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Objective:To explore the correlation between self-efficacy and discharge readiness in patients with enterostomy.Methods:It was a cross-sectional study. Using the self-efficacy Scale and the Readiness for Discharge Scale as research tools, the patients who underwent enterostomy in the Department of General Surgery of Peking Union Medical College Hospital from December 2018 to December 2019 were conveniently selected for questionnaire survey. Statistical descriptive variables such as mean values, median values and frequency were used to investigate the current situation of self-efficacy and discharge readiness of patients with enterostomy. Pearson correlation analysis (or Spearman correlation analysis) was used to explore the correlation between self-efficacy and discharge readiness in these patients.Results:The total self-efficacy score of the 121 patients with enterostomy was (75.81±21.16) points, and the total discharge readiness score was (138.11±34.60) points. The total score of self-efficacy in the patients with enterostomy was positively correlated with the total score of readiness for hospital discharge ( r=0.379, P<0.01). No correlation was found between the self-condition dimension and the confidence and efficacy of sexual life ( r=0.125, P>0.05) and the confidence and efficacy of sexual life satisfaction ( r=0.062, P>0.05). The disease knowledge dimension was positively correlated with the following variables, self-efficacy score ( r=0.311, P<0.01), stoma care efficacy ( r=0.358, P<0.01), self-social efficacy ( r=0.227, P<0.05), diet choice efficacy ( r=0.221, P<0.05) and stoma self-care confidence efficacy ( r=0.249, P<0.01). The post-discharge coping ability dimension was positively correlated with the total score of self-efficacy ( r=0.428, P<0.01). Anticipatory social support dimension was positively correlated with self-efficacy ( r=0.218, P<0.05), self-social efficacy ( r=0.226, P<0.01), vitality confidence ( r=0.202, P<0.05) and stoma self-care confidence ( r=0.198, P<0.05). Conclusion:The self-efficacy level of patients with enterostomy can positively predict the level of readiness for discharge.
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Objective:To investigate the distribution and drug resistance of pathogens in urinary tract infection in children.Methods:The clinical data of 108 cases of urinary tract infections with positive urinary culture from January 2018 to December 2018 in our hospital were analyzed retrospectively.The patients were divided into simple urinary tract infection group( n=29) and complex urinary tract infection group( n=79). Antibiotic resistance in each group was compared. Results:Gram-negative bacilli were found in 90 cases(77.59%, 90/116). Gram-positive cocci were found in 26 cases(22.41%, 26/116). Escherichia coli, Klebsiella pneumoniae and Enterococcus faecium were the main pathogens.Gram-negative bacilli had the lowest resistance rate to amikacin, imipenem and piperacillin/tazobactam(about 10%). The resistance rate of Gram-negative bacilli to furantoin and quinolones was about 20%, while 30% to 40% to the third and fourth generation cephalosporins and their enzymatic preparations.No Gram-positive cocci was found to be resistant to vancomycin and linezolid.The resistance rate of Gram-positive bacteria to streptomycin and furantoin was 0-20%.There was no significant difference in resistance rate of Gram-negative bacteria to common antibiotics between simple urinary tract infection group and complex urinary tract infection group( P>0.05). Conclusion:Gram-negative bacteria are the main pathogens of urinary tract infections.With the change of drug resistance of pathogens, it may be necessary to change the empirical treatment of urinary tract infection.Furantor can be used as a recommendation for the empirical treatment of mild infection.In the past, there may be underestimate of drug resistance of simple urinary tract infection, and further research is needed.
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Objective@#To compare the treatment effect of surgical clipping and endovascular coil embolization for aneurysmal subarachnoid hemorrhage (aSAH) in the elderly.@*Methods@#Elderly patients with aSAH (aged >65 years) treated in Shanghai Pudong Hospital from January 2009 to December 2017 were enrolled retrospectively. They were divided into craniotomy clipping group and endovascular intervention group according to the treatment strategy. The Glasgow Outcome Scale was used for short-term outcome assessment at discharge, 4-5 were defined as good outcome, and 1-3 were defined as poor outcome. Long-term follow-up was performed to assess clinical outcomes using the modified Rankin Scale, 0-2 was defined as good outcome and 3-6 were defined as poor outcome. The clinical and imaging information, perioperative complications, short-term and long-term clinical outcomes, and long-term imaging outcomes were compared between the two groups. Multivariate logistic regression analysis was used to assess the independent influencing factors of clinical outcomes.@*Results@#A total of 68 elderly patients with aSAH were enrolled. Of these, 47 (69.1%) received endovascular coil embolization and 21 (30.9%) underwent microsurgical clipping. There were no significant differences between the two groups in the incidence of perioperative complications, short-term and long-term adverse outcomes, and imaging recurrence rate. Multivariate logistic analysis showed that smoking (odds ratio [OR] 36.319, 95% confidence interval [CI] 3.530-373.640; P=0.003), modified Fisher grade (OR 20.406, 95% CI 2.022-205.964; P=0.011) and World Federation of Neurological Societies (WFNS) grade (OR 4.686, 95% CI 1.012-21.692; P=0.048) were the independent risk factors for short-term poor outcomes in elderly patients with aSAH.@*Conclusion@#Both endovascular intervention and microsurgical clipping are safe and effective treatments for elderly patients with aSAH.
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Objective To compare the treatment effect of surgical clipping and endovascular coil embolization for aneurysmal subarachnoid hemorrhage (aSAH) in the elderly.Methods Elderly patients with aSAH (aged ＞65 years) treated in Shanghai Pudong Hospital from January 2009 to December 2017 were enrolled retrospectively.They were divided into craniotomy clipping group and endovascular intervention group according to the treatment strategy.The Glasgow Outcome Scale w as used for short-term outcome assessment at discharge,4-5 were defined as good outcome,and 1-3 were defined as poor outcome.Longterm follow-up w as performed to assess clinical outcomes using the modified Rankin Scale,0-2 w as defined as good outcome and 3-6 w ere defined as poor outcome.The clinical and imaging information,perioperative complications,short-term and long-term clinical outcomes,and long-term imaging outcomes w ere compared between the two groups.Multivariate logistic regression analysis was used to assess the independent influencing factors of clinical outcomes.Results A total of 68 elderly patients with aSAH were enrolled.Of these,47 (69.1％) received endovascular coil embolization and 21 (30.9％) underwent microsurgical clipping.There were no significant differences between the two groups in the incidence of perioperative complications,short-term and long-term adverse outcomes,and imaging recurrence rate.Multivariate logistic analysis showed that smoking (odds ratio [OR] 36.319,95％ confidence interval [CI] 3.530-373.640;P =0.003),modified Fisher grade (OR 20.406,95％ CI 2.022-205.964;P =0.011) and World Federation of Neurological Societies (WFNS) grade (OR 4.686,95％ CI 1.012-21.692;P=0.048) were the independent risk factors for short-term poor outcomes in elderly patients with aSAH.Conclusion Both endovascular intervention and microsurgical clipping are safe and effective treatments for elderly patients with aSAH.
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Objective To study the clinical and pathological features of histiocytic necmtizing lym-phadenitis( HNL) in children. Methods The clinical data and histological findings of 38 cases of HNL admitted in our hospital from June 2000 to May 2015 were reviewed. Results Most of the patients were school-age children with male-femal ratio of 1. 4: 1. The main clinical features were lymphadenopathy (100%),fever(68. 24%),leucocytopenia(52. 63%),rising of lymphocytes percentage(84. 21%). All of the lymph node excisional biopsy met the criterion of HNL. Some cases spontaneously relieved and some cases were treated with NSAID,glucocorticoid or immunoglobulin and benefited significantly. There was no recurrence. Conclusion The clinical situation is not specific. The diagnosis is established by lymph node ex-cisional biopsy. HNL is benign and self-limited disease. The effect of management using glucocorticoid, NSAID and immunoglobulin is remarkable. Long term follow-up is necessary.
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Objective To study the clinical and pathological features of histiocytic necmtizing lym-phadenitis( HNL) in children. Methods The clinical data and histological findings of 38 cases of HNL admitted in our hospital from June 2000 to May 2015 were reviewed. Results Most of the patients were school-age children with male-femal ratio of 1. 4: 1. The main clinical features were lymphadenopathy (100%),fever(68. 24%),leucocytopenia(52. 63%),rising of lymphocytes percentage(84. 21%). All of the lymph node excisional biopsy met the criterion of HNL. Some cases spontaneously relieved and some cases were treated with NSAID,glucocorticoid or immunoglobulin and benefited significantly. There was no recurrence. Conclusion The clinical situation is not specific. The diagnosis is established by lymph node ex-cisional biopsy. HNL is benign and self-limited disease. The effect of management using glucocorticoid, NSAID and immunoglobulin is remarkable. Long term follow-up is necessary.
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Objective To investigate clinical effect of surgery combined with the rehabilitation treatment for the patients with burn scar contracture on hand,to provide a reference for clinical treatment.Methods 60 cases of hand burn scar contracture patients were selected,according to the digital table they were divided into control group and observation group(n =30 cases),which was underwent surgery in both groups.The control group was treated based on out -patient routine hand exercise methods,while a heated therapy,compression therapy and other profes-sional rehabilitation exercises were performed in the observation group.TAM in patients and ADL were compared. Results The observation group after treatment TAM score was (198.67 ±21.08)point,which was significantly higher than (144.43 ±16.65)point,the difference was statistically significant (t =8.476,P =0.000).Manicure, taking food,combing,brushing teeth,washing face,clothing,shoeing ADL scores in the observation group after treatment were (3.26 ±0.51)point,(3.56 ±0.55)point,(3.68 ±0.72)point,(3.38 ±0.68)point,(3.61 ±0.52)point, (3.55 ±0.61 )point and (2.57 ±0.47)point,which were improved significantly better than those of the control group,the differences were statistically significant (t =4.524,P =0.024;t =5.041,P =0.011;t =4.924,P =0.019;t =4.442,P =0.027;t =5.136,P =0.010;t =5.347,P =0.008).Conclusion Clinical effect of surgery combined with professional rehabilitation on hand burn scar contracture is good,and it is worthy of clinical application.
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Objective To study the clinical characteristics, treatment and prognosis of infective endocarditis in children. Methords Clinical data from 83 patients of infective endocarditis admitted from 1998 to 2012 were retrospectively analyzed. Results In a total of 83 patients, there were 53 males and 30 females, and the average age was 6.8±4.6 years. The main clinical characteristics were fever (77.1%) and mild to moderate anemia (71.1%). The C-reaction protein (67.5%), erythrocyte sedimen-tation rate (60.2%), and white blood cell (47.0%) were elevated. Twenty (24.1%) patients had embolism. Blood culture was pos-itive in 56 (67.5%) cases with bacteria mainly being Gram-positive and Streptococcus and Staphylococcus accounted for 89.3%. Vancomycin and other sensitive antibiotics were effective. Neoplasm was detected in 68 cases (82%) by transthoracic echocar-diograerphy. Fifty-ifve (66.2%) patients underwent cardio surgery. Seven patients (8.4%) died. Conclusion In recent years, the distribution of pathogenic bacteria in infective endocarditis had changed. Streptococcus mitis and Staphylococcus aureus has become a major pathogens and need to be treated by vancomycin and other sensitive antibiotics. The detection rate of neoplasm is higher by echocardiography.
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Objective To investigate the pathogen of 21 infective endocarditis (IE) cases treated with operation in Shanghai Children's Medical Center from 2007 to 2010.Methods Blood culture,vegetation culture and vegetation PCR assay(target gene to the conserved region V3 in 16SrRNA gene) were detected in 21 IE patients; multiplex PCR amplification of staphylococci for methicillin-resistant staphylococcus was performed.Results Of 21 IE cases,20 cases were detected positive by vegetation PCR with the detection rate of 95.2％,12 IE cases were detected positive by blood culture with the detection rate of 57.1％,2 IE cases were detected positive by vegetation culture with the detection rate of 9.5％.The difference of the positive rates of the three methods was statistically significant (P ＜ 0.0001).The vegetation PCR of one case was actinobacillus actinomycetemcomitans,while the blood culture was haemolysis pasteurell which was inconsistent with the vegetation PCR result.Howerver,the PCR result of colony obtained by blood culture was consistent with vegetation PCR that was confirmed as actinobacillus actinomycetemcomitans.The endocardium PCR results of 11 IE cases were consistent with the results of blood culture.MecA gene was detected by multiplex PCR,which could identify methicillin-resistant staphylococcus quickly,sensitively and accurately and could also effectively identify methicillin resistant staphylococcus aureus,when coupled with femA gene detection,thus glycopeptides antibiotic could be prescribed promptly.All the 21 patients recovered and discharged without infection recurrence in the follow-up.Conclusion Universal primer V3 coupled with multiplex PCR can improve vegetation pathogen detection rate of IE patients and is minimally influenced by antibiotic therapy.Multiplex PCR can be applied for etiological diagnosis of IE patients with indication of surgery and negative blood culture or difficult diagnosis,contributing to post-surgery antibiotics selection and improvement of recovery rate of IE patients.
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<p><b>OBJECTIVE</b>To explore the influence of recombinant human growth hormones (rhGH) postburn systemic metabolism.</p><p><b>METHODS</b>Twenty-four burn patients were randomly and equally divided into treatment and control groups. Same amount of rhGH (9 U/d) or isotonic saline was injected subcutaneously to respective patients during 3 approximately 17 postburn days (PBDs). Blood samples were harvested at 3, 10 and 17 PBDs for the determination of serum growth hormone, insulin-like growth factor (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), serum proteins, plasma insulin, plasma glucagons and blood glucose, which were then compared and analyzed between two the groups.</p><p><b>RESULTS</b>The serum levels of GH, IGF-1, IGFBP-3, serum prealbumin and transferrin in rhGH treatment group were evidently higher than those in control groups at 10 and 17 PBDs (P < 0.05 approximately 0.01). But there was no obvious difference in serum albumin, plasma insulin, glucagon and blood glucose (P > 0.05).</p><p><b>CONCLUSION</b>Small dose of rhGH could promote systemic protein synthesis with no side effects on blood glucose levels.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Blood Proteins , Metabolism , Burns , Blood , Growth Hormone , Blood , Pharmacology , Insulin , Blood , Insulin-Like Growth Factor I , Recombinant Proteins , PharmacologyABSTRACT
Objective To analyse the changes of T lymphocytes and its subset in patients with scar hypertrophy. Methods In 6 keloid, 14 hypertrophic scar patients and 10 normal control, peripheral blood T lymphocytes (PBTL) and its subset were analysed with flow cytometry (FCM). Lymphocytic proliferation responsed to Con A stimulation in vitro lymphocytic culture system were performed and lymphocytic proliferation activity were assayed by the measurement of 3H TdR incorporation. Results The percent of CD3 +,CD4 +,CD8 + and ratio of CD4 +/CD8 + in PBTL of keloid patients were 78.6 %, 49.7 %, 23.5 % and 2.4, and in hypertrophic scar patients group were 68.9 %, 47.6 %, 26.6 % and 2.2, in normal control group were 69.2 %, 37.2 %, 30.9 % and 1.9, respectively. Lymphocytic proliferation activity expressed as proliferation stimulation index were 17.4,15.9 and 8.7 respectively in keloid, hypertrophic scar and normal group. The level of CD4 +?CD4 +/CD8 + and lymphocytic proliferation stimulative index were all significantly higher in both keloid and hypertrophic scar patients than that in normal control. Conclusion Aberrant immunologic function may play an important role in the pathogenesis of scar.