Analysis of bacterial spectrum and variability of drug resistance of bile in patients with common bile duct stones and biliary tract infections / 中华消化杂志

Objective:To analyze the distribution of pathogenic bacteria in bile culture in patients with common bile duct stones and biliary tract infections, in order to guide clinical optimization of antibiotics application.Methods:From March 30, 2017 to December 31, 2021, at Affiliated Hospital of Qingdao University, 753 patients with common bile duct stones and biliary tract infections and received endoscopic retrograde cholangiopancreatography were selected. Bile samples were obtained for bacterial culture, strain type identification and drug sensitivity test in order to analyze bile pathogenic bacteria distribution, change trend and drug resistance. Chi-square test was used for statistical analysis.Results:From 2017 to 2021, the total positive rate of bile culture in 753 patients with choledocholithiasis complicated with biliary tract infection was 90.17% (679/753). From 2017 to 2021, the positive rates of bile culture were 82.05% (64/78), 88.81% (119/134), 88.03% (125/142), 93.87% (199/212), and 91.98% (172/187), respectively, and the difference was statistically significant ( χ2=10.78, P=0.029). The positive rate of bile culture in 2017 was lower than those in 2020 and 2021, and the differences were statistically significant ( χ2=9.43 and 5.57, P=0.002 and 0.018). There were no significant differences in the positive rates of bile culture among the other years (all P>0.05). A total of 1 033 pathogenic bacteria were detected in the 679 bile specimens with positive bile culture results. Among which the total proportion of Gram-negative bacilli was 57.02% (589/1 033), and from 2017 to 2021 the proportions were 66.38% (77/116), 66.47% (111/167), 59.43% (104/175), 54.75% (173/316), and 47.88% (124/259), respectively. The total proportion of Gram-positive cocci was 41.05% (424/1 033), and from 2017 to 2021 the proportions were 31.90% (37/116), 31.74% (53/167), 38.86% (68/175), 44.30% (140/316), and 48.65% (126/259), respectively. The total proportion of fungus was 1.94% (20/1 033), and from 2017 to 2021 the proportions were 1.72% (2/116), 1.80% (3/167), 1.71% (3/175), 0.95% (3/316), and 3.47% (9/259), respectively. From 2017 to 2021, the proportion of Gram-negative bacilli gradually decreased, while the proportion of Gram-positive cocci gradually increased, and the differences were statistically significant ( χ2=20.14 and 17.91, P<0.001 and =0.001). From 2017 to 2021, the change in the proportion of fungus was not statistically significant ( P>0.05). The main Gram-negative bacilli in the bile culture were Escherichia coli (31.36%, 324/1 033) and Klebsiella pneumoniae (12.68%, 131/1 033); the main Gram-positive cocci were Enterococcus faecalis (14.04%, 145/1 033) and Streptococcus salivarius (4.36%, 45/1 033). From 2017 to 2021, the proportions of Escherichia coli were 39.66% (46/116), 38.92% (65/167), 33.14% (58/175), 28.48% (90/316), and 25.10% (65/259), respectively, with gradual decrease and the difference was statistically significant ( χ2=14.34, P=0.006). From 2017 to 2021 the detection rates of extended-spectrum β-lactamase (ESBL) in Escherichia coli and Klebsiella pneumoniae were 30.43% (14/46), 26.15% (17/65), 29.31% (17/58), 38.89% (35/90), 40.00% (26/65), and 4/15, 20.00% (5/25), 20% (5/25), 24.32% (9/37), and 31.03% (9/29), and there were no significant differences in the detection rates of ESBL between different years (both P>0.05). Conclusions:From 2017 to 2021, the positive rate of bile culture in patients with choledocholithiasis complicated with biliary tract infection showed an overall increasing trend. Gram-negative bacilli were still dominated in bile pathogenic bacteria, while the proportion of Gram-positive cocci remarkably increased, and the bile bacterial spectrum significantly changed. Clinicians should adjust the antibiotic dosing regimens according to the variation of bacterial spectrum and drug resistance.

Current status and demand of health services in primary and middle school clinic in 16 provinces of China / 中国学校卫生

Objective@#To analyze the current situation and needs of primary and secondary school health clinic services, and to provide a reference for strengthening school health service in China.@*Methods@#Investigation provinces were selected according to China s three major economic zones, 1 or 2 survey centers were selected from each province, 16 provinces and 26 survey centers were selected. In each survey centers, six schools from primary and secondary schools, junior high schools and high schools in urban and rural areas were randomly selected as research sites. Each research site randomly selected 10 students in each grade(grade three, four, five from primary schools) to fill in the questionnaire anonymously. A total of 4 661 valid questionnaires were collected.@*Results@#Among the services provided by the school clinics to students, "trauma treatment" "consulting health problems" "physical examination" accounted for 49.4%, 40.5% and 39.0% respectively. Within the past one year, 45.1% students went to the school clinic for consultation or consultation 1-3 times, 6.4% for 4-5 times, and 3.7% for 6 times or more. When students were sick in school, 65.8%(primary school), 64.0%(junior high school), and 54.4%(high school) of them selected to go to the school clinic. When suddenly suffered trauma in school, 78.2%(primary school), 73.2%(junior high school) and 69.6%(high school) of the students went to the school clinic.@*Conclusion@#Primary and middle school students have a great demand for school health services, and it is necessary to continue to strengthen the construction of primary and secondary school health clinics.

The expressions and diagnostic values of miR-18a and miR-21 in esophageal cancer / 中华肿瘤杂志

Objective@#To investigate the expressional levels and diagnostic values of miR-18a and miR-21 in esophageal carcinoma.@*Methods@#The expressions of miR-18a and miR-21 in esophageal cancer tissues and adjacent tissues from 45 esophageal cancer patients, peripheral blood from 45 esophageal cancer patients and 50 healthy donors respectively were detected by RT-PCR. The expressions of miR-18a and miR-21 in normal esophageal epithelial cell HET-1A, esophageal cancer cell lines including ECA109, KYSE150 and TE1 were also detected. Chemiluminescence immunoassay was used to quantitatively detect the concentrations of carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), CYRFA21-1 and TPA (tissue polypeptide antigen) in peripheral blood serum from esophageal cancer patients and healthy controls. Meanwhile, the diagnostic effects of miR-18a and miR-21 on esophageal cancer were compared with those of tumor markers in serum.@*Results@#The expression levels of miR-18a and miR-21 in esophageal cancer cells ECA109, KYSE150 and TE1 were 1.64±0.17, 1.62±0.19, 1.46±0.12 and 20.52±1.48, 6.73±0.73, 1.43±0.19, respectively, higher than those in normal esophageal epithelial cells (both P<0.01). The expressions of miR-18a and miR-21 in esophageal cancer tissues were 32.48±28.62 and 8.67±11.98, respectively, significantly higher than those in adjacent tissues (all P<0.001). The expression levels of miR-18a and miR-21 in peripheral blood of patients with esophageal cancer were 12.66±11.92 and 9.15±8.14, respectively, significantly higher than those in the normal control group (both P<0.001). The receiver operating characteristic (ROC) curve analysis showed that the area under the curve of miR-18a and miR-21 for diagnosis of esophageal cancer were 0.948 and 0.913 5, respectively. Compared with traditional esophageal tumor markers, the expressions of miR-18a and miR-21 were more sensitive in the diagnosis of esophageal cancer. The sensitivity and accuracy of the expressions of miR-18a and miR-21 combined with traditional esophageal tumor markers in diagnosis of esophageal cancer can be further improved to 97.8% and 68.4%, respectively.@*Conclusion@#Our study reveals that the expressions of miR-18a and miR-21 play important roles in the diagnosis of esophageal cancer and may be potentially novel biomarkers.

Application and evaluation of wireless mobile infusion system in the outpatients and emergency patients / 中国实用护理杂志

Objective To evaluate the apphcation of wireless mobile infusion system in the outpatients and emergency patients.Methods A total of 566 outpatients and emergency patients with infusion were divided into the observation group and the control group according to the order of infusion.The observation group with 297 cases was used wireless mobile infusion system,and the control group with 269 cases was used traditional infusion method.The reception time,infusion waiting time and satisfaction for nurses' job of patients between two groups were compared.The satisfaction for job of nurses among different work models were compared,too.Results The reception time,infusion waiting time of patients in the observation group were less than those in the control group:(2.07±0.26) min vs.(3.17±0.26) min,(9.89±0.31) min vs.(13.49± 0.21) min,and there were significant differences,P＜0.01.The satisfaction for nurses' job of patients in the observation group were better than those in the control group,x2=8.921,7.064,5.251,and there were significant differencs,P＜0.05.The satisfaction for job of nurses in the observation group was better than that in the control group,and there was significant difference,P＜0.05.Conclusion Wireless mobile infusion system can improve work efficiency,guarantee the safety of infusion,improve patients and nurses' satisfaction.

Measurement and correlation analysis of plasma VEGF level in the patients of hyperthyroidism / 生物医学工程学杂志

Vascular endothelial growth factor (VEGF) is a glycoprotein that promotes endothelial regeneration, stimulates formation of collateral blood vessels and increases vascular permeability. The purpose of this study was to measure the peripheral blood plasma level of VEGF and FT3, FT4, TSH and to analyze the correlation of the level of VEGF and TSH, FT3, FT4, age and gender in the patients of hyperthyroidism. The relationship between hyperthyroidism and VEGF was investigated as well. The plasma level of VEGF in 45 hyperthyroidism patients and 27 healthy persons were measured by enzyme-linked immunosorbent assay (ELISA), while plasma FT3, FT4, TSH were detected by chemiluminescence. The result showed that the plasma level of VEGF in hyperthyroidism patients [(92.53 +/- 62.38) pg/mL] was significantly lower than that in the control group [(158.28 +/- 77.15) pg/mL] (P < 0.01). The plasma level of VEGF correlated with age, and that of those over 40Y was significantly higher than that of 40Y or younger (P < 0.05) in healthy group. Whereas there was no correlation among VEGF, TSH, FT3, FT4, age and gender in hyperthyroidism patients (P > 0.05). These results suggested that the peripheral blood plasma level of VEGF in hyperthyroidism patients was significantly lower than that in the control group. Further experimental investigations are needed to estimate the relationship between VEGF and hyperthyroidism.

Development of community health information systems in Zhabei District, Shanghai / 中华医院管理杂志

The paper covered the development, structure, functionality, effectiveness and goals of the community health information system in the district. It is found that Zhabei district has developed the standard electronic health archives which can be collected by various sources and renewed instantly;regional health information sharing and collaboration platform has been established as well; a sharing and joint service platform has been built for regional health information sharing between communities and secondary hospitals shared; "Health key" has been developed as a model for self-service health management for residents.

Outline of research into the management system reform in community health services in Zhabei District of Shanghai / 中华医院管理杂志

The paper gives an account of the background, feasible model, content and procedure of the reform in community health services in Zhabei District of Shanghai and the content, method and preliminary conclusions of periodic evaluations of the reform. Taking the management system as its starting point, selecting the model of delegation management, and focusing on the basic idea of “separation of two powers and delegation of three powers”, the reform went ahead on two fronts: the health bureau and the centers for community health services. Experts making external periodic evaluations hold that the adoption of delegation management contributes to innovations in the internal operating systems, the improvement of community health services and the enhancement of economic compensation capability. However, some problems still remain to be solved. [

Analysis of the scores of 456 doctors from 72 township health centers in a written knowledge test / 中华医院管理杂志

doctors from 72 township health centers in 3 counties of Jiangxi Province were given a written test in basic medical knowledge, clinical knowledge of prevention and healthcare and professional knowledge. The rate of excellence of the scores was 45.4% while the rate of failure was 16.9%. A comparative analysis is made of the differences in the scores of doctors of different sexes, ages, specialties, educational backgrounds, and professional titles. It is suggested that it is imperative to conduct training for all doctors so as to enhance the overall quality, to lay stress on the key points and focus on the tackling of the weak links, and to perfect the mechanism so as to promote the renewal of knowledge.

Enforcing government purchases and setting up sustainable fundraising mechanisms for community health services / 中华医院管理杂志

In order to set up sustainable fundraising mechanisms for community health services, it is necessary to calculate the sum of compensation needed for basic public health services and formulate compensation policies on the basis of defining items of basic public health services and in accordance with the economic levels of various regions. At the same time, it is necessary to enforce government purchases after working out strict assessment criteria so as to ensure that funds for community health services are genuinely devoted to basic public health services.

Relationship between doctors'service quality and benefit in township public health centers / 中华医院管理杂志

Objective To better understand the relationship between doctors service quality and benefit in township public health centers so as to grasp the priorities of management and reform and promote the healthy development of the health cause. Methods The method of single factor analysis was combined with the method of stepwise logistic regression analysis. Results The study indicates that doctors delivering high quality service on average see more patients per day and contribute more to the business income and that service expenses are lower for patients seeking service from doctors who on average see more patients per day. Conclusion There is a positive correlation between doctors service quality and benefit in township public health centers.

THE RESEARCH ABOUT SERUM TRACE ELEMENTS OF 7-20 YEARS-OLD POPULATION IN SHANGHAI / 营养学报

Seventeen trace elements, including twelve essential trace element, and three normal elements in serum of 417 healthy students aged 7 to 20 in Shanghai were analysed. Except Se which was determined by catalytic pulse polarography, Zn, Cu, Fe, Mn, Cr, Mo, Si, Sn, Ni, V, Co, Cd, Pb, Al, Ti, Sr, Ca, Mg and P in serum were measured by ICP-AES. The result showed that the distribution curve of normal elements and Zn, Cu in serum was more concentrated than the other trace elements. There were significant positive correlation between serum Zn, Fe, Mn, Sr and age, and negative correlation between Cu, Cr, Se, Pb and age, respectively. The elements of males were the same as that of females in total population, but the majority of the elements in serum had sex difference in different age-groups. The serum Cr, Si, Pb contents were higher, and Cu, Fe, Mn, Sr were lower in the urban than in the rural adolescents.