiliated to Nanjing Medical University from January 201 0 to June 201 5,were analyzed retrospectively.Results The ages of 6 cases ranged from 3 years and 3 months old to 1 3 years and 1 0 months old,and 3 cases were boys,3 cases were girls.All of 6 patients had high fever,positive anti -Mycoplasma IgM antibody (≥1 160)and sputum fluores-cence quantitative -Mycoplasma pneumonia (FQ -MP DNA),and all the chest imaging was consistent with pneumonia. Among 6 patients,4 cases complicated with liver function damage,4 cases had D -dimer rise,5 cases of erythrocyte sedi-mentation rate increased at different degree,while pleural effusion or pleuritis was found in 5 cases.The region of embo-lism in the cases included left renal artery in 1 case,the left popliteal artery in 1 case,the right middle cerebral artery em-bolism combined with cerebral infarction in 1 case,the right subclavian vein embolism combined with right upper extremi-ty embolism in 1 case,the basilar artery and bilateral posterior cerebral artery embolism combined with cerebral infarction in 1 case,and the other case involved the right pulmonary embolism.One case received thrombus dislodgment operation, and all of 6 cases were given the treatment including anti -infection,anticoagulation and low dose of glucocorticoid the-rapy,among whom 1 case died of cerebral hernia,and the other 5 cases improved.Conclusions MPP is often complicated with hypercoagulative state and potentialized to thrombosis,and thrombus may occur in vessels of whole body organs,and cerebral infarction had poor prognosis.Consequently,doctors should be aware of the potential risk factors for thrombosis. Early diagnosis and prompt anticoagulation and thrombolytic therapy could reduce mortality and disability rate.
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Objective To compare the clinical effects of the traditional operation and the new patch technique for the elderly women with pelvic organ prolapse.Methods 60 elderly women with pelvic organ prolapse patients were randomly divided into the traditional group and the modern group with 30 cases.The traditional group was treated with traditional surgery.The madern group was treated by new patch repair.Compare of the operation time,operative blood loss,catheter duration,hospital stay,postoperative recovery and 3 years recurrence rate in two groups.Results The catheter duration and hospital stay of the mederm group were significantly shorter than those of the traditional group (t =8.9471,14.2584,P ＜ 0.05).The postoperative recovery of the new group was better than the traditional group (x2 =5.9341,P ＜ 0.05).The 3 years recurrence rate of the mederm group was significantly lower than those of the traditional group (x2 =4.7059,P ＜ 0.05).The operation time of the mederm group was longer than those of the traditional group (t =4.4631,P ＜ 0.05) and the operative blood loss was more than the traditional group (t =2.0318,P ＜ 0.05).Conclusion The effect of the new patchin the treatment of elderly women with pelvic organ prolapse is better than the traditional surgery.
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Objective To investigate the trends of colorectal cancer incidence in Shanghai Xuhui District from 2001 to 2011.Methods Total 3042 cases of colon cancer and 1958 cases of rectal cancer were collected from the Shanghai Cancer Reporting System.The results were age-adjusted according the census data of 2000 as the standardized incidence.Results The standardized incidence rate of colorectal cancer in Xuhui District rose from the 21.83/100 000 in 2001 to 27.35/100 000 in 2006 and increased by 25.29％ ; from 2009 to 2011 the incidence rate was stabilized.The ratio of colon to rectal cancer was 1.55:1,and the incidence of colon cancer was significantly higher than rectal cancer.The incidence rate of male and feinale colorectal cancer increased with age,especially at ＞ 45 y group accounting for 98.70％ and 98.37％ of total incidence rate respectively.The ratio of male to female in colon cancer incidence rate was 0.98∶ 1,while that of rectal cancer was1.25∶ 1.Conclusion The incidence of colorectal cancer in Xuhui District from the last 11 years is significantly higher than of national level.More effective preventive measures should be taken.
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Objective The truncated fibronectin-binding proteins A (Fba protein) were cloned and expressed, then animals were immunized with Fba protein and subsequently challenged with group A streptococcus (GAS) to further investigate protective antibodies induced by each domain and determine the most immunogenic domain. Methods Fba proteins, which were divided into four overlaps based on the structural domains, were truncated and expressed. The fba truncated genes were amplified by polymerase chain reaction (PCR) with SSI-9 of GAS as template, and cloned into prokaryotic expression plasmid pGEX-2T and expressed in E. coli BL-21. The products were confirmed by Western blot and purified by affinity chromatography column. Female BALB/c mice were immunized with the four truncated proteins respectively, with phosphate buffered solution (PBS) as control. The serum IgG of mice was detected by enzyme-linked immunosorbent assay (ELISA). After the third immunization, mice were challenged with fatal dose of GAS (M+ Fba+ ) to evaluate the protective rates in each group. The data were compared by analysis of variance and Fisher's exact test.Results Prokaryotic expression plasmids of pGEX-2T/FbaAl, pGEX-2T/FbaA2, pGEX-2T/FbaA3 and pGEX-2T/FbaA4 were successfully constructed and the four truncated proteins were expressed and purified successfully. Serum levels of IgG in each experimental group gradually increased with immunization with Fba protein more times. After the third immunization, the IgG titer against FbaA2 1290.2, P<0. 01). After GAS challenge, four out of eight mice were protected in FbaA2 protein group, while two out of eight mice in FbaAl protein, FbaA3 protein and FbaA4 protein groups,respectively (P<0. 05). Conclusions Four truncated Fba proteins are constructed and expressed successfully. Truncated FbaA2 protein could be able to induce strongest protective immune response.
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Objective To express the novel fibronectin-binding protein Fba of group A streptococcus(GAS)and analyze its immunogenicity,so that to evaluate the immune responses to GAS infection.Methods fba gene was amplified by polymerase chain reaction(PCR)and confirmed by sequencing.Then it was cloned into pGEX4T-2 vector and Fba protein was expressed in E.coli BL21.The protein expression was identified by enzyme-linked immunosorbent assay(ELISA)and Westernblot.The sera from mice infected with GAS and anti-streptolysin-O positive patients were detected using microtiter plates coated with purified Fba protein as antigen.Afterward Balb/C mice were immunized with this purified protein and the sera were collected after the third immunization for the detection of IgG titer.Results It was confirmed by ELISA and Western blot that the recombinant Fba protein had a specific affinity with anti-Fba sera of rabbit.The anti-serum IgG titer of mice imrnunized with Fba protein was up to 1:4800.Conclusions GAS infection or Fba protein immunization are able to induce high serum titer of anti-Fba which could react specifically with the recombinant Fba protein.It indicates that Fba protein has good immunogenicity and antigenicity.So Fba protein could be a GAS candidate vaccine and an important tool to detect anti-GAS titer in GAS infected patients.
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Objective To investigate the cataract patients' awareness on the cataract diseases, treatment and major obstacles for patients to seek eye care. Design Prospective cross-sectional study. Participants All 251 patients in Jiangyan county were screened by the group of eye diseases selection in 6 months for cataract treatment performed by prevention blind surgery group. Methods Patients accepted surveys before operation. The patient's awareness questionnaire was developed in Aravind Eye Hospital, India. Main outcome measures Awareness of eye disease, awareness of treatment, obstacles of therapy and false treatment. Results 89.6% of patients were aware of the occurrence of eye disease for more than 1 year. However, it was only 0.12% of patients when they realized that their eye diseases could be treated more than 1 year,the time less than 6 months was 31.9%,and the time less than 1 month was 65.7%. The major obstacles for seeking eye care were still able to see a little, economic reason, no demand for operation, short of belief for the operation, etc. Conclusions It's high necessary and imperative to educate patient the knowledge of eye health and care. Developing economy is the radical measure in a long run to improve the cataract surgical rate (CSR) in our country. Low price service and high quality surgery is the key of improving CSR at present.