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Pancreaticobiliary maljunction means the common bile duct and the main pancreatic duct in the duodenal wall, or is the formation of a long common channel leading to biliopancreatic reflux, resulting a series of biliopancreatic diseases, and even the occurrence of biliary malignancy. The pathogenesis of pancreaticobiliary maljunction is complex, involving biliary fluid dynamics, the activation of phospholipase A2, protease activation, amino acids, fat metabolism, gene mutation. This paper summarized the latest study of the pathogenesis of the pancreaticobiliary maljunction to let clinicians understand pancreaticobiliary maljunction diseases, and provide new treatment ideas.
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Objective:To acquire more scientific, accurate and efficient unplanned extubation (UEX) quality management data by using information technology to directly take the quality index data of unplanned extubation from the nursing medical record system.Methods:From June 2019 to August 2019, a knowledge base of pipeline management including the name of pipeline, pipeline evaluation, pipeline care measures, and reasons for unplanned extubation of pipeline was established in Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine. Through the analysis of each node of pipeline management, pipeline management system was established. And the non-planned pipeline management data set was directly collected to the nursing quality management system for statistics and analysis, which was verified.Results:In clinical application from September 2019 to september 2020, the direct collection of unplanned extubation quality index data saved 496 hours of nursing labor costs per month, and the accuracy of direct data collection increased from 95.8% (161/168) in trial operation to 100.0% (494/494). The underreporting rate of adverse events decreased to 0. Satisfaction with the application of the quality index management system for unplanned extubation was (4.35 ± 0.73) points.Conclusions:The direct collection of quality index data for unplanned extubation improves the accuracy of the data. Nurses no longer need to report unplanned extubation incidents. The clinical nursing information system and the nursing management system are interconnected to improve the management efficiency of unplanned extubation. It is worthy of application and promotion in clinic.
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To develop a quality control checklist for the prevention and control of coronavirus disease 2019 （COVID-19） in fever clinic and isolation ward of the general hospital and to assess its application. Based on the relevant prevention and control plans and technical guidelines for COVID-19，Delphi method was used to identity items for evaluation，and a quality control checklist for the prevention and control of COVID-19 in the fever clinic and isolation ward was developed in Sir Run Run Shaw Hospital. The checklists included 8 dimensions and 32 items for fever clinic，7 dimensions and 27 items for the isolation ward. The appointed inspectors conducted daily quality control for each shift with this checklist. The expert authority coefficient was 0.88，the mean of the importance of each index in the quality control table was not less than 4.8，and the coefficient of variation was not more than 0.07. During the entire February 2020，8 problems were found and rectified on-the-spot with the application of the checklist. Quality inspection rate was 100% in both isolation wards and fever clinic. The compliance rate and accuracy rate of hand hygiene were 100%; the correct rate of wearing and removing protective equipment increased from 96% to 100%. During the same period，a total of 1915 patients were admitted to the fever clinic，including 191 suspected patients （all were isolated in the hospital，3 were confirmed）. There were no medical staff infected with COVID-19，no cross infection of patients and their families in the hospital. A quality control checklist for the prevention and control of COVID-19 has been developed and applied in the isolation wards and fever clinic，which plays an important role in preventing nosocomial infection.
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Humanos , COVID-19 , Lista de Checagem , Febre , Hospitais Gerais , SARS-CoV-2RESUMO
In the past, hernia and abdominal wall surgery has been ignored, which may endanger the life of patients due to untimely treatment. In 1997, the concept of tension-free hernia repair was introduced to China. Chinese hernia and abdominal wall surgery entered a new era and developed rapidly. In 2015, scholars in China decided to create our own Hernia Registry. In 2017, Hernia Registry was officially released, and the Chinese Hernia Surgery Alliance was established in the same period. The Chinese Hernia Registry has became the second largest Hernia clinical registry database in the world. Although the follow-up rate needs to be improved, it is possible to have a preliminary understanding and analysis of the incidence of hernia disease in China. There are many difficulties in its application, and it requires the multi-level coordination and long-term commitment. The authors hope that through this work, the diagnosis and treatment of hernia and abdominal wall can be improved, and the ability of communication and cooperation at home and abroad will be enhanced, benefiting the general population of hernia patients.
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Objective:To analyze the relationship between plasma fibrinogen(FIB) within normal range and microalbuminuria in elderly patients with type 2 diabetes mellitus.Methods:A total of 869 elderly subjects with type 2 diabetes mellitus admitted to the Department of Endocrinology of Shanghai Fifth People′s Hospital from October 2012 to October 2014 were included in the study. The patients were divided into four groups based on the quartile level of FIB: Q1 group(<2.42 g/L), Q2 group(2.42-2.89 g/L), Q3 group(2.90-3.61 g/L), and Q4 group(≥3.62 g/L). The relationship between FIB and urinary albumin/creatinine ratio(UACR) was analyzed.Results:With the increasing of FIB, the level of UACR was significantly elevated( P<0.05). Pearson correlation analysis showed that FIB was positively associated with age, duration of diabetes, creatinine(Cr) and UACR in men and women( P<0.01). Multiple regression analysis showed that FIB was an independent factor of UACR( P<0.01). Logistic regression analysis showed that the risks of microalbuminuria and macroalbuminuria were respectively 4.536 folds(95% CI 2.516-8.175, P<0.01) and 13.314 folds(95% CI 2.925-60.612, P<0.01) in Q4 group, and 2.177 folds(95% CI 1.273-3.724, P<0.01) and 4.098 folds(95% CI 1.101-19.226, P<0.05) in Q3 group as compared with Q1 group after adjused by following factors: gender, age, duration of diabetes, body mass index(BMI), systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting plasma glucose(FPG), HbA 1C, total cholesterol(TC), triglyceride(TG), low density lipoprotein-cholesterol(LDL-C), Cr, alanine aminotransferase(ALT), as well as smoking and drinking behavior. Based on the cut off values to UACR 30 mg/g and 300 mg/g, the receiver operating characteristic curve(ROC) was used to evaluate the value of FIB for UACR. The optimal cut-off value of FIB was 3.18 g/L and 3.22 g/L respectively. Conclusions:Plasma FIB was closely associated with microalbuminuria in elderly patients with type 2 diabetes mellitus, which may be considered as one of the predictors for diabetic nephropathy.
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The clinical application of digestive endoscopic technique in the field of pancreaticobiliary diseases profoundly affects or even overturns many traditional thoughts. From endoscopic sphincterotomy and endoscopic biliary drainage to endoscopic ultrasonography-guided drainage and debridement of infectious pancreatic necrosis, and pancreatic pseudocyst drainage at present, digestive endoscopic technique helps to achieve revolutionary changes in disease diagnosis and treatment, especially during the past two or three years. In order to help clinicians in the field of pancreaticobiliary diseases quickly understand the latest research advances in digestive endoscopy and related advanced techniques, this article elaborates on the latest research advances in digestive endoscopy in the field of pancreaticobiliary diseases.
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Objective Chorioamnionitis in pregnancies with preterm premature rupture of membranes(PPROM) may lead to perinatal morbidity. There is no definite diagnostic method for detecting chorioamnionitis before delivery. In this retrospective study, the diagnostic value of five inflammatory markers, including white blood cell (WBC), neutrophil percentage (NEU), c-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) of subclinical chorioamnionitis in PPROM were investigated. Methods A total of 74 PPROM (Group A: 21 PPROM without infection; Group B: 43 PPROM with subclinical chorioamnionitis;Group C:10 PPROM with chorioamnionitis) and 46 controls (Group D:normal full-term pregnancies) were recruited from the Third Affiliated Hospital of Army Medical University between 2013 and 2017. The five markers were measured within 24 hours before the delivery. The diagnostic value of inflammatory markers for subclinical chorioamnionitis were assessed by t test and ROC curve. Results The levels of WBC, NEU and IL-6 in group A were significantly higher than those in group D (T=5.412, Z=-3.312, T=2.798, all P<0.05). The levels of five inflammatory markers in group B and C were all significantly increased compare with group D(Zb=-5.797, Zb=-5.296, Zb=-5.116, Zb=-3.279, Zb=-4.36, Tc=7.732, Zc=-4.622, Zc=-4.591, Zc=-3.509, Zc=-4.387,all P<0.05). Group B CRP, IL-6 and PCT levels were significantly higher than those of group A(Z=-3.10, Z=-2.95, Z=-2.202, all P<0.05). All five markers of group C were significantly higher than those of group A(T=-5.285, Z=-2.536, Z=-3.819, Z=-3.228, Z=-3.719, all P<0.05). The levels of WBC, NEU and IL-6 in group C were significantly higher than those in PPROM group B(Z=-3.296, T=-2.738, Z=-3.501, all P<0.05). In terms of predictive capability of subclinical chorioamnionitis, the individual area under ROC curve (AUC) of CRP, IL-6, and PCT were 0.740, 0.671, and 0.728 corresponding to the optimal cutoff 10.3 mg/L, 5.995 pg/ml, and 0.055 ng/ml respectively. The sensitivity value were 39.5％, 60.5％ and 74.4％, the specificity value were 100％, 85.7％and 61.9％.The area under the ROC curves of CRP+IL-6,CRP+PCT,IL-6+PCT and CRP+IL+6+PCT were 0.746, 0.805, 0.776 and 0.816. The sensitivity value were 51.2％, 74.4％, 81.4％ and 62.8％, the specificity value were 95.2％, 81％, 66.7％and 90.5％. Conclusions The model (combined with PCT, CRP and IL-6) may be helpful for the diagnosis of the subclinical chorioamnionitis in PPROM. Combined diagnosis of two markers in PCT,CRP and IL-6 could be superior to single inflammatory marker. Combined diagnosis of three could be better,which may provide a reference for clinical diagnosis.
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The different extracts and of Viola yedoensis Makino and Viola inconspicua were analyzed and identi-fied by Fourier transform infrared spectroscopy (FT-IR). One-dimensional infrared spectrum showed that the extracts of Viola yedoensis Makino and Viola inconspicua contained the aromatics,volatile substances and glyco-sides,with not significant differences from each other. However,different extraction sites of the two medicinal materials in second derivation spectrum were obviously different,especially the number of automatic peaks and peak intensity in the range of 970 800 cm-1. Viola yedoensis Makino displayed 5 automatic peaks,6 automatic peaks and 6 automatic peaks,while Viola inconspicua displayed 7 automatic peaks,4 peaks,4 peaks in the second derivation spectrum of petroleum ether extraction site,chloroform extraction site and the ethyl acetate extraction site. In addition,the peak position of the strongest peak in the second derivative of the ethyl acetate extraction site was 1 467 cm-1,while the strongest peak of the Viola inconspicua was at 1 384 cm-1,so the two medicinal mate-rials can be distinguished by the strongest peak position of ethyl acetate extraction site in second derivation spec-trum. Studies demonstrated that one-dimensional infrared spectroscopy combined with the second-order derivative analysis could achieve the accurate identification between Viola yedoensis Makino and Viola inconspicua. This research provides new ideas and new methods for the identification of Viola and other adulterants.
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Hernia is a most common disease requiring surgery.In recent years,the number of newly emerging patients with inguinal hernia is 300-400 million cases per year and surgical amount of tension-free hernia repair surpasses 150 million cases per year in China.However,overall effects of hernia treatment are unsatisfactory and complications such as postoperative infection,chronic pain and hernia recurrence have troubled clinical surgeons and patients.How to improve diagnosis and treatment of hernia and abdominal wall surgery,how to achieve clinical data accumulation with which to evaluate,monitor and normalize medical behavior,how to realize polycentric data sharing,Chinese hernia registry and follow-up system provides effective helps for above mentioned aspects,especially lays a solid foundation for clinical standardization,quality monitoring,scientific research enhancement,ultimately provides mutual rewarding for both patients and clinical surgeons.
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Objective To analyze the risk factors for ventilator-associated pneumonia(VAP) in the intensive care unit(ICU) of a hospital,and provide theoretical reference for preventing and controlling VAP.Methods ICU patients receiving mechanical ventilation for more than 48 hours between October 2013 and December 2014 were monitored by targeted monitoring method,risk factors for the occurrence of VAP were analyzed.Results A total of 483 patients received mechanical ventilation for more than 48 hours,76 (15.73％) of whom developed VAP;the overall ventilator days were 5 347 days,incidence of VAP was 14.21 per 1 000 ventilator days.Univariate analysis showed that groups of gender,age,length of hospital stay,and duration of artificial airway were all significantly different,VAP rate in male patients was higher than that in female patients(x2 =9.838,P＜0.01);VAP rate was highest in patients aged 41-70 years(x2 =10.242,P＜0.01),followed by patients aged≥71 years;VAP rate were relatively higher in patients with longer length of hospital stay and longer duration of artificial airway(x2 =59.533,P＜0.01;x2 =74.215,P＜0.01,respectively).Conclusion Incidence of VAP in the ICU of this hospital is higher,especially in male patients,patients aged 41-70 years,as well as patients with long length of hospital stay and long duration of artificial airway.
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Objective To intervene hand hygiene(HH)of health care workers (HCWs)in an intensive care unit(ICU)of a hospital,and evaluate HH compliance of HCWs and influencing factors.Methods 37 HCWs from an ICU of a teaching hospital were chosen as studied subjects,HH status before and after intervention was observed and analyzed by direct and indirect methods.Results In the first monitoring stage,HH rate in baseline and post-intervention survey stage was signifi-cantly different (46.96% vs 63.30%,χ2 =7.344,P =0.007);in the second monitoring stage,HH compliance rate in-creased from 57.85% to 88.58%.HH compliance rate was positively correlated with consumption of HH product per bed-day(r=0.725,P <0.001),but negatively correlated with incidence of healthcare-associated infection(HAI)and case rate of HAI(r=-0.983,-0.990,respectively,both P <0.001),HH rate to alcohol-based hand sanitizers was positively correlated with consumption of HH product per bed-day (r=0.391,P <0.001 ).Conclusion Long-term monitoring and intervention of HH compliance is necessary,combination of direct observation and indirect assessment of HH product con-sumption is helpful for effective monitoring and intervention of HH compliance among HCWs.
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Objective To evaluate the effects of various head and neck postures and phonation on oropharyngeal view(Mallampati score),and ex-plore the correlation with laryngoscopic view tested by the improved Cormach-Lehane score(MCLS). Methods Following the local ethics commit-tee approval and patients′informed consent to anesthesia,124 patients were enrolled for this study. Prior to anesthesia,these patients were placed in supine position with various head and neck positions for oropharyngeal structures visualization and evaluation,including two head positions(neu-tral and full extension),two tongue positions(in and out),and with and without phonation,according to the modified Mallampati test score(MMT). Following induction,laryngoscopic view scores according to MCLS were recorded,then the sensitivity,specificity,positive and negative predictive value and accuracy of the various MMT scores were calculated. Correlation coefficient(r)of MMT scores with MCLS were also studied. Results Mallampati score was decreased in all the postures of head full extension,tongue outside and phonation,which makes oropharyngeal structures to be better visualized. There is no correlation between MMT scores and MCLS. The sensitivity,specificity,positive and negative predictive value and accu-racy of the various MMT scores is most satisfied in the posture of head full extension,tongue outside and phonation. Conclusion During airway as-sessment in supine position,the best posture is head full extension,tongue outside and phonation.
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Objective To improve health care workers’(HCWs)infection prevention and control consciousness through carrying out catheter-associated urinary tract infection(CAUTI)prevention and control project,and imple-ment prevention and control measures in practical work.Methods Diagnostic criteria of CAUTI issued by the U.S. Centers for Disease Prevention and Control/National Healthcare Safety Network were adopted,from October 2013 to September 2014,monitoring was conducted on CAUTI in patients with indwelling urinary catheters for >2 con-secutive days at different types of ICUs in hospitals participated in the project .Results A total of 14 124 CAUTI cases were collected,410 patients developed CAUTI,urinary catheter usage rate was 79.33%(203 114/256 042), incidence of CAUTI was 2.02‰(410/203 114),urine specimen detection rate was 46.52%(6 570 /14 124).The detection rate of urine specimens increased from 37.24% (the fourth quarter of 2013)to 49.76% (the third quarter of 2014).Of prevention measures,the difference in the indication of catheterization was significantly different(P <0.01).Conclusion Through the development of competence building project of healthcare-associated infection pre-vention and control,prevention and control of CAUTI has achieved good intervention effect.
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Total 406 community residents entered in fitness improvement program with “management by objectives model of health promotion” from 2009 to 2011.The fitness status was monitored by Xuhui Physical Constitution Center before and after entering the program.The results showed that the level of fitness assessment,the composite score,lung capacity and reaction time were improved with the years (P ＜ 0.01) ; the step index and sitting-and-reach test in 2010 was better than those in 2009(P ＜ 0.01) ; the grip strength in 2010 and 2011 was better than that in 2009 (P ＜ 0.01); the test of single leg-standing with closing eyes in 2011 was better than that in 2009(P ＜ 0.05).There was no difference in body mass index before and after program (P ＞ 0.05).The results indicate that physical fitness and overall health can be improved by management by objectives model for health promotion.
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Objective To investigate perioperative nursing of interventional therapy for patients with chronic occluded internal carotid artery. Methods We retrospectively analyzed the clinical nursing data of 12 patients with chronic occlusion of internal carotid artery who were successfully performed recanalization for the occluded vessels. Results The vital signs of all patients were normal during the procedures. The patients got favorable outcomes and no complications occurred during the perioperation. Conclusions Interventional therapy for chronic occlusion of internal carotid artery is a new technology for carotid diseases. Perfect preoperative health education and psychological nursing, comprehensive monitoring of vital signs and nerve function, strengthening body position nursing can ensure prevention of complications and the success of surgery.