Clinical application of upper arm central venous port in cancer patients / 中国实用护理杂志

Objective:To investigate the clinical effect of upper arm central venous port in cancer patients.Methods:A total of 500 patients with tumor were selected as the study subjects from March 29, 2018 to January 19 2020. Complications such as catheter-related thrombosis and catheter-related bloodstream infection during the indwelling period were recorded.Results:One patient with severe superior vena cava syndrome failed to be intubated. The other 499 patients were successfully intubated with a success rate of 99.8% (499/500). The rate of complications was 2.6% (13/499), and the rate of catheter-related bloodstream infection was 0.029‰ (4/139 614) in 4 cases, the incidence of catheter-related thrombus was 0.057‰ (8/139 614) in 8 cases. There were 1 case of body turnover, 1 case of median nerve injury, 1 case of local tissue necrosis and 1 case of lymphatic leakage. Extubation was planned in 15 patients, and unplanned extubation in 6 patients due to complications.Conclusions:The upper arm port has less complications and is suitable for patients with tumor chemotherapy and long-term need of infusion. It is worthy of clinical promotion.

Long period dynamics of viral load and antibodies for SARS-CoV-2 infection: an observational cohort study

OBJECTIVETo investigate the dynamics of viral RNA, IgM, and IgG and their relationships in patients with SARS-CoV-2 pneumonia over an 8-week period. DESIGNRetrospective, observational case series. SETTINGWenzhou Sixth Peoples Hospital PARTICIPANTSThirty-three patients with laboratory confirmed SARS-CoV-2 pneumonia admitted to hospital. Data were collected from January 27 to April 10, 2020. MAIN OUTCOME MEASURESThroat swabs, sputum, stool, and blood samples were collected, and viral load was measured by reverse transcription PCR (RT-PCR). Specific IgM and IgG against spike protein (S), spike protein receptor binding domain (RBD), and nucleocapsid (N) were analyzed. RESULTSAt the early stages of symptom onset, SARS-CoV-2 viral load is higher in throat swabs and sputum, but lower in stool. The median (IQR) time of undetectable viral RNA in throat swab, sputum, and stool was 18.5 (13.25-22) days, 22 (18.5-27.5) days, and 17 (11.5-32) days, respectively. In sputum, 17 patients (51.5%) had undetectable viral RNA within 22 days (short persistence), and 16 (48.5%) had persistent viral RNA more than 22 days (long persistence). Three patients (9.1%) had a detectable relapse of viral RNA in sputum within two weeks of their discharge from the hospital. One patient had persistent viral RNA for 59 days or longer. The median (IQR) seroconversion time of anti-S IgM, anti-RBD IgM, and anti-N IgM was 10.5 (7.75-15.5) days, 14 (9-24) days, and 10 (7-14) days, respectively. The median (IQR) seroconversion time of anti-S IgG, anti-RBD IgG, and anti-N IgG was 10 (7.25-16.5) days, 13 (9-17) days, and 10 (7-14) days, respectively. By week 8 after symptom onset, IgM were negative in many of the previously positive patients, and IgG levels remained less than 50% of the peak levels in more than 20% of the patients. In about 40% of the patients, anti-RBD IgG levels were 4-times higher in convalescence than in acute phase. SARS-CoV-2 RNA coexisted with antibodies for more than 50 days. Anti-RBD IgM and IgG levels, including anti-RBD IgM levels at presentation and peak time, were significantly higher in viral RNA short persistence patients than in long persistence patients. CONCLUSIONThis study adds important new information about the features of viral load and antibody dynamics of SARS-CoV-2. It is clear from these results that the viral RNA persists in sputum and stool specimens for a relatively long time in many patients. Anti-RBD may also serve as a potential protective antibody against SARS-CoV-2 infection, as viral persistence appears to be related to anti-RBD levels. Earlier treatment intervention also appears to be a factor in viral persistence. WHAT IS ALREADY KNOWN ON THIS TOPICThere are several reports about the serum antibodies against SARS-CoV-2. However, most of them evaluate diagnostic accuracy. Only two articles report dynamics of SARS-CoV-2 viral RNA and antibodies with serial samples, but the observation periods are within 30 days. None of the studies investigate the profiles of SARS-CoV-2 viral load and antibodies in a long period. Three reports investigate profiles in respiratory samples, but there are no reports on the dynamics of the viral load in stool samples. WHAT THIS STUDY ADDSIn both sputum and stool, SARS-CoV-2 RNA persists for a long time. The anti-RBD antibodies may involve in the clearance of SARS-CoV-2 infection. After eight weeks from symptom onset, IgM were negative in many of the previously positive patients, and IgG levels remained less than 50% of the peak levels in more than 20% of the patients. In about 40% of the patients, anti-RBD IgG levels increased 4-time higher in convalescence than in acute phase. Long persistence of SARS-CoV-2 viral RNA in sputum and stool presents challenges for management of the infection. The IgM/IgG comb test is better than single IgM test as a supplement diagnostic tool. Anti-RBD may be a protective antibody, and is valuable for development of vaccines.

The effects of enhancing confidence of active cycle of breathing technique training on pulmonary rehabilitation in elder lung cancer patients with lung resection / 中华护理杂志

Objective To explore the effects of enhancing confidence of active cycle of breathing technique training on pulmonary rehabilitation in elder lung cancer patients with lung resection.Methods The control group (n=35) received routine breathing exercise from September to December 2016;the intervention group (n=35) received the confidence-enhancing active cycle of breathing technique in addition to routine perioperative care from January to April 2017.We compared the 24-hours wet sputum weight,postoperative pulmonary complications,the peak expiratory flow(PEF),6-minute walk test(6MWT),and exercise self-efficacy from baseline until hospital discharge.Results The sputum weight of postoperative on day 2 and day 3 in the intervention group were significantly higher than those in the control group(P＜0.05).The PEF,6MWT and exercise self-efficacy were also improved and the differences between two groups were statistically significant(P＜0.05).However,there was no significant difference in postoperative pulmonary complications between two groups (P＞0.05).Conclusion Confidence-enhancing active cycle of breathing technique is a simple,effective and easy short-term pulmonary rehabilitation method.

Analysis of clinical phenotypes and GJB2 gene mutations in families affected with hearing loss from southern Zhejiang / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and pathological mutations in 44 families affected with hearing loss from southern Zhejiang, and to provide genetic counseling and prenatal diagnosis for 6 of the families.</p><p><b>METHODS</b>Microarray was employed to detect c.35delG, c.176del16, c.235delC and c.299-300delAT mutations of the GJB2 gene among 228 patients. For those carrying a single heterozygous mutation, the whole coding region of the GJB2 gene was analyzed by Sanger sequencing. For prenatal diagnosis, maternal DNA contamination was excluded by application of STR analysis.</p><p><b>RESULTS</b>The microarray assay has detected 49 patients with GJB2 mutations, which included 24 homozygous c.235delC mutations, 5 compound heterozygous c.235delC/c.176del16 mutations, 2 compound heterozygous c.235delC/c.299-300delAT mutations. Respectively, 16, 1 and 1 patients have carried single heterozygous c.235delC, c.176del16, and c.299-300delAT mutation. For the 16 patients, 7, 1, 1, 2, and 3 were detected by Sanger sequencing with a second heterozygous mutation of c.109G>A (2 of which were in conjunction with heterozygous c.176del16 and c.299-300delAT mutations), c.230G>A, c.427C>T, c.508-511 dupAACG, 79G>A+341A>G, respectively. Prenatal diagnosis revealed a compound heterozygous mutation in a fetus, heterozygous mutations in 4 fetuses, and no mutation of the GJB2 gene in 1 fetus.</p><p><b>CONCLUSION</b>The proportion of carriers for GJB2 gene mutations in patients with hearing loss from southern Zhejiang has reached 21.5%. The c.235delC, c.176del16, and compound c.299-300delAT and c.109G>A mutations can cause moderate to severe hearing loss. In most affected families, Heterozygous mutations may be identified by sequencing the whole coding region of the GJB2 gene. Genetic analysis and prenatal diagnosis can prevent birth of further affected children.</p>

Mutation analysis and prenatal diagnosis for 12 families affected with hereditary hearing loss and enlarged vestibular aqueduct / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To carry out mutation analysis and prenatal diagnosis for 12 families affected with hearing loss and enlarged vestibular aqueduct from southern Zhejiang province.</p><p><b>METHODS</b>Clinical data and peripheral venous blood samples of 38 members from the 12 families were obtained. Mutations of 4 genes, namely SLC26A4, GJB2, c.538C to T and c.547G to A of GJB3, m.1555A to G and m.1494C to T of 12S rRNA, were detected by PCR and Sanger sequencing. Maternal contamination was excluded by application of STR detection during prenatal diagnosis.</p><p><b>RESULTS</b>Among the probands from the 12 families, 11 were found to be compound heterozygotes or homozygotes and 25 were heterozygotes. All of the families were detected with IVS7-2A to G mutations, and 4 had a second heterozygous mutation (c.2168A to G of the SLC26A4 gene). Four rare pathogenic mutations, namely IVS5-1G to A, c.946G to T, c.1607A to G and c.2167C to G, were detected in another four families. In addition, the partner of proband from pedigree 3 was identified with compound heterozygous mutations of c.235delC and c.299-300delAT, and proband of pedigree 5 has carried a mutation of c.109G to A in GJB2. For SLC26A4 gene, prenatal diagnostic testing has revealed heterozygous mutations in 6 fetuses and compound heterozygous mutations in 2 fetuses.</p><p><b>CONCLUSION</b>IVS7-2A to G and c.2168A to G of the SLC26A4 gene were the most common mutations in southern Zhejiang. Such mutations can be found in most families affected with hearing loss and enlarged vestibular aqueduct, which may facilitate genetic counseling and prenatal diagnosis for such families.</p>

Clearance of free fetal DNA after delivery of fetuses carrying chromosomal aneuploidies / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the rules for free fetal DNA clearance after delivery of fetuses carrying chromosomal aneuploidies.</p><p><b>METHODS</b>For 10 women carrying 18-to-25-gestation-week singletons confirmed to have chromosomal abnormalities by amniotic karyotyping, 5 mL of peripheral venous blood was drawn respectively before and 15 minutes, 30 minutes, 60 minutes, 120 minutes, 3 hours, 6 hours, 9 hours, 12 hours, 24 hours, 48 hours and 72 hours after their elective termination of pregnancies. Free fetal DNA was isolated from the plasma and subjected to high throughput sequencing.</p><p><b>RESULTS</b>Statistical analysis of the sequence information showed that the free DNA of fetuses with trisomy 21 or 18 was rapidly cleared after delivery. The average half-life was approximately 1.24 hours within the first 2 hours after delivery. It was then slowly cleared between 6 and 72 hours, with an average half-life of 11.70 hours. No fetal DNA was detectable 72 hours after delivery.</p><p><b>CONCLUSION</b>Free fetal DNA rapidly decreases after delivery and will completely disappear by 72 hours. Above results may provide a basis for clinical application of the non-invasive detection of chromosomal aneuploidies during prenatal diagnosis.</p>

SNP array analysis of three cases with partial 21q trisomy / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze three cases with partial 21q trisomy, and correlate their genotypes with phenotypes.</p><p><b>METHODS</b>G-banding chromosomal analysis and single nucleotide polymorphism (SNP array) were performed for the three cases and their parents.</p><p><b>RESULTS</b>SNP array has detected partial 21q trisomy in three cases and one mother, with variable size and location of the duplications. Case 1 harbored a 12.35 Mb duplication at 21q22.11q22.3, which spanned the Down syndrome critical region. Case 2 harbored a 35.32 Mb duplication at 9p24.3p13.3 and a 14.42 Mb duplication at 21q11.2q21.3, with the former spanning the partial 9p trisomy syndrome critical region excluding the Down syndrome critical region, and was inherited from his mother. Case 3 harbored a 4.17 Mb tetraploidy at 21q11.2q21.1 in the form of mosaicism, which spared the Down syndrome critical region. His mother carried a 4.17 Mb triploidy at 21q11.2q21.1, which was also a mosaicism.</p><p><b>CONCLUSION</b>Partial 21q trisomy may occur in various forms and its clinical phenotypes are heterogeneous. Combined use of genetic techniques, particularly SNP array, is crucial for diagnosing partial 21q trisomy and delineating its genotype-phenotype correlation.</p>

Application of Quality Control Circle for reducing health checkup report's error rate / 中华健康管理学杂志

Objective To explore the effect of quality control circle (QCC) in reducing the health examination report errors. Methods QCC was founded, activity themes were selected, activity schedule was planned, the reasons of health examination report errors were analyzed, goal setting, countermeasures were planned and implemented jointly by circle members. Totally 11 738 reports of health checkup were selected and analyzed the errors were analyzed during the activity, 6 892 were male, 4 846 were female, their average age was(38.01 ± 11.31)years, 5 000 reports were made before improvement, 5 120 reports during improvement, 1 618 reports after improvement and compared the report error rates were compared. Evaluation of QCC activity results and tracking effect were evaluated. Results Error rate of health checkup report from 17.80‰ decreased to 7.23‰ during improvement, dropped to 2.48‰ after improvement. The rate of standard was 141.9%, progress rate was 86.1%. Tracking results for 8 months, error rate remained below the target value of 3.40‰although error rate roise to 5.25‰in August 2016, the effect was good. The additional benefit, working efficiency of the doctors was improved; Average time for each written report was reduced to 4 minutes from 5 minutes;Saved about 1 hours per person a day to review the accuracy of the report and learning; Formed“communication model between clinical departments”;Established the error registration system for the report has been distributed;Similar error of ECG department has been avoided. Conclusions Application of QCC not only reduced the error rate of the health checkup report, but also ensured quality, objective, and accurate physical examination report; activities not merely help to improve the work efficiency of physician, team's mutual cooperation, and is beneficial to optimize the system of medical institution and avoid the error.

Application of medical equipment quality control and measurement management system / 中国医学装备

Objective:To promote hospital medicalmetrology and quality control management. by using information management mode.Methods: Through the analysis of our hospital medical equipment measurement and quality control management present situation, put forward the necessity of metrology and quality control management of Xinxi sanitary equipment,introduces the application situation of our hospital dynamic health equipment metrology and quality control management system.Results: The medical equipment metrology and quality control management system perfect the medical equipment measurement and quality control of management process, improve the qualified rate of equipment.Conclusion:Application of sanitary equipment measurement and quality control management platform to improve the delivery rate of equipment, ensure the equipment unqualified clinical use.

Impact of fixed specialist nurse triage on the quality of triage / 中国实用护理杂志

Objective To investigate the influence of fixed nurse specialists triage to improve the quality of patient triage.Methods Nurses were divided into the fixed nurse specialist triage group (group A) and the out-patient department rotation nursing group (group B),respectively,each group was responsible for triage of patients in clinic of medical department for five days.Then the number of two subdiagnosis error and the average daily working overtime for doctors were compared.Results A total of 3806 patients were in clinic triage in group A,165 patients had triage error.A total of 3812 patients were in clinic triage in group B,308 patients had triage error.The average daily working overtime of doctors in group A was(5.24 ± 0.37)hours,and(8.16 ± 0.58) hours in group B.The errors in triage and working overtime of doctors had significant differences between two groups.Conclusions Fixed specialist nurse triage can significantly improve the quality of patient triage in clinic.

Correlation between intracellular magnesium and expression of beta 2-adrenergic receptor mRNA in the lung of C57BL/6 asthmatic mice / 中国病理生理杂志

0.05,respectively).Plasma Mg2+,intracellular Mg2+,the beta 2-AR mRNA and protein in lung tissue in group C at 21st d and 34th d were significantly higher than those in group A at 21st d and 34th d 21st d:(0.84?0.09)mmol/L vs 0.57?0.10)mmol/L,(2.39?0.14)mmol/L vs(2.11?0.08)mmol/L,(0.75?0.09)pmol/g vs(0.59?0.06)pmol/g,(88.50?8.50)pmol/g vs(60.10?7.70)pmol/g,P

Glucokinase gene promoter G/A variant is associated with higher fasting glucose levels / 中华内分泌代谢杂志

Objective To study the distribution of the G/A variant at position -30 of the glucokinase gene promoter in southern Chinese subjects with impaired glucose tolerance (IGT) and normal glucose tolerance (NGT) and to investigate the association between different genotypes and indices of glucose metabolism. Methods Four hundred and fourty four unrelated Chinese subjects 〔aged (50.8?12.2)years〕 without diabetics were studied, among them 222 subjects with NGT and 222 with IGT. The G to A substitution at position -30 of the glucokinase promoter, resulting in the loss of a BsiHKA Ⅰ cut site, was detected after BsiHKA Ⅰ digestion of PCR amplified genomic DNA. Results Allele frequency of the A variant was 18.2% in NGT (similar to finding in native Japanese) and 19.8% in IGT subjects. Fasting plasma glucose level was significantly higher in subjects with the A allele (n=153; GA:AA=137:16), when compared to the GG subjects (n=291), 〔(5.35?0.59 vs 5.19?0.53) mmol/L, P=0.006〕. Higherfastingglucoselevelwasalsofound when only IGT subjects with the A variant and GG allele were analyzed 〔(5.54?0.58 vs 5.35?0.52) mmol/L, P=0.02〕. In subjects with NGT, there was no significant difference in fasting plasma glucose levels between different GCK genotypes. Conclusion GCK gene promoter -30 G/A variant is associated with higher fasting plasma glucose levels, and may contributes to the development of IGT in Southern Chinese.