Occupation burnout and its influencing factors of rural general practitioners / 中华全科医师杂志

Objective:To survey the status quo of job burnout among rural general practitioners and to analyze its influencing factors.Methods:A total of 2 805 rural general practitioners in three counties in southwest Shandong province were enrolled in the study. The survey was conducted with a basic information questionnaire and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS). The influencing factors of job burnout were analyzed by Pearson chi-square test (χ2) and binary logistic regression model.Results:A total of 2 272 rural general practitioners completed the survey with a completion rate of 81.0%. The rates of middle or high job burnout in the dimensions of emotional exhaustion, depersonalization and reduced personal sense of achievement were 55.1%(1 251/2 272), 34.0%(772/2 272) and 91.3%(2 075/2 272), respectively. Binary logistic regression model showed that working hours/week ≥ 60 h ( OR=1.341, 95 %CI:1.057-1.702, P<0.05), monthly shift times ≥20 ( OR=1.434, 95 %CI:1.182-1.739, P<0.05), daily consultation time≥13 h ( OR=1.294, 95 %CI:1.055-1.589, P<0.05), daily consultation of 11-20 patients ( OR=1.317, 95 %CI:1.075-1.614, P<0.05), no part-time job ( OR=1.583, 95 %CI:1.201-2.087, P<0.05), insomnia ( OR=2.638, 95 %CI:2.225-3.128, P<0.05), feeling depressed at work ( OR=3.170, 95 %CI:2.661-3.776, P<0.05) were risk factors for emotional exhaustion; participation in public health services ( OR=1.485, 95 %CI:1.155-1.910, P<0.05), being married ( OR=2.273, 95 %CI:1.198-4.313), no part-time jobs ( OR=1.677, 95 %CI:1.276-2.203, P<0.05), insomnia ( OR=1.487, 95 %CI:1.211-1.827, P<0.05), and feeling depressed at work ( OR=1.642, 95 %CI:1.339-2.015, P<0.05) were risk factors for depersonalization; working hours/week ≥ 60 h ( OR=2.089, 95 %CI:1.454-3.002, P<0.05), daily consultation time ≥ 9 h ( OR=2.495, 95 %CI:1.748-3.561, P<0.05), insomnia ( OR=2.061, 95 %CI:1.519-2.796, P<0.05), and feeling depressed at work ( OR=1.894, 95 %CI:1.383-2.593, P<0.05) were risk factors for reduced personal achievement. Protective factors included monthly income ≥3 000 Yuan ( OR=0.589, 95 %CI: 0.353-0.982, P<0.05) and monthly shift of 10-19 times ( OR=0.581, 95 %CI:0.411-0.820, P<0.05). Conclusion:The overall job burnout among rural general practitioners in southwest Shandong province is serious, especially the depersonalization and the reduction of personal sense of achievement. It is suggested to improve the salary, reduce the working intensity, optimize the working hours, and pay attention to their physical and mental health for rural general practitioners to alleviate the current situation of their occupational burnout.

Feasibility analysis on membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer.</p><p><b>METHODS</b>The clinical data of 41 patients with advanced distal gastric cancer who underwent laparoscopic gastrectomy using membrane-based right-sided approach for laparoscopic suprapancreatic lymph node dissection at the Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University from January 2016 to January 2018 were retrospectively analyzed. There were 24 males and 17 females with a mean age of 56.8 years and a mean body mass index of 22.6 kg/m². Membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection contained 4 steps briefly: (1) dissection of mesenteria above the head of pancreas: the tri-junction of pancreas-duodenum was cut to expose and identify the logo of Benz;clearance of the membrane of No.5a was performed towards the left, and then expanded to the posterior layer of No.12a. (2) dissection of the V shape dorsal mesogastrium: membrane bridge at splenic artery trunk root was cut; in suprapancreatic space, clearance was performed towards to the left to the middle of the splenic artery trunk and expanded to the posterior Tolds plane upwards to the posterior phrenic angle and retroperitoneal esophagus, then the surrounding tissue of anterior abdominal aorta. (3) dissection of the U shape mesenteria:membrane bridge at common hepatic artery root was cut; mesentery was separated; the left gastric vein was freed and ligated at its root; in posterior pancreatic space, the mesentery of No.7, No.9 and No.8 was dissected in turns; the left gastric artery was high ligated and cut; the portal vein and posterior dorsal mesogastrium Toldt plane was routinely exposed; clearance was performed to right for No.8a and upward to the hepatic portal meeting at posterior mesentery No.12 plane. (4) dissection of the upper triangular area of pylorus: the trigone mesentery was cut along the upper edge of the pylorus; No.12a was swept upward along the gastric ventral mesentery; the upper boundary(No.8a) on the right side of the U-shaped membrane was joined. Intraoperative and postoperative presentations were analyzed.</p><p><b>RESULTS</b>Laparoscopic gastrectomy for advanced distal gastric cancer with membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection was successfully carried out in all the 41 patients. Distal gastric mesenteria en bloc resection was successfully performed. The operation time was (145.2±25.4) minutes and intraoperative blood loss was (53.3±18.3) ml without massive bleeding and severe complication. Number of lymph nodes dissected was 41.1±6.4, and number of suprapancreatic lymph node dissected was 23.3±3.7 without residual cancer at cut margin by pathology. Postoperative drainage volume was (65.8±21.7) ml; time to withdraw of catheter was (7.0±1.7) days; time to fluid intake was (3.5±1.8) days; postoperative hospital stay was (10.4±2.8) days; time to postoperative anal exhaust was (3.3±1.1) days. No complications, such as chyle leakage, postoperative massive bleeding, anastomotic leakage, abdominal cavity infection or gastroplegia occurred within 30 days after surgery.</p><p><b>CONCLUSION</b>Membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer can achieve en bloc resection and conform to the radical principle of oncology, and is safe and feasible.</p>

Research progress on pathogenesis of systemic inflammatory response syndrome in critical illness children / 中国医师进修杂志

Systemic inflammatory response syndrome (SIRS) is a pathophysiological process of critical children.It's pathogenesis involved many sides such as immune dysfunction,gene expression regulation and intestinal barrier.By studying the regulation mechanism of SIRS,early diagnosis of SIRS can be made.According to the inflammatory status and each sides of pathogenesis,effective control results can be taken in time to stop the further developmentof SIRS and improve outcomes of critical children.

Clinical Observation of Albumin Tannate and Barm Powder in the Treatment of Infantile Acute Diarrhea / 中国药房

OBJECTIVE:To observe therapeutic efficacy and safety of Albumin tannate and barm powder in the treatment of infantile acute diarrhea. METHODS:81 cases of infantile acute diarrhea were selected and randomly divided into treatment(41 cas-es)and control group(40 cases). Both groups received routine treatment;treatment group was additionally given Albumin tannate and barm powder orally;control group was additionally given Montmorillonite powder. Clinical efficacy,the taste of drugs and ADR were observed in 2 groups after treatment. RESULTS:There was no statistical significance in total effective rate(97.56%)of treatment group and that (100%) of control group (P>0.05). After treatment,defecation times and urine volume score of treat-ment group were higher than those of control group,with statistical significance(P<0.05). The taste score of Albumin tannate and barm powder(2.93±0.35)in treatment group was significantly higher than(1.25±0.44)in control group,with statistical signifi-cance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Albumin tannate and barm powder and Montmorillon-ite powder have good clinical efficacy and safety in the treatment of infantile acute diarrhea. Albumin tannate and barm powder is better than Montmorillonite powder in improving children’s appetite and relieving abdominal pain. Albumin tannate and barm pow-der tastes better when taking,gain a better adherence in the children patients.

Construction of Recombinant Marek's Disease Virus Expressing the NDV-F gene and its Replication in Chickens and in Vitro / 病毒学报

We used a meq-deleted attenuated MDV-I strain GX0101Δmeq as a vector to construct a recombinant virus expressing the exogenous gene NDV-F. The ORF of exogenous gene NDV-F was inserted into the eukaryotic expression vector pcDNA3.1(-). Then, the expression cassette of NDV-F which contains the CMV promoter was amplified. Simultaneously, we amplified the selected gene Kan+ expression cassette and inserted them into the PMD18-T vector. Tandem expression cassettes were amplified using primers containing the 50-bp homologous arm of MDV-US2. The PCR product was electroporated into EL250 host bacteria containing GX0101Δmeq. Then, the Kan+ expression cassette was deleted from the recombinant virus genome using 1% arabinose. The plasmid of the positive clone which the Kan+ expression cassette was deleted was extracted and transfected into CEFs to rescue the recombinant virus. The recombinant virus was injected into chickens to observe its growth and replication. The recombinant virus rMDV-F containing the exogenous gene NDV-F was rescued successfully. The recombinant virus could duplicate and express well in CEFs, and grow and replicate well in chickens. Using GX0101Δmeq as a vector, combined with a recombinant system of Red E/T and FLP/FRT, we constructed a recombinant virus that expressed the exogenous gene NDV-F. This study could lay the foundation for further study of recombinant viruses.

Investigation on ABO,Rh blood group distribution among 72 928 blood donors in Baoshan city / 国际检验医学杂志

Objective To understand the blood ABO,Rh blood group distribution of the main nationalities in Baoshan city to set up the local rare blood group donors archives for meeting the voluntary blood donor recruitment and the need of clinical blood use. Methods The ABO,Rh were detected by the microplate method.124 RhD negative individuals were extracted and screened for C/c,E/e by the test tube method.Results Among 7 main ethnic groups with blood donor,the ABO blood group distribution of Han, Yi,Bai,Lisu and Hui nationalities were A>O>B>AB;which in Brown and Dai nationalities were O>B>A>AB;the Rh negative ratio was 0.33% in Han,0.35% in Yi,0.09% in Bai,0.00% in Brown,0.32% in Lisu,0.21% in Dai,0.18% Hui;the Rh pheno-types were mainly ccdee (60.5%),Ccdee (33.1 %),CCdee (4.0%)and ccdEe (2.4%).Conclusion The distribution rate of ABO blood group in Han,Yi,Bai,Lisu,Hui blood donors in Baoshan was consistent with the distribution of Han population in China;Brown and Dai are different from Han in China;the Rh negative frequency is 0.00%-0.35%,which reflects the regional and na-tional characteristics of blood group distribution in baoshan city.

Aplplication of quality control circle in the pass rate of PICC maintenance for discharged cancer children / 现代临床护理

Objective To explore the effect of quality control circle(QCC)on the maintenance of peripherally inserted central catheter(PICC)for discharged cancer children.Methods Ninety-seven discharged cancer children with PICC were nursed by QCC, including establishing activity theme,analyzing key factors,making objectives,and working out and manipulating coping strategy. This study also compared the pass rates of PICC maintenance before and after the implementation.Result The pass rate of PICC maintenance was increased from 44.4%before manipulation of PICC to 71.7%after its use(χ2=17.63,P<0.01).Conclusion By the application of QCC,the pass rate of PICC maintenance for discharged cancer children can be effectively raised and the teamwork spirits of nurses may be consolidated as well.

Study on effects of duration of migration to high-altitude on cerebral hemodynamics and their ethnic differences / 中华超声影像学杂志

Objective To study the effects of duration of migration from sea-level to high-altitude on cerebral hemodynamic parameters and their ethnic differences.Methods This randomized comparative study recruited 5 groups of healthy male subjects which were native Hans at sea-level (NHS),Han migrants from sea-level to high-altitude (HMSH,where HMSH-a for residence duration of 4 days,HMSH-b for 1 year,and HMSH-c for 5 years),and native Tibetans at high-altitude (NTH).Color duplex Doppler sonography (CDDS) was used to measure bilateral vertebral and internal carotid arterial diameters,mean flow velocities.The heart rate,arterial blood pressure,and arterial oxygen saturation were also recorded simultaneously,and in combination,hemoglobin was measured to assess total cerebral blood flow (TCBF),total cerebrovascular resistance (TCVR),and total cerebral oxygen supply (TCOS).Results After migration to high-altitude,Hans' TCVR and TCBF maintained the level of NHS after transient changes during early stage (P<0.05),and the TCBF was markedly higher than that of NTH (P<0.05);while the blood pressure and TCOS increased abruptly (P<0.05) at the beginning and kept for a relatively long time at a constant level which were higher than those of NTH all the time (P<0.05).Conclusions Han migrants can acclimate to high-altitude by adaptive change of cerebral blood flow over a short time and maintain a constant adaptability which is always weaker than that of native Tibetans.CDDS can be used for non-invasive measurement of actual cerebral blood flow,and is of good value in the study on high-altitude-related cerebral hemodynamics.

Detection of Transposon Tn5281 Mediating High-level Gentamicin Resistance in Enterococcus faecalis / 中华医院感染学杂志

OBJECTIVE To explore the role of Tn5281 in high-level gentamicin resistance(HLGR) of Enterococcus faecalis. METHODS Fifty four strains of HLGR E.faecalis were tested for Tn5281 by PCR method.The PCR products were confirmed by dot blot hybridization and sequencing.Filter mating method was used to investigate the conjugative plasmid transfer.Antimicrobial susceptibility test was performed by agar dilution method of CLSI/NCCLS. RESULTS Of 54 HLGR E.faecalis strains,27(50.0%) carried different types of Tn5281,with 6 strains carrying complete type,17 strains carrying truncated type Ⅰ(lacked IS256 in the right flanking extremity) and 4 strains carrying truncated type Ⅱ(lacked IS256 in the left flanking extremity).All types of transposons were loaded on plasmids. Among four HLGR E.faecalis in which Tn5281 was successfully transferred to recipient strains by filter mating method,one carried complete type and three carried truncated type Ⅰ.Tn5281 carrying strains had higher resistance rates to penicillin and ampicillin and lower resistance rates to tetracycline and chloramphenicol compared to the strains not carrying Tn5281.(CONCLUSIONS Tn5281) is commonly carried by HLGR E.faecalis.It may integrate into conjugative plasmids and play an important role in the dissemination of HLGR among E.faecalis.

Resistance and Homology Analysis of Acinetobacter baumannii / 中华医院感染学杂志

OBJECTIVE To investigate the resistance and the homology of the Acinetobacter baumannii(ABA) strains isolated from inpatients to offer basis for clinical treatment and preservation.METHODS VITEK2-compact system was used to identify 110 ABA strains,and detect their susceptibility to antibiotics.REP-PCR was carried out to detect their homology.RESULTS The 110 isolated strains were multidrug resistant.Rate of sensitivity to amikacin was 91.3%,Rates of resistance to ceftazadime,ciprofloxacin and imipenem were 100.00%,97.83% and 91.30%,respectively.REP-PCR was confirmed part of them was from the same clone.CONCLUSIONS Most of the isolated strains are multidrug-resistant.The same clone of MDR-ABA probably leads to transmission among patients.

Detection of ?-Lactamase and blaZ Gene of Ampicillin-resistant Enterococcus / 中华医院感染学杂志

OBJECTIVE To detect ?-lactamase of ampicillin-resistant Enterococcus in order to choose drugs for clinical treatment.METHODS According to CLSI's guideline,antimicrobial susceptibility tests were performed:to detect ?-lactamase with nitrocefin,to detect blaZ by PCR and to detect mutation of pbp4 by single-strand conformation polymorphism(SSCP).RESULTS The resistant rates of E.faecium and E.faecalis to ampicillin,penicillin,high level gentamicin,high level streptomycin,levofloxacin,erythromycin,tetracycline,and chloramphenicol were 100%,100%;86%,76%;46%,44%;84%,74%;100%,94%;54%,58%;and 42%,36%;to rifampicin 62%,58%;and to vancomycin both 0%,respectively.The positive rate of ?-lactamase in 50 E.faecalis strains with paper disk method and test tube method was 8% and 26%;and that of blaZ by PCR was 88%.But in 50 E.faecium strains the results were 0% and 2%,respectively.There was no significant mutation by SSCP and sequencing in E.faecalis.CONCLUSIONS The positive rate to ?-lactamase in E.faecalis is markedly higher than in E.faecium.The method of PCR is better than that of nitrocefin.The positive rate of test tube method is higher than paper disk method with nitrocefin.

Detection of Extended-spectrum ?-Lactamases and AmpC ?-Lactamases and Analysis of Drug Resistance in Enterobacter cloacae / 中华医院感染学杂志

OBJECTIVE To investigate the genotypes of extended-spectrum ?-lactamases(ESBLs)and drug resistance in Enterobacter cloacae for clinical treatment.METHODS E.cloacae was identified by VITEK-AMS;ESBLs and AmpC ?-lactamases phenotypes were detected by three-dimensional tests.Detection of ?-lactamases resistant genes were performed by PCR.Plasmid conjugation test was used to determine the location and the transmission of encoding genes of ?-lactamases.The antibotic susceptibility of E.cloacae was detected according to the CLSI guideline.RESULTS The incident rate of ESBLs producing E.cloacae was 48.8% in 86 strains.CTX-M was the main type of ESBLs.The detection rate of CTX-M-3,CTX-M-9,CTX-M-14 and SHV-12 genotypes in isolates were 27.9%,16.3%,3.4% and 18.6%,respectively.Strains producing both ESBLs and AmpC ?-lactamases were 11(12.8%).The strains only producing ESBLs or AmpC ?-lactamases were 31(36.0%) and 8(9.3%),respectively.The sensitive rate of ESBLs isolates to imipenem was 100.0%.Eight ESBLs strains were conjugated successfully.CONCLUSIONS CTX-M and SHV-12 are the main genotypes of ESBLs strains.ESBLs genes can be horizontally transferred to recipient by plasmid conjugated test.

Genotype and Homology Analysis in 37 Vancomycin-resistant Enterococcus faecium Strains / 中华医院感染学杂志

512 ?g/ml for vancomycin.Thirty seven VanA genes were detected in 37 VREFm.The drug resistance rates to erythromycin,ampicillin,levofloxacin,gentamicin,ciprofloxacin,nitrofurantoin(Euradantin) and chloramphenicol were 100.0%,100.0%,89.2%,86.5%,91.9%,59.5%,and 5.4%,respectively.The REP-PCR generated 3-14 bands between 100 and 2000bp.They were divided into six types.CONCLUSIONS There is 100.0% agreement between phenotypes and genotypes in VREFm.VREFm are multiresistant.REP-PCR method is simple,rapid,and with lower cost to detect the homology in enterococci.

Cardiac function change of healthy people after migration from plain to plateau by color Doppler echocardiography / 中华超声影像学杂志

Objective To investigate the relationship of cardiac function and ventricular structure with the training intensity and the periods lived in Tibet.Methods Sixty recruits to Tibet were selected and examined of their cardiac function,cardiac ventricular structure and the changes of elctrophysiology by color Doppler echocardiography and electro cardiogram.They were examined continuously in two years.After their training for three months together,they were divided into the different training intensity groups,Group A and Group B.The 30 recruits in Group A had high-intensity training,and the others in Group B had normal training.Results After three months,their cardiac function and ventricular structure had obvious difference in comparison with the level on plain( P 0.05 ).But there were obvious differences between in Tibet and on plain in the parameters of cardiac function and ventricular structure two years later( P 0.05 ).Conclusions Hypoxia can effect the cardiac function and ventricular structure directly.After three months in Tibet,cardiac function can fit the condition of hypoxia.The parameters of cardiac function are still less than those on plain.The right ventricules are bigger and the pulmonary arteries wider as the main character of the ventricular structure changes.The indexes of cardiac function showed no significant difference with the training intensity and the periods in Tibet.

Study on mutation of pbp5 of ampidllin resistance in enterococcus faedum / 中华检验医学杂志

Objective To study the relationship of ampicillin resistance and?lactamase production, and gene mutation on pbp5 gene fragment in Enterococcus faecium. Methods?lactamase production was tested with nitrocefin, the pbp5 gene fragment of 57 isolates of ampicillin-resistant Enterococcus faecium (ARE. faecium) was amplified by PCR, the mutation of amplified pbp5 gene was detected by single-strand conformation polymorphism(SSCP), the specific mutation types were confirmed by sequencing. Results?lactamase was negative in 57 isolates of ARE. faeciums; there were 3-6 gene mutation sites on pbp5 gene fragment, and the frequent mutation sites were the position 485 ,499 and 466'. Conclusion The gene mutation of pbp5 gene fragment may play an important role in the ARE. faecium.

Detection of partial virulence determinants and phenotypes in Enterococci / 中华检验医学杂志

Objective To investigate the incidence of six virulence determinants and two phenotypes in clinical strains of Enterococci.Methods PCR and dot blot were used to detect the six virulence determinants in 145 clinical isolates. The two phenotypes , including ?-hemolysis and gelatin hydrolyze ,were performed on agar plate containing 7% rabbit blood and Todd-Hewitt agar plate supplemented with 3% gelatin, respectively.Results In E. faecalis and E. faecium ,the rates of detection of the six virulence determinants were gelE72.9% vs 30.6%,efaA79.2% vs 36.7%,cylA54.2% vs 34.7%,esp34.4% vs 36.7%,agg 18.8% vs 0, ace28.1% vs 0, respectively; the ? hemolysis was 45.8% vs 20.4%,the gelatin hydrolyze was 35.4% vs 16.3%.Conclusions E. faecalis possess more virulence determinants and phenotypes than E. faecium do. The virulence determinants are more common among the strains isolated from urine sample than those from among sputum . Most of the E. faecalis carry virulence determinants of gelE,efaA and cylA .

Resistance Analysis and Detection of Resistant Genes in Acinetobacter baumannii / 中华医院感染学杂志

OBJECTIVE To investigate the resistance and the resistant mechanism of the imipenem-resistant Acinetobacter baumannii(IRAb) strains isolated from inpatients to guide for the clinical treatment and prevention.METHODS VITEK2-compact system was used to identify 77 IRAb strains,and to detect their susceptibility to antibiotics.K-B susceptibility testing was used to detect their susceptibility to amikacin and minocycline.PCR was carried out to detect their related genes.RESULTS The 77 isolated strains were multidrug-resistant.The rate of resistance to cephalosporins and quinolones was respectively higher than to amikacin whose sensitivity came to 90%;PCR confirmed OXA-23 was 100% related with IRAbs,OXA-51 was the same.CONCLUSIONS Most of IRAb were MDRAb.The mechanism of A.baumannii(ABA) to imipenem is closely related with OXA-23,K-B susceptibility test is more accurate and minocycline could be used for IRAbs.

Detection of Quinolone Resistance Gene in Enterobacter cloacae / 中华医院感染学杂志

OBJECTIVE To investigate the appearance of quinolone resistance gene(qnr)in Enterobacter cloacae for clinical treatment.METHODS E.cloacae was identified by VITEK-AMS;detection of qnr and extended-spectrum ?-lactamases(ESBLs)resistant genes were performed by PCR.Plasmid conjugation test was used to determine the transmission of qnr.The antibotic susceptibility of E.cloacae was detected according to the CLSI guideline.RESULTS The incident rate of E.cloacae with qnr was 23.6% in 55 strains.The sensitive rate to ciprofloxacin was 46.2% in isolates with qnr,but it was 83.3% in isolates without qnr.qnr Genes of 38.2% ESBLs isolates were positive.Two strains harboring qnr genes were conjugated successfully.CONCLUSIONS ESBLs strains usually harbor qnr genes.qnr Genes can be horizontally transferred to recipient by plasmid conjugated test.