Fetal/neonatal atrial flutter at the onset of perinatal period: clinical analysis of 21 cases / 中华围产医学杂志

Objective:To analyze the clinical features, treatment, and outcomes of fetal/neonatal atrial flutter (AFL) at the onset of the perinatal period to improve the management of this condition.Methods:This retrospective study analyzed the clinical data, treatment, and follow-up results of fetal/neonatal AFL cases transferred to Shanghai Children's Medical Center from November 2013 to August 2021. Clinical characteristics, cardioversion procedures, and outcomes were summarized. Descriptive method was used for statistical analysis.Results:A total of 21 fetuses/neonates presenting with AFL in the perinatal period were involved in this study, including 17 males and four females. Ten of them were born at full term, and 11 were preterms. All of the patients were delivered by cesarean section at 32 to 41 gestational weeks [ (36.6±1.9) weeks] with a birth weight of 2 130 to 4 450g [ (3 059±528) g]. Increased fetal heart rate was all detected after 32 weeks of gestation, and three of them were diagnosed with AFL by fetal echocardiography before being born. The heart rate remained elevated in all cases after birth. All were diagnosed as AFL based on an electrocardiogram on the day of birth, which showed a 2 to 6 over one ratio of atrioventricular conduction. Among the six cases of cardiac insufficiency and low blood pressure complicated by dyspnea and cyanosis, the symptoms were relieved in four cases after mask oxygenation and two cases after ventilation. Among the 21 cases, one was converted spontaneously to normal sinus rhythm and the other 20 recovered after medication or electrical cardioversion. Seven cases were initially treated by drug conversion with a success rate of 5/7 and hospitalized for 23 d (13-25 d). There was one with cardiac insufficiency before treatment and three newly developed cardiac insufficiency during treatment among the seven cases. Thirteen cases were offered electrical cardioversion initially, and the success rate of cardioversion was 12/13. There were five cases of cardiac insufficiency before treatment, while no new cases of cardiac insufficiency was reported during treatment. The duration of hospitalization was 11 d (9-14 d). Apart from one case, the rest 20 infants were followed up from one month to eight years old, and no recurrence was reported.Conclusions:For fetal/neonatal AFL with the onset during the perinatal period, the symptoms mainly manifest in late pregnancy. Its diagnosis depends on fetal echocardiography before birth or electrocardiogram after birth, and electrical cardioversion is a fast and effective measure. While the prognosis of perinatal-onset AFL is generally good.

Risk prediction of neonatal hyperbilirubinemia / 中国新生儿科杂志

Objective:To study the predictive value of hour-specific total serum bilirubin(TSB) nomogram combined with clinical risk factors in the risk of hyperbilirubinemia.Method:Perinatal clinical data of newborns born in Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai Pudong New Area People's Hospital and Shanghai Pudong Hospital from August 2017 to July 2018 were collected in this prospective study. Transcutaneous bilirubin (TcB) was monitored before discharge from hospital. Enrolled neonates were followed up for 28 days. The patients were assigned to neonatal hyperbilirubinemia group (NHB) and non-hyperbilirubinemia group (Non-HB) according to the occurrence of hyperbilirubinemia. The predictive value of models for the risk of hyperbilirubinemia was evaluated by receiver operating characteristic (ROC) curves and Logistic regression analysis.Result:A total of 8 664 newborns were included in this study, with 1 196 cases of hyperbilirubinemia, with an incidence of 13.8%. Logistic regression analysis showed that maternal blood type O, premature rupture of membranes, male gender, gestational age 35~37 weeks, subcutaneous ecchymosis/cranial edema, and breastfeeding were independent risk factors for NHB ( P<0.05). The area under receiver operative characteristic curve (ROC) of predischarge bilirubin risk zone only was 0.874(95% CI 0.861~0.885, P<0.05)and for all independent risk factors was 0.664 (95% CI 0.647~0.680, P<0.05). The area under ROC curve was 0.891 (95% CI 0.880~0.902, P<0.05) by combining predischarge bilirubin risk zone with clinical risk factors. Conclusion:Predischarge bilirubin risk zone combined with clinical risk factors can reasonably predict neonatal hyperbilirubinemia well.

Effect of Tanreqing injection assisted Ganciclovir on children with respiratory syncytial virus pneumonia / 中国生化药物杂志

Objective To investigate the effect of Tanreqing injection assisted ganciclovir on children with respiratory syncytial virus pneumonia . Methods 145 cases of RSVP pediatric patientsin from February 2013 to January 2016 in our hospital were retrospectively chosen,according to different drug regimen,they were divided into two groups,the contronl group of 71 cases with ganciclovir injection treatment and study group of 74 cases,with Tanreqing injection treatment on the basis of the contronl group.The blood gas analysis was performed on the arterial blood of the two groups before treatment and 7 and 14 days after continuous administration.The changes of blood gas indexes (pH,PaO2,PaCO2) were compared.The lung rales, wheezing, fever, cough, wheeze disappearance of time and side effects of the children were recorded.Results After 7 and 14 days of treatment, the Ph of blood gas parameters in the study group were (7.38 ±0.21) and (7.41 ±0.26), the level of PaO2 were (96.45 ±4.06) mmHg and (98.84 ± 5.27) mmHg,which were significantly higher than those of the control group (P<0.05);the level of PaCO2 in the study group were(45.02 ±4.23) mmHg and (41.26 ±3.16) mmHg, which were significantly lower than those in the contronl group (P<0.05).The rale resorption time in the study group was (4.47 ±1.06) days, the duration of wheezing subsided was (5.03 ±0.43) days, the duration of wheezing was (4.89 ±0.72) days, the duration of fever subsided was (2.46 ±0.32) days, the duration of cough was (8.41 ±1.54) days,were significantly lower than the control group(P<0.05).The adverse reaction rate in the study group was 8.11%, significantly lower than that in the control group 21.13%(P<0.05).Conclusion The combination of Tanreqing injection combined with ganciclovir has a good effect on children with RSVP , and can significantly shorten the time of clinical evidences such as wheezing, wheezing and pulmonary rales, and improve the blood gas level in children,reduce adverse reactions.

Effect of hand hygiene on cost-effectiveness of healthcare-associated infection / 中国感染控制杂志

Objective To understand hand hygiene(HH) compliance among health care workers(HCWs) and incidence of healthcare-associated infection(HAI) in surgical patients before and after the intervention, analyze the effect of HH on cost-effectiveness of HAI.Methods From December 2012-June 2014, 78 HCWs in the department of neurosurgery of a hospital were as the intervention objects of HH compliance, 325 patients who underwent craniocerebral clean operation were as the surveyed objects, HH compliance among HCWs, incidence of HAI in surgical patients, cost of HH, and hospitalization expense before and after intervention were compared respectively.Results HH compliance among HCWs before and after intervention were 35.24% (216/613) and 73.75%(486/659)respectively (X2=180.091,P<0.001);incidence of HAI in surgical patients before and after intervention were 31.85%(50/157)and 18.45%(31/168)respectively(X2=7.782,P<0.001).Hospitalization expense before and after intervention were (89 524.90±38 856.70)￥ and (61 401.00±29 237.80)￥ respectively;average length of hospital stay before and after intervention were 36.70 days and 26.90 days respectively(t=3.296, 3.511,respectively, both P<0.01).Conclusion Improving HH compliance among HCWs can reduce the incidence of HAI and hospitalization cost, and shorten the average length of hospital stay of patients.

Evaluation of the effect of evidence-based nursing model in improvement of the quality of life and emotional state of parturients with natural childbirth during perinatal period / 中国实用护理杂志

Objective To investigate the clinical effect of evidence-based nursing model on improvement of the quality of life and emotional state of parturients with natural childbirth during perinatal period. Methods 120 cases of parturients with natural childbirth from November 2009 to November 2010 in our hospital were chosen.They were randomly divided into the control group and the observation group with 60 cases in each group.The control group was taken conventional methods of nursing care,and the observation group was given evidence-based nursing.The anxiety and depression scores and quality of life score,pain score of the first labor stage of the two groups were compared.The clinical effect of evidence-based nursing on improvement of the quality of life and emotional state of parturients with natural childbirth was evaluated comprehensively. Results After observation,the quality of life prenatal and postnatal for the two groups were compared,the observation group had obvious advantages than the control group,the difference between the two groups was significant.The anxiety and depression scores antepartum and postpartum for the two groups were compared,the observation group was lower than the control group,and the difference between the two groups was significant.The labor pain of the first stage was compared,the rate of the third-grade pain in the observation group was significantly lower than the control group. Conclusions Evidence-based nursing has been applied effectively into the clinic.It has been proven that effective measures can prevent and improve the questions that have arisen or prone to arise for perinatal stage.It can improve the quality of life and improve the emotional state for maternal perinatal period.It is conducive to maternal and child health,and is worthy of clinical application.

Influence of humanized management mode on infection consciousness and infection control effect of medical staff / 中国实用护理杂志

ObjectiveTo study the influence of humanized management mode for infection consciousness and control effect of infection of medical staff. Methods90 medical staff from June 2010 to March 2011 were selected as research object,and they were randomly divided into the control group and the observation group with 45 cases in each group,then the infection consciousness,grasping situation of related knowledge and infection control effect of two groups before and after the management on the third and sixth month were analyzed and compared.Results The infection consciousness,grasping situation of related knowledge and infection control effect of the observation group after the management on the third and sixth month were all better than those of the control group,there were significant differences. ConclusionsThe humanized management mode plays an active role in improving infection related evaluation indices of hospital staff,and is also effective in control of infection.

Digital Signature on a DICOM Medical Image File / 中国医学物理学杂志

Objective: To ensure the integrity、non-repudiation、authenticity of pictures and relevent messages by making a digital signature for a DICOM file. Methods: By using OpenSSL toolkits and dcmsign of DCMTK toolkits, make a digital sig nature for the relevent messages of DICOM medical image and then save it behind of the DICOM file. Results: We can evaluate integrity、non-repudiation、authenticity of pictures and relevent messages in the DICOM file which has been made a digital signature. Conclusion: To make a digital signature in a DICOM file by using the OpenSSL toolkits and dcmsign of DCMTK toolkits can realize the security when DICOM file transported in remote medical treatment and PACS.

Management of perioperative respiratory problems in patients with tumor of trachea or carina / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarise and analyse the experience and methods of managing the perioperative respiratory problems in patients with tumor of trachea or carina surgically treated during the last decade, and the ways of preventing severe postoperative respiratory complications in the future.</p><p><b>METHODS</b>Thirty-eight patients with tumor of trachea or carina surgically treated from 1991 to 2000 by different modes of tracheobronchial plastic surgery were retrospectively studied to summarise and analyse the changes in preoperative pulmonary function, postoperative complications and the management of perioperative respiratory problems.</p><p><b>RESULTS</b>Out of 38 patients, 29 (76.3%) gave abnormal results to preoperative pulmonary function tests. 55.3% (21/38) of the whole series developed 45 postoperative complications with respiratory complications as the major one (80.0%). Seventeen patients who had undergone carinal pneumonectomy or carinal resection plus reconstruction gave far more complications (28 complications) than the remaining 21 patients treated by other modes of surgery (17 complications). Four patients died of postoperative complications with a mortality rate of 10.5%.</p><p><b>CONCLUSION</b>Patients treated with carinal pneumonectomy or carinal resection plus reconstruction give much more complications than patients treated by any other modes of large airway surgery. Fiberoptic bronchoscopic (FOB) guided intubation, precise surgical treatment, postoperative mechanical ventilation support, use of effective antibiotics and sufficient nutritional support are important for a successful management of these patients.</p>

Diagnosis and surgical treatment of esophageal leiomyoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the characteristics of diagnosis and surgical treatment of esophageal leiomyoma.</p><p><b>METHODS</b>Preoperative radiology, esophagoscopy and results of surgical treatment were retrospectively analyzed in 141 patients with esophageal leiomyoma.</p><p><b>RESULTS</b>Dysphagia (64.5%) and chest or epigastric pain (20.6%) were the most common presenting symptoms with a mean duration of 15.7 months. Eleven patients had been misdiagnosed as malignant esophageal disease, mediastinal or retroperitoneal tumor before operation. Thirteen patents received partial esophageal resection, including 2 patients with gigantic tumor, 3 still misdiagnosed as malignancy in the operation theater and 8 accompanied with esophageal or gastric cardiac carcinoma. 128 patients were treated with tumor removal only, among whom the esophageal mucosa was ruptured and sutured in 13 patents. The tumor was single in 130 patients and multiple in 11 patients. The tumor shape was either oval, horseshoe-or ginger-like. Tumor surrounded the esophagus less than half circumference in 75 patients, more than half in 59 patients and involved the whole circumference in 7 patients. The tumor was polypoid and intraluminal in one patient. It was extraluminal in 2 patients and was intramural in all the others. The morbidity and 30-day mortality rates were 3.6% and 0%.</p><p><b>CONCLUSION</b>Preoperative differentiation of esophageal leiomyoma is important for it may be misdiagnosed as esophageal malignant disease or mediastinal tumor. Tumor removal only is indicated if possible. Biopsy is inadvisable if leiomyoma has been suspected by esophagoscopy. The incidence of esophageal carcinoma complicating esophageal leiomyoma is high, of which the reason needs further study.</p>

Surgical treatment for lung cancer patients with poor pulmonary function / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarize surgical treatment of lung cancer patients with poor pulmonary function.</p><p><b>METHODS</b>From 1991 to 1999, 181 lung cancer patients with poor pulmonary function underwent operation. The correlation between the results of preoperative pulmonary functional tests and the postoperative cardiopulmonary complications was analyzed by Chi-square test (chi(2)).</p><p><b>RESULTS</b>In 181 patients, pneumonectomy was done in 43, lobectomy in 118, partial lung resection in 16 and exploration in 4. The postoperative complication and mortality rates of the resection group were 42.3% (75/177) and 7.9% (14/177). The cardiopulmonary complication rates were 25.6%, 48.3%, 31.3% in pneumonectomy, lobectomy and partial lung resection. The morbidity and mortality rates of 8 patients who received preoperative chemotherapy and/or radiotherapy were 75.0% and 37.5%. The morbidity and mortality rates of 12 patients who had had a previous history of thoracotomy were 66.7% and 33.3%. In the present series, the 1-, 3- and 5-year survival rates were 71.1%, 42.2% and 31.1%. The 5-year survival rates of patients with stage I, II and III lesions were 55.0%, 25.0% and 0.</p><p><b>CONCLUSION</b>Preoperative spirometry is an important evaluation test for lung cancer patients with poor pulmonary function. It should be evaluated in combination with other pulmonary function tests such as CO(2) diffusion and cardiopulmonary excise tests, etc whenever possible. Patients with a history of thoracotomy, chemotherapy and radiotherapy should be carefully evaluated before operation to avoid high morbidity and mortality. Stage I and II lung cancer patients with poor pulmonary function can undergo operation if they have been well managed preoperatively and well taken care of with nursing care perioperatively.</p>

Clinical value of prophylactic radiotherapy after curative resection of esophageal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of prophylactic radiotherapy for esophageal carcinoma after curative operation.</p><p><b>METHODS</b>495 esophageal squamous cell cancer patients who had undergone radical resection were randomized by the envelope method into a surgery alone group (S, 275) and a surgery plus radiotherapy group (S + R, 220). Radiation treatment was started 3 - 4 weeks after operation. The portals encompassed the whole mediastinum and bilateral supraclavicular areas. A mid-plane dose of 50 approximately 60 Gy in 20 approximately 30 fractions over 5 approximately 6 weeks was delivered.</p><p><b>RESULTS</b>1. Survival rate: the overall 5-year survival rate was 39.4%. Those of S alone and S + R groups were 37.1% and 41.3% (P = 0.447 4). The 5-year survival rate for Stage III patients were 13.1% in S alone group and 35.1% in R + S group (P = 0.002 7), 2. Pattern of failure: The incidence of local recurrence intra-thoracic lymph node metastasis, anastomotic recurrence and extra-thoracic lymph node metastasis in S + R group (16.2%, 0.5% and 3.1%) were lower than those (25.9%, 5.8% and 13.2%) (P < 0.05) in S alone group and 3.</p><p><b>COMPLICATIONS</b>the anastomotic stricture frequencies were similar in the two groups (S 1.8%; S + R 4.1%).</p><p><b>CONCLUSION</b>1. Prophylactic radiotherapy is able to improve the survival rate of stage III patients treated by radical resection, 2. Postoperative radiotherapy is able to reduce the incidence of failure by recurrence in the intra-thoracic lymph nodes and anastomotic recurrence to where radiation therapy had been given, 3. Postoperative radiotherapy does not increase the incidence of anastomotic stricture.</p>

Hospital Infection Monitoring:Problems and Strategies / 中华医院感染学杂志

OBJECTIVE To analyze problems of hospital infection monitoring and its strategies.METHODS Having investigated hospital infection cases during 2005 and statistically to analyze the data of infection monitoring.RESULTS Both of the missed report rate of hospital infection and the rate for detection of microbe samples were decreased.Antibiotics were misused.CONCLUSIONS Strengthening the training about hospital infection knowledge for increasing the rate for detection,strengthening the infection monitoring,checking the infection control strictly,and raising the antibiotics control policy and practice are important.