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A 3-week practice-oriented training course on chronic obstructive pulmonary disease (COPD) management was conducted in December 2020, 34 primary care physicians from township or community health service centers attended the course. The impact of the training course on the knowledge levels of COPD management was evaluated with a questionnaire survey, the questionnaire contained the knowledge of COPD and its management. The survey showed that before the training, the participants had low knowledge levels on the definition of COPD and its risk factors; 67.6% (23/34) were not aware of COPD-related guidelines and new developments, and 17.6%(6/34) had conducted COPD follow-up assessments, pulmonary rehabilitation, and health education; only 8.8% (3/34) had used the improved British Medical Research Council Dyspnea Index (mMRC) and the chronic obstructive pulmonary disease assessment test (CAT) for patient self-assessment; there was no pulmonary function instrument in their units, and only 3 doctors (8.8%) had previously participated in pulmonary function training and knew indications and contraindications of the pulmonary function test, and complete report interpretation; all participants were unable to use common inhalation devices and master inhalation techniques completely and correctly; 11.8% (4/34) had assessed patients′ handling inhalation devices and performing inhalation. After the training, the knowledge levels of COPD clinical features, lung function and inhalation technique were significantly improved, and the scores were significantly increased compared with those before the training ( P<0.001). The study shows that primary care physicians have insufficient knowledge and management skill of COPD. The practice-oriented training can significantly improve the knowledge and skills of primary care physician for COPD management in the community.
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Objective:To analyze the characteristics of drug resistance genes in a Klebsiella pneumoniae strain coproducing carbapenemases KPC-2 and NDM-5. Methods:Klebsiella pneumoniae KPN-hnqyy was separated from the stool specimen of a patient in the Hematology Department of Affiliated Cancer Hospital of Zhengzhou University. The strain was identified with a BD Phenix-M50 automated microbiology system and the minimum inhibitory concentration against the strain was measured as well. The genotypes of the carbapenemases were tested by enzyme immunochromatographic assay and PCR method. The transferability of related plasmids was analyzed by conjugation test. Whole-genome sequencing of the strain was conducted using PacBio and Illumina platforms. The MLST type, resistance gene and plasmid type of the strain were retrieved in BacWGSTdb. The genome and open reading frame sequence of the strain were compared using Easyfig_2.2.3. Visual cycle graphs were generated using BRIG v0.95. Results:Klebsiella pneumoniae KPN-hnqyy was resistant to carbapenem antibiotics. It belonged to ST11 and carried two carbapenemase genes of blaKPC-2 and blaNDM-5. The conjugant only harbored the blaKPC-2 gene. Whole-genome sequencing revealed that the strain contained one chromosome and three plasmids. Its chromosome genome shared more than 99.9% similarity with that of Klebsiella pneumonia KP69 and KP19-2029. Moreover, a similar IncR and IncFⅠ resistance gene fusion region was contained in different types of plasmids carried by them: the blaKPC-2 gene was located in a structure—which evolved from the Tn3-△Tn4401-Tn1721/Tn1722 sequence—inside this fusion region with its ends inserted into the transposase IS26 gene; the blaNDM-5 gene was located on a transposon containing the special plasmids of the insertion fragment in phages, with its ends inserted into the transposase IS26 gene too. Conclusions:The IncR and IncFⅡ resistance gene fusion region of blaKPC-2 carried by Klebsiella pneumoniae ST11 might be widely coexistent with the chromosomal genome. The blaNDM-5 gene carried by special plasmids might be accidentally obtained through gene recombination mediated by transposable element IS26. The wide transmission of Klebsiella pneumoniae ST11 carrying the blaKPC-2 gene in China and its ability to obtain other carbapenemase genes through transposable element IS26 were well worth attention.
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Esophageal cancer (EC) is one of the most fatal cancers worldwide. According to GLOBOCAN 2020, it was estimated that there were 600, 000 new EC cases and 540 000 EC deaths, while nearly half of all newly diagnosed cases of EC and associated deaths worldwide occurred in China. The annual incidence and mortality of EC have been reduced in the last 20 years in China. However, the early symptoms and signs of EC are not easily distinguished and the disease tends to be within the middle and late stage of pathogenesis when identified, leading to its low 5-year survival rate. Therefore, it could help effectively reduce the burden of EC by clarifying its etiology and risk factors, as well as taking preventive and early diagnosis measures. This article reviews the epidemiology, etiology, screening and early diagnosis of EC in China, to provide systematic references for EC prevention and control.
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Pancreatic cancer (PC) is one of most fatal cancers worldwide. According to the 2020 cancer registry data, PC was the 12th common cancer and the 7th leading cause of cancer deaths globally. PC is a rare cancer, but the 5-year survival is very low because of its rapid progress and poor prognosis. The disease burden of PC in China is quite different from western countries, indicating that the distribution of genetic factors, lifestyle and environmental factors varies from different regions. This article reviews the epidemiology, etiology and screening of PC in China, to provide systematic references for PC prevention and control.
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Objective:To analyze the characteristics of plasmids in KPC-2-producing Serratia marcescens ( S. marcescens) isolates. Methods:Four carbapenem-resistant S. marcescens strains were isolated from four patients admitted to the hepatobiliary ward of Affiliated Cancer Hospital of Zhengzhou University in 2016. BD Phenix-100 was used to identify the strains and detect the minimum inhibitory concentrations (MICs). Homology analysis was performed using pulsed-field gel electrophoresis (PFGE). The modified Hodge test was used to detect the phenotypes of carbapenemase. PCR and gene sequencing were used to detect the types of carbapenem resistance genes. The transferability of plasmids was detected by conjugation test. The characteristics of plasmids were analyzed by genomic alignment method after whole genome sequencing. DNAMAN V9 software was used to compare the amino acid sequences of the replication initiation proteins. A phylogenetic tree was constructed with neighbor-joining method using MEGA7.0. Results:All of the four S. marcescens strains were resistant to carbapenem antibiotics. They were highly homologous according to PFGE. Hodge test results were all positive and the carbapenemase genotype was blaKPC-2. Conjugation test results were positive. The plasmid was a circular DNA of 42 742 bp in length. It had the similar skeleton of incX6 plasmid and the similar amino acid sequence of replication initiation protein. Moreover, it and incX6 plasmid were at the same node in the phylogenetic tree. The blaKPC-2 was located in the core of drug resistance, which was composed of insertion elements including Tn3 family transposons, recombinant enzyme genes, △ISKpn6 and ISKpn27. Conclusions:The plasmid was incX6-like. The blaKPC-2 gene was located in the transposon of △Tn6296. More attention should be paid to the bacteria carrying KPC-2 in incX plasmids.
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Objective To investigate the expression of human epididymal protein 4 ( HE4) and its effect on prognosis in patients with epithelial ovarian cancer (EOC). Methods From 2009 to 2014,ninety-eight cases of epithelial ovarian cancer (EOC group) and 29 cases of benign ovarian tumor (benign group) and 100 healthy subjects (control group) were selected as research subjects. The serum HE4 was detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA),and the positive expression was determined by HE4＞150 pmol/L in serum. The concentration and positive rate of serum HE4 were compared among the three groups. The median serum HE4 level of EOC patients before treatment was divided into high level HE4 group and low level HE4 group. The median survival time of the two groups of EOC patients was compared. Results The median value of serum HE4 concentration (four percentile) in EOC group was 421. 8 (68. 7 ～ 2173. 9) pmol/L,47. 8 (35. 24 ～ 68. 5) pmol/L in the benign group and 43. 8 ( 32. 91 ～ 70. 4) pmol/ L in the control group. The serum concentration of HE4 in the EOC group was significantly higher than that in the benign group and the control group ( P＝0. 000) . The serum HE4 concentration in group EOC was significantly higher than that in benign group and control group (P＜0. 01),but there was no significant difference between benign group and control group (P＞0. 05). The positive rate of serum HE4 in the EOC group was 74. 5 (73/98),the positive rate of the benign group and the control group were 0,the difference between the three groups was statistically significant (P＝0. 000). The positive rate of serum HE4 in the EOC group was significantly higher than that in the benign group and the control group ( P＜0. 01), while the benign group and the control group had no statistical significance (P＞0. 05). The median survival time of EOC patients in low level HE4 group was 66. 2 months,while that in high level HE4 group was 36. 9. The difference between two groups was statistically significant (P＝0. 001). Conclusion The serum HE4 level of EOC patients was significantly higher than that of patients with benign ovarian tumors and healthy controls. The higher serum HE4 level,the worse the prognosis, and the shorter the survival time of patients. Therefore,the expression level of serum HE4 can be used for the diagnosis and prognosis of ovarian cancer.
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Objective:To investigate the ways of pharmaceutical care performed by clinical pharmacists for the patients with severe infection. Methods:Through deciding the anti-infection therapeutic regimen, providing drug counselling and pharmacy education and focusing on adverse drug reactions, pharmacists offered suggestions for one patient with severe legionella pneumonia complicated with AECOPD. Results:The pharmaceutical care performed by clinical pharmacists could solve the problems and improve the compliance, safety, effectiveness and rationality in the drug treatment of the patient. Conclusion:According to the individual condition of patients, clinical pharmacists can realize their own values through looking for the breakthrough points of pharmaceutical care and participating in clinical practice.
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Objective To realize real-time medical insurance settlement system of Xi'an based on Outpatient One Card Solution to reduce the errors due to artificial accounting.Methods The system was developed with C# language and Oracle 10g, based on interface function dynamic library calling rule and HIS data structure requirements provided by Xi'an municipal medical insurance center.Results The system realized real-time settlement of the patient with medical insurance card.Conclusion The system simplifies medical insurance outpatient treatment flow and implements data communication.
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Objective To observe expressions of ?-smooth muscle actin(?-SMA) and collagen type Ⅰ,Ⅲ deposition in the liver tissues, and to evaluate potential mechanism of fibrosis in patients with fibrosing cholestatic hepatitis (FCH) by collagen synthesis. Method Immunohistochemical staining was used to detect the expressions of ?-SMA and contents of type Ⅰ,Ⅲ collagen proteins, which were from the specimens of the biopsy liver in 9 cases with FCH associated with hepatitis virus B (HBV) developed following renal transplantation and in 5 cases without liver disease(control group), respectively. Results The expressions of ?-SMA and type Ⅰ,Ⅲ collagen proteins in the patients with FCH were significantly higher than those in the control group. The expression and distribution pattern of ?-SMA and type Ⅰ,Ⅲ collagen proteins were almost identical, and quantitative analysis showed a positive correlation (P
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Objective To observe the expressions of matrix metalloproteinase 1(MMP1) and tissue inhibitor of matrix metalloproteinase1(TIMP1) and the collagen type Ⅰ,Ⅲ deposition in the liver tissues,and evaluate the possible fibrosis mechanism of patients with chronic hepatitis B(CHB) in the way of degradation of collagen. Methods The specimens of the biopsy liver in 50 cases with CHB were detected for the expressions of type Ⅰ,Ⅲ collagen proteins,MMP1 and TIMP1 by immunohistochemical staining. Results The expressions of type Ⅰ,Ⅲ collagen proteins and TIMP1,were significantly increased along with the advancing of hepatic fibrosis.There was a positive correlation between the expressions of type Ⅰ,Ⅲ collagen proteins and TIMP1. Conclusions Hepatic fibrosis in the patients with CHB may be related to increase of TIMP1 expression that inhibit the degradation of collagen.
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Standardization management of the procurement,supply,maintenance,filing,rejection and measurement of medical equipment is very important for determination of the right obligations and responsibilities of medical equipment management facility. It also avails to establish a set of systemic regulations to improve the performance of medical equipment facility and the continuous education of medical engineering technicians.
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Objective To explore the fibrosis mechanism of patients with fibrosing cholestatic hepatitis(FCH) in the way of degradation of collagen.Methods The expressions of matrix metalloproteinase 1(MMP1) and tissue inhibitor of metalloproteinase 1(TIMP1),and contents of type I,III collagen proteins were detected by immunohistochemical staining in the liver tissues of 9 cases with FCH associated with HBV developed following renal transplantation and 5 cases without liver disease as controls.Results The expressions of MMP1 and TIMP1,and type I,III collagen proteins in the patients with FCH were significantly higher than those in the control group.There was a positive correlation between the expressions of type I,III collagen proteins and TIMP1/ MMP1 ratio.Conclusion Hepatic fibrosis in the patients with FCH associated with HBV developed following renal transplantation may be relative to the increase of TIMP1 expression which inhibit the degradation of collagen.
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Influences of environment on medical equipment lie in many fields and exist independent of human consciousness.In order to lengthen the service life of medical equipment and produce the best possible results,human beings use scientific methods to utilize and change the natural situation.Bad influence from natural conditions to medical equipment is expatiated from such aspects as influence from thunder,rain,snow,electricity,warmth,humidity,mist,magnetism,etc.The management and the protection of the medical equipment under the natural situations are discussed.