How to Navigate Challenging Patient Encounters in Dermatology Residency.

Dermatology residents experience a variety of challenging clinical encounters in their work. There are multiple factors that can contribute to the clinical situation to make it challenging-not only for the resident but also for the patient. Thankfully, there are several strategies published in the medical literature that may be utilized to mediate conflict resolution and de-escalate tension in the dermatology clinic.

Microneedle-Coupled Epidermal Sensors for In-Situ-Multiplexed Ion Detection in Interstitial Fluids.

Maintaining the concentrations of various ions in body fluids is critical to all living organisms. In this contribution, we designed a flexible microneedle patch coupled electrode array (MNP-EA) for the in situ multiplexed detection of ion species (Na+, K+, Ca2+, and H+) in tissue interstitial fluid (ISF). The microneedles (MNs) are mechanically robust for skin or cuticle penetration (0.21 N/needle) and highly swellable to quickly extract sufficient ISF onto the ion-selective electrochemical electrodes (∼6.87 µL/needle in 5 min). The potentiometric sensor can simultaneously detect these ion species with nearly Nernstian response in the ranges wider enough for diagnosis purposes (Na+: 0.75-200 mM, K+: 1-128 mM, Ca2+: 0.25-4.25 mM, pH: 5.5-8.5). The in vivo experiments on mice, humans, and plants demonstrate the feasibility of MNP-EA for timely and convenient diagnosis of ion imbalances with minimal invasiveness. This transdermal sensing platform shall be instrumental to home-based diagnosis and health monitoring of chronic diseases and is also promising for smart agriculture and the study of plant biology.

Effects of the expression of miR-375 on the proliferation and invasion of choroidal melanoma cells / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of the expression of miR-375 on the proliferation and invasion of choroidal melanoma(CM)MUM-2B cells.METHODS: MUM-2B cells were cultured and were transfected with miR-375 mimic sequence(mimic group), miR-375 inhibitor sequence(inhibitor group), negative control group and no treatment(blank group). The qRT-PCR, CCK-8, apoptosis and Transwell experiments were used respectively to detect the expression of miR-375, cell proliferation activity, apoptosis, cell migration and invasion.RESULTS: Compared with the negative control group(1.01±0.10)and the blank group(1.03±0.07), the expression level of miR-375 in the cells of the mimic group(2.65±0.15)was increased, while the expression level of miR-375 in the cells of the inhibitor group(0.28±0.06)was decreased(P<0.05). Compared with the blank group and negative control group, the OD values of the cells in the mimic group at 24, 48, 72, and 96h were decreased(P<0.05), while the OD values of the cells in the inhibitor group at 24, 48, 72, and 96h were increased(P<0.05). Compared with the apoptosis rates in the blank group and negative control group, which were(20.54±4.01)% and(22.80±4.28)%, the apoptosis rate in the mimic group(39.11±3.37)% was increased(P<0.05), while it was decreased in the inhibitor group(10.13±2.17)%(P<0.05). Compared with the blank group and negative control group, the number of migration cell and the number of invasion cell in the mimic group were decreased(P<0.05), while the number of migration cell and the number of invasion cell in the inhibitor group were increased(P<0.05). CONCLUSIONS: Up-regulating the expression of miR-375 in MUM-2B cells can reduce cell proliferation activity, accelerate cell apoptosis, and inhibit cell migration and invasion, while down-regulating the expression of miR-375 has the opposite effect. It indicates that miR-375 may play the function of tumor suppressor in the course of CM.

Emerging blood exosome-based biomarkers for preclinical and clinical Alzheimer's disease: a meta-analysis and systematic review.

Blood exosomes, which are extracellular vesicles secreted by living cells into the circulating blood, are regarded as a relatively noninvasive novel tool for monitoring brain physiology and disease states. An increasing number of blood cargo-loaded exosomes are emerging as potential biomarkers for preclinical and clinical Alzheimer's disease. Therefore, we conducted a meta-analysis and systematic review of molecular biomarkers derived from blood exosomes to comprehensively analyze their diagnostic performance in preclinical Alzheimer's disease, mild cognitive impairment, and Alzheimer's disease. We performed a literature search in PubMed, Web of Science, Embase, and Cochrane Library from their inception to August 15, 2020. The research subjects mainly included Alzheimer's disease, mild cognitive impairment, and preclinical Alzheimer's disease. We identified 34 observational studies, of which 15 were included in the quantitative analysis (Newcastle-Ottawa Scale score 5.87 points) and 19 were used in the qualitative analysis. The meta-analysis results showed that core biomarkers including Aß1-42, P-T181-tau, P-S396-tau, and T-tau were increased in blood neuron-derived exosomes of preclinical Alzheimer's disease, mild cognitive impairment, and Alzheimer's disease patients. Molecules related to additional risk factors that are involved in neuroinflammation (C1q), metabolism disorder (P-S312-IRS-1), neurotrophic deficiency (HGF), vascular injury (VEGF-D), and autophagy-lysosomal system dysfunction (cathepsin D) were also increased. At the gene level, the differential expression of transcription-related factors (REST) and microRNAs (miR-132) also affects RNA splicing, transport, and translation. These pathological changes contribute to neural loss and synaptic dysfunction. The data confirm that the above-mentioned core molecules and additional risk-related factors in blood exosomes can serve as candidate biomarkers for preclinical and clinical Alzheimer's disease. These findings support further development of exosome biomarkers for a clinical blood test for Alzheimer's disease. This meta-analysis was registered at the International Prospective Register of Systematic Reviews (Registration No. CRD4200173498, 28/04/2020).

Colorimetric microneedle patches for multiplexed transdermal detection of metabolites.

Skin Interstitial Fluid (ISF) is an alternative source for biomarkers. Herein, a highly swellable microneedle patch (MNP) to rapidly extract ISF painlessly and bloodlessly is presented. The MNP is made of crosslinked methacrylated hyaluronic acid (MeHA) and dissolvable hyaluronic acid (HA) with the optimal balance of mechanical strength (0.6 N/MN) and absorption capability (16.22 µL in 20 min). Incorporated with wax-patterned and sensing-reagent-decorated test paper (TP) for multiplexed colorimetric detection of metabolites (glucose, lactate, cholesterol, and pH), this TP-MNP biosensor gives rapid color change in biomarker concentration-dependent manner based on specific enzymatic reactions, whereby allowing diagnosis by the naked eye or quantitative RGB analysis. Both the in vitro and in vivo experiments demonstrate the feasibility of TP-MNPs to detect multiple biomarkers in skin interstitial fluid within minutes. Such convenient and self-administrable profiling of metabolites shall be instrumental for home-based long-term monitoring and management of metabolic diseases.

Cystic Neutrophilic Granulomatous Mastitis Regression with the Tumor Necrosis Factor-α Inhibitor, Adalimumab.

Idiopathic granulomatous mastitis (IGM) is a rare, benign, inflammatory breast disease that primarily affects parous women within a period of five years post-partum. Cystic neutrophilic granulomatous mastitis (CNGM) is clinically identical to IGM, but histopathology demonstrates distinct central lipid vacuoles rimmed by neutrophils with an outer cuff of epithelioid histiocytes/granulomas, with inconsistent presence of Coryneform bacteria within the vacuoles. There is no consensus on the treatment for either IGM or CNGM, which may be managed surgically with wide local excision or mastectomy or medically with antibiotics, steroids, and steroid-sparing immunosuppressive agents. We present a 30-year-old woman with plaque psoriasis and CNGM whose breast symptoms resolved after treatment with the tumor necrosis factor alpha (TNF-α) inhibitor adalimumab, which has not previously been described as a treatment option for CNGM.

Impact of Video Technology on the Comprehension of Patients With First Insulin Injection and the Efficiency of Nurse Education.

This study aims to compare the effectiveness of video and paper materials used for teach-back education on the first insulin injection for patients with diabetes. The study enrolled 110 patients hospitalized for diabetes who had received education on their first insulin injection in the endocrinology department. The patients were divided into an intervention group (n = 55) and a control group (n = 55) using convenience sampling. Video materials were employed for the teach-back education of the intervention group, while paper materials were employed for the teach-back education of the control group. We compared cases who answered correctly to the common parts (selection and management of injection devices, selection and rotation of injection sites, proper use of injection angles and pinching, insulin storage, injection-related complications and their prevention, selection of the correct needle length, and safe disposal of needles after use) for the first time, the number of educational sessions and total education duration between the two groups and employed the "My View on Insulin" questionnaire to survey the two groups before and 28 days after the intervention. The intervention group had a shorter total education duration than the control group, a difference that was statistically significant (p < .001). The intervention group had more advantages over the control group in terms of rotation education at the injection site (p < .05). There was no statistically significant difference in the questionnaire scores between the two groups after the intervention (p > .05); however, both groups scored significantly higher than before the intervention, a difference that was statistically significant (p < .001). The teach-back method combined with video materials applied for educating patients on their first insulin injection could reduce the education duration by healthcare providers and improve the patients' psychological insulin resistance. The key to successfully teaching patients to self-administer insulin, and allowing them to master the steps involved, is to focus on "why" rather than "what" to do.

Observation on efficacy of pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation in the treatment of patients with pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy of pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation in the treatment of patients with pterygium. METHODS:Prospective controlled study. A total of 102 patients(102 eyes)with pterygium treated in the hospital between October 2015 and October 2019 were selected as study subjects, and they were divided into observation group and control group according to the random number table method, with 51 cases in each group. The control group was treated with pterygium excision combined with amniotic membrane transplantation, and the observation group was given pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation. The perioperative indicators(intraoperative blood loss, surgical time, corneal epithelial repair time)and clinical efficacy at 3mo after surgery were compared between the two groups, and the disease recovery-related indicators \〖tear film break-up time(BUT), uncorrected visual acuity(UCVA), Schirmer Ⅰ test(SⅠt), corneal astigmatism degree(CAD)\〗 before and 3mo after surgery, postoperative aesthetic degree and recurrence during follow-up were recorded.RESULTS:The corneal epithelial repair time in observation group was shorter than that in control group(4.14±1.35 <i>vs</i> 4.72±1.37d,<i>P</i><0.05), while the surgical time was longer than that in control group(32.24±6.69 <i>vs</i> 29.67±5.21min,<i>P</i><0.05), and there was no statistical significance in the intraoperative blood loss between the two groups(<i>P</i>>0.05). At 3mo after surgery, there was no statistical difference in the effective rate of treatment between the two groups(86.3% <i>vs</i> 78.4%, <i>P</i>>0.05). At 3mo after surgery, the BUT, UCVA and SⅠt in the two groups were significantly enhanced compared with those before surgery(all <i>P</i><0.05), and the UCVA and SⅠt in observation group were higher than those in control group(all <i>P</i><0.05), but there was no statistical difference in the BUT between the two groups(<i>P</i>>0.05). The CAD in the two groups was significantly lower than that before surgery(<i>P</i><0.05), but the difference was not significant between the groups(<i>P</i>>0.05). At 3mo after surgery, the scores of dimensions of aesthetic scale for pterygium treatment(ocular recovery, subjective symptoms)were significantly higher in observation group than those in control group(all <i>P</i><0.05), but there were no statistical differences in the scores of cleanliness of surgical area and congestion between the two groups(all <i>P</i>>0.05). There was no statistically significant difference in recurrence rate between the two groups during follow-up(<i>P</i>>0.05).CONCLUSION: Pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation can effectively treat pterygium and prevent recurrence, and it has faster postoperative recovery and better aesthetic degree compared to pterygium excision combined with amniotic membrane transplantation.

Clinical Performance of the Xpert® CT/NG Test for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae: A Multicenter Evaluation in Chinese Urban Hospitals.

Background: We aimed to evaluate the clinical performance of the GeneXpert® (Xpert) CT/NG assay for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) using urine and cervical swabs collected from patients in China. Methods: This study was conducted from September 2016 to September 2018 in three Chinese urban hospitals. The results from the Xpert CT/NG test were compared to those from the Roche cobas® 4800 CT/NG test. Discordant results were confirmed by DNA sequence analysis. Results: In this study, 619 first void urine (FVU) specimens and 1,042 cervical swab specimens were included in the final dataset. There were no statistical differences between the results of the two tests for the detection of CT/NG in urine samples (p > 0.05), while a statistical difference was found in cervical swabs (p < 0.05). For CT detection, the sensitivity and specificity of the Xpert test were 100.0% (95%CI = 96.8-99.9) and 98.3% (95%CI = 96.6-99.2) for urine samples and 99.4% (95%CI = 96.5-100.0) and 98.6% (95%CI 97.5-99.2) for cervical swabs, respectively. For NG detection, the sensitivity and specificity of the Xpert test were 99.2% (95%CI = 94.9-100.0) and 100.0% (95%CI = 99.0-100.0) for urine and 100% (95%CI = 92.8-100.0) and 99.7% (95%CI = 99.0-99.9) for cervical swabs, respectively. Conclusion: The Xpert CT/NG test exhibited high sensitivity and specificity in the detection of CT and NG in both urine and cervical samples when compared to the reference results. The 90-min turnaround time for CT and NG detection at the point of care using Xpert may enable patients to receive treatment promptly.

Management of common scabies and postscabetic itch in adults: Lessons learned from a single-center retrospective cohort study.

BACKGROUND: Common scabies can be difficult to diagnose and treat. There are limited data on the clinical characteristics of patients who may benefit from combined topical permethrin plus oral ivermectin. Postscabetic itch is common, but there is scant data describing its prognosis and management. OBJECTIVE: This study describes the clinical characteristics and evaluates treatment outcomes of participants with common scabies treated with combined topical permethrin plus oral ivermectin and describes the prognosis and management of postscabetic itch. METHODS: We conducted a single-center retrospective cohort study of participants with common scabies treated with combined topical permethrin plus oral ivermectin therapy and topical permethrin only. Participants previously treated with permethrin and/or ivermectin were excluded. The primary outcome was clinical outcome at follow-up, categorized as cure, worsening, or no change. Secondary outcomes included time from treatment initiation to cure, duration of follow-up after cure, recurrence rate, frequency of postscabetic itch, and duration of postscabetic itch. RESULTS: Of 55 participants treated with combined topical permethrin plus oral ivermectin, 49 (89%) achieved cure, 5 (9%) had no change, and 1 (2%) had worsening disease. Of 48 participants treated with topical permethrin only, 46 (96%) achieved cure, 2 (4%) had no change, and 0 (0%) had worsening disease. Thirty-five participants (34%) experienced postscabetic itch for 52.5 days (interquartile range, 28-135). More participants in the older (mean: 55 years; standard deviation: 21 years; p = .002) combined treatment group experienced postscabetic itch than in the younger (mean: 42 years; standard deviation: 19 years) permethrin-only treatment group (42% vs. 25%; p = .072). CONCLUSION: These findings support the use of combined topical permethrin plus oral ivermectin therapy in treating common scabies, highlight that postscabetic itch can persist for longer than previously reported, and reveal a potential relationship between older age and postscabetic itch.

Factors Predicting Metastatic Disease in 68Ga-PSMA-11 PET-Positive Osseous Lesions in Prostate Cancer.

Bone is the most common site of distant metastatic spread in prostate adenocarcinoma. Prostate-specific membrane antigen (PSMA) uptake has been described in both benign and malignant bone lesions, which can lead to false-positive findings on 68Ga-PSMA-11 PET. The purpose of this study was to evaluate the diagnostic accuracy of 68Ga-PSMA-11 PET for osseous prostate cancer metastases and improve bone uptake interpretation using semiquantitative metrics. Methods: Fifty-six prostate cancer patients (18 before prostatectomy and 38 with biochemical recurrence) who underwent 68Ga-PSMA-11 PET/MRI or PET/CT examinations with osseous PSMA-ligand uptake were included in the study. Medical records were reviewed retrospectively by board-certified nuclear radiologists to determine true or false positivity based on a composite endpoint. For each avid osseous lesion, we measured biologic volume; size; PSMA Reporting and Data System (RADS) rating; SUVmax; and ratio of lesion SUVmax to liver, blood pool, and background bone SUVmax Differences between benign and malignant lesions were evaluated for statistical significance, and cutoffs for these parameters were determined to maximize diagnostic accuracy. Results: Among 56 participants, 13 (22.8%) had false-positive osseous 68Ga-PSMA-11 findings and 43 (76.8%) had true-positive osseous 68Ga-PSMA-11 findings. Twenty-two patients (39%) had 1 osseous lesion, 18 (32%) had 2-4 lesions, and 16 (29%) had 5 or more lesions. Cutoffs resulting in statistically significant (P < 0.005) differences between benign and malignant lesions were a PSMA RADS rating of at least 4, an SUVmax of at least 4.1, and SUVmax ratios of at least 2.11 for lesion to blood pool, at least 0.55 for lesion to liver, and at least 4.4 for lesion to bone. These measurements corresponded to a lesion-based 68Ga-PSMA-11 PET lesion detection rate of 80%, 93%, 89%, 21%, and 89%, respectively, for malignancy, and a specificity of 73%, 73%, 73%, 93%, and 60%, respectively. Conclusion: PSMA RADS rating, SUVmax, and SUVmax ratio for lesion to blood pool can help differentiate benign from malignant lesions on 68Ga-PSMA-11 PET. An SUVmax ratio of more than 2.2 for lesion to blood pool is a reasonable parameter to support image interpretation and presented a superior lesion detection rate and specificity when compared with visual interpretation by PSMA RADS. These parameters hold clinical value by improving diagnostic accuracy for metastatic prostate cancer on 68Ga-PSMA-11 PET/MRI and PET/CT.

Septal dysembryoplastic neuroepithelial tumor: a comprehensive clinical, imaging, histopathologic, and molecular analysis.

BACKGROUND: Dysembryoplastic neuroepithelial tumors (DNETs) are uncommon neural tumors presenting most often in children and young adults and associated with intractable seizures. Rare midline neoplasms with similar histological features to those found in DNETs have been described near the septum pellucidum and termed "DNET-like neoplasms of the septum pellucidum." Due to their rarity, these tumors have been described in just a few reports and their genetic alterations sought only in small series. METHODS: We collected 20 of these tumors for a comprehensive study of their clinical, radiological, and pathological features. RNA sequencing or targeted DNA sequencing was undertaken on 18 tumors, and genome-wide DNA methylation profiling was possible with 11 tumors. Published cases (n = 22) were also reviewed for comparative purposes. RESULTS: The commonest presenting symptoms and signs were related to raised intracranial pressure; 40% of cases required cerebrospinal fluid diversion. Epilepsy was seen in approximately one third of cases. All patients had an indolent disease course, despite metastasis within the neuraxis in a few cases. Radiologically, the septum verum/septal nuclei were involved in all cases and are the proposed site of origin for septal DNET (sDNET). Septal DNET showed a high frequency (~80%) of mutations of platelet derived growth factor receptor A (PDGFRA), and alterations in fibroblast growth factor receptor 1 (FGFR1) and neurofibromatosis type 1 (NF1) were also identified. In a genomic DNA methylation analysis alongside other neural tumors, sDNETs formed a separate molecular group. CONCLUSIONS: Genetic alterations that are different from those of cerebral DNETs and a distinct methylome profile support the proposal that sDNET is a distinct disease entity.

Using the Delphi method to establish nursing-sensitive quality indicators for ICU nursing in China.

In this study, the Delphi method was used to develop evidence-based indicators of intensive care unit (ICU) nursing quality of care in China. Nursing quality indicators reflect elements of patient care that are directly affected by nursing practice. A comprehensive literature search identified 2,857 potentially relevant articles. From the 50 articles that were included in this study, researchers identified 38 commonly used nursing quality indicators. A panel of experts reduced these to 20, which were then subjected to two rounds of Delphi discussion by a different panel, and a final consensus was achieved. The 20 indicators were grouped into three dimensions: structure, process, and outcome (including adverse consequences). The agreement among the experts for the 20 indicators was high. These evidence-based nursing quality indicators provide for ease in data collection and a basis for clinical application and improvement in the quality of ICU nursing throughout China.

Protective effects and action mechanism of extract from Tibetan medicine Yajima(Chrysosplenium nudicaule) on mice with intrahepatic cholestasis induced by ANIT / 中国中药杂志

Chrysosplenium nudicaule,Tibetan name " Yajima",is recorded as an effective medicine for the treatment of liver and gallbladder diseases by Tibetan Pharmacopoeia published in the past dynasties,but its traditional efficacy has not yet been investigated by means of modern pharmacological research methods. In this paper,the protective effect of extract of C. nudicaule(ECN) on liver injury in mice was observed by using the mice model of intrahepatic cholestasis(IC) induced by α-naphthyl isothiocyanate(ANIT) and the possible mechanism by which ECN work as the therapeutic agent was discussed. The results showed that the serum levels of AST,ALT,ALP,DBIL,TBIL and TBA of the model mice were notably reduced in dose-dependent manner(P<0. 01,P<0. 05). The activity of SOD and GSH-Px in the liver homogenate of mice was increased,while the content of MDA was decreased(P<0. 01,P<0. 05).Pathological examination of liver in mice showed that ECN could improve the pathological changes of liver tissue in mice. The mRNA expression level of genes related to bile acid metabolism were detected by RT-PCR and the results suggested that ECN could significantly increase the expression of genes such as BSEP,FXR and MRP2(P<0. 01,P<0. 05),meanwhile significantly reduce the expression of CYP7 A1(P<0. 01,P<0. 05). These results confirmed the protective effect of ECN on intrahepatic cholestasis-induced liver injury in mice,and indicated that the mechanism may be related to activating FXR and its target genes,reducing bile acid synthesis and increasing bile acid excretion. This study provides a modern pharmacological basis for the clinical application of Yajima in Tibetan medicine.

Increasing Resistance to Azithromycin in Neisseria gonorrhoeae in Eastern Chinese Cities: Resistance Mechanisms and Genetic Diversity among Isolates from Nanjing.

Azithromycin resistance (AZM-R) of Neisseria gonorrhoeae is emerging as a clinical and public health challenge. We determined molecular characteristics of recent AZM-R Nanjing gonococcal isolates and tracked the emergence of AZM-R isolates in eastern Chinese cities in recent years. A total of 384 N. gonorrhoeae isolates from Nanjing collected from 2013 to 2014 were tested for susceptibility to AZM and six additional antibiotics; all AZM-R strains were characterized genetically for resistance determinants by sequencing and were genotyped using N. gonorrhoeae multiantigen sequence typing (NG-MAST). Among the 384 isolates, 124 (32.3%) were AZM-R. High-level resistance (MIC, ≥256 mg/liter) was present in 10.4% (40/384) of isolates, all of which possessed the A2143G mutation in all four 23S rRNA alleles. Low- to mid-level resistance (MIC, 1 to 64 mg/liter) was present in 21.9% (84/384) of isolates, 59.5% of which possessed the C2599T mutation in all four 23S rRNA alleles. The 124 AZM-R isolates were distributed in 71 different NG-MAST sequence types (STs). ST1866 was the most prevalent type in high-level AZM-R (HL-AZM-R) isolates (45% [18/40]). This study, together with previous reports, revealed that the prevalence of AZM-R in N. gonorrhoeae isolates in certain eastern Chinese cities has risen >4-fold (7% to 32%) from 2008 to 2014. The principal mechanisms of AZM resistance in recent Nanjing isolates were A2143G mutations (high-level resistance) and C2599T mutations (low- to mid-level resistance) in the 23S rRNA alleles. Characterization of NG-MAST STs and phylogenetic analysis indicated the genetic diversity of N. gonorrhoeae in Nanjing; however, ST1866 was the dominant genotype associated with HL-AZM-R isolates.

Development of evidence-based nursing-sensitive quality indicators for emergency nursing: A Delphi study.

AIMS AND OBJECTIVES: To establish evidence-based nursing-sensitive quality indicators for emergency nursing in China. BACKGROUND: China lacks nursing-sensitive quality indicators necessary for assessing the quality of emergency nursing and essential to nursing management. DESIGN: Prospective. METHODS: A literature search for relevant evidence-based studies was performed using several databases from January 2009-May 2014. Previously reported quality indicators were identified as appropriate for assessment by a panel of 40 experts in emergency medicine and nursing. Two successive rounds of Delphi surveys were conducted using questionnaires designed by the experts. Kendal's W coordination coefficients were calculated for indicator importance, rationality of calculation and feasibility of data collection. RESULTS: Thirty-three quality indicators were initially proposed for expert evaluation. After round 1 of expert discussion, Kendal's W coordination coefficients were .152 for importance, .092 for rationality and .141 for feasibility of data collection (all p < .001). Seven unsuitable items were discarded in round 1 and 11 discarded in round 2, which also added one new item. Finally, the experts reached consensus on 16 items established as appropriate nursing-sensitive quality indicators for emergency nursing care. CONCLUSION: Evidence-based nursing-sensitive quality indicators were established through a consensus of experts in emergency nursing and medicine. RELEVANCE TO CLINICAL PRACTICE: The current findings may provide a theoretical basis for establishing an emergency nursing quality database and improving the quality of emergency nursing care in China.

[Mycoplasma genitalium infection in patients attending the STD clinic in Nanjing].

OBJECTIVE: To analyze Mycoplasma genitalium (MG) infection among the patients attending the clinic of sexually transmitted diseases (STD) in Nanjing. METHODS: Urethral and cervical swabs were collected from 2 753 patients (2 161 males and 592 females) who first sought medical care at our STD Clinic from November 2015 to December 2017. The patients ranged in age from 18 to 67 years (ï¼»37.55 ± 10.37ï¼½ yr), divided into six age groups: ≤20, 21－30, 31－40, 41－50, 51－60, and >60 yr. The samples were examined for MG infection by simultaneous amplification and testing, Chlamydia trachomatis (CT) by quantitative real-time PCR, Neisseria gonorrhoeae (NG), Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) with the Thayer-Martin medium, and the count of polymorphonuclear leukocytes (PMNL) by microscopy with Methylene blue stain. RESULTS: Among the 2 753 samples, 219 (7.95%), including 176 males (8.14%) and 43 females (7.26%), were found positive for MG, with no statistically significant differences between the male and female groups (χ2 = 0.492, P = 0.483). The MG infection rates in the male and female groups were 6.67% vs 12.12% in the ≤20-year-olds, 8.44% vs 8.64% in the 21－30-year-olds, 7.63% vs 6.19% in the 31－40-year-olds, 10% vs 4.72% in the 41－50-year-olds, 5.64% vs 0 in the 51－60-year-olds, and 8.33% vs 0 in the >60-year-olds, with no statistically significant differences among the age groups (χ2 = 4.76, P = 0.446), or in the males (χ2 = 7.240, P = 0.200) or females (χ2 = 6.718, P = 0.076). The incidence rate of MG simple infection was markedly higher in the males than in the females (62.30% ï¼»76/122ï¼½ vs 36.84% ï¼»14/38ï¼½, χ2 = 7.041, P < 0.01). MG infection was found in combination with one or more pathogens like NG, CT, UU and MH, with MG+UU as the most common co-infection (21.31% ï¼»26/122ï¼½ in males and 31.85% ï¼»12/38ï¼½ in females). Of the 76 male patients with MG simple infection, 30 (39.47%) had ≥5 PMNLs per high-power field, and 66 (86.84%) showed symptoms of urethritis. CONCLUSIONS: MG infection was found in both the symptomatic and asymptomatic patients attending the STD clinic in Nanjing, with no significant difference in the incidence rate between males and females. A higher rate of MG simple infection was observed in the males than in the females, most of the male patients with symptoms of urethritis and urethral PMNLs.

Efficacy and Safety of TCM Prescription for Gout versus Allopurinol in the Treatment of Gout: A Systematic Review / 中国药房

OBJECTIVE: To evaluate therapeutic efficacy and safety of allopurinol versus (vs.) TCM prescription for gout in the treatment of gout, and to provide evidence-based reference for clinical treatment of gout. METHODS: Retrieved from PubMed, Embase, Medline, The Cochrane library, Chinese Journal Full-text Database (CJFD), China Scientific Journal Database (CSJD) and Wanfang database, randomized controlled trials (RCTs) about therapeutic efficacy (total response rate, level of uric acid) and safety (the occurrence of ADR) of TCM prescription for gout alone or combined with allopuinol (trial group) vs. allopurinol (control group) in the treatment of gout were collected. After data extraction of clinical studies meeting inclusion criteria, Cochrane system evaluator manual 5. 1. 0 was used to evaluate the quality of included studies, and Meta-analysis was conducted by using Rev Man 5. 3 statistical software. RESULTS: A total of 20 RCTs were included, involving 1 961 patients. Results of Meta-analysis showed that total response rate of trial group was significantly higher than that of control group [OR=2. 29, 95％ CI(1. 84, 2. 84), P<0. 001], uric acid level was significantly lower control group [MD= -27. 99,95％ CI(-33. 04, -22. 93),P<0. 001],with statistical significance. The incidence of ADR in trial group was significantly lower than control group, with statistical significance (P<0. 05). CONCLUSIONS: Therapeutic efficacy and safety of TCM prescription are better than those of allopuinol for gout.

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from Hefei (2014-2015): genetic characteristics of antimicrobial resistance.

BACKGROUND: Antimicrobial resistance (AMR) and genetic determinants of resistance of N. gonorrhoeae isolates from Hefei, China, were characterized adding a breadth of information to the molecular epidemiology of gonococcal resistance in China. METHODS: 126 N. gonorrhoeae isolates from a hospital clinic in Hefei, were collected between January, 2014, and November, 2015. The minimum inhibitory concentration (MIC) of N. gonorrhoeae isolates for seven antimicrobials were determined by the agar dilution method. Isolates were tested for mutations in penA and mtrR genes and 23S rRNA, and also genotyped using N. gonorrhoeae multi-antigen sequence typing (NG-MAST). RESULTS: All N. gonorrhoeae isolates were resistant to ciprofloxacin; 81.7% (103/126) to tetracycline and 73.8% (93/126) to penicillin. 39.7% (50/126) of isolates were penicillinase producing N. gonorrhoeae (PPNG), 31.7% (40/126) were tetracycline resistant N. gonorrhoeae (TRNG) and 28.6% (36/126) were resistant to azithromycin. While not fully resistant to extended spectrum cephalosporins (ESCs), a total of 14 isolates (11.1%) displayed decreased susceptibility to ceftriaxone (MIC ≥ 0.125 mg/L, n = 10), cefixime (MIC ≥ 0. 25 mg/L, n = 1) or to both ESCs (n = 3). penA mosaic alleles XXXV were found in all isolates that harbored decreased susceptibility to cefixime, except for one. Four mutations were found in mtrR genes and mutations A2143G and C2599T were identified in 23S rRNA. No isolates were resistant to spectinomycin. Gonococcal isolates were distributed into diverse NG-MAST sequence types (STs); 86 separate STs were identified. CONCLUSIONS: N. gonorrhoeae isolates from Hefei during 2014-2015, displayed high levels of resistance to antimicrobials that had been recommended previously for treatment of gonorrhea, e.g., penicillin, tetracycline and ciprofloxacin. The prevalence of resistance to azithromycin was also high (28.6%). No isolates were found to be fully resistant to spectinomycin, ceftriaxone or cefixime; however, 11.1% isolates, overall, had decreased susceptibility to ESCs.

Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection.

Mycoplasma genitalium is an important pathogen that is transmitted through sexual contact. For patients diagnosed with M. genitalium infection, the current guidelines recommend 1 g of azithromycin as the first-line treatment. Moxifloxacin is used as a second-line drug due to its remarkable efficacy; however, increased use of moxifloxacin to treat M. genitalium infections has caused the emergence of cases of moxifloxacin treatment failure. This meta-analysis aims to estimate the treatment efficacy of moxifloxacin for M. genitalium infection. Electronic databases were searched for articles published from 1983 to the end of May 2016 using the following search terms: ( Mycoplasma genitalium) AND (moxifloxacin OR 1-cyclopropyl-7-(2,8-diazabicyclo(4.3.0)non-8-yl)-6-fluoro-8-methoxy-1,4-dihydro-4-oxo-3-quinoline carboxylic acid OR Proflox OR moxifloxacin hydrochloride OR Octegra OR Avelox OR Avalox OR Izilox OR Actira OR [treatment efficacy]). All included studies were published in English; all participants were diagnosed with M. genitalium infection, and microbial cure times were measured within 12 months after treatment. Treatment efficacy was measured as microbial cure at the final follow-up after treatment. In total, 17 studies including 252 participants met the inclusion criteria. The majority of these studies were observational. The random-effects pooled microbial cure rate was 96% (95% confidence interval [CI], 90%-99%; I2 = 28.59%, P = 0.13). For studies with sample collection deadlines prior to 2010, the pooled microbial cure rate was 100% (95% CI, 99%-100%; I2 = 0.00%, P = 1.00). For studies with sample collection deadlines of 2010 and later, the pooled microbial cure rate was 89% (95% CI, 82%-94%; I2 = 0.00%, P = 0.59). The elimination rate of moxifloxacin for M. genitalium infection has decreased from 100% to 89% since 2010. This decline merits considerable attention. We suggest close follow-up to investigate the efficacy of moxifloxacin for treating M. genitalium infections. Additionally, sentinel points should be established to detect mutations in the gyrA/B and parC/E genes, which are associated with moxifloxacin resistance.