Shanghai General Hospital Research Articles

Erratum: Modulation of human melanoma cell proliferation and apoptosis by hydatid cyst fluid of Echinococcus granulosus [Corrigendum

[This corrects the article on p. 1447 in vol. 11, PMID: 29588599.].

China’s cancer patients’ perceptions, attitudes and participation in clinical trials of complementary and alternative medicine: A multi-center cross-sectional study

IntroductionComplementary and alternative medicine is quite popular among oncologists and cancer patients, nevertheless many clinical trials of complementary and alternative medicine (CTCAM) are not registered. This study was designed to investigate the perceptions of cancer patients toward CTCAM in China and their attitudes to participating in such trials. MethodsA multicenter cross-sectional study was conducted from June to December 2016. Cancer inpatients over the age of 18 years and with a clear disease diagnosis were recruited from the integrative oncology departments of five general hospitals in Shanghai, China. After obtaining informed consent and having had the definitions of CTCAM, CAM and CT explained by their oncologist, each participant completed a questionnaire in a face to face interviews under the guidance of the oncologist. ResultsA total of 662 cancer patients participated in this study. Half (49.8%) self-reported they understood the meaning of clinical trials (CTs), 14 cancer patients (2.1%) had participated in CTs before, but none had participated in CTCAM. Of cancer patients who knew about CTs, most showed conditional attitude towards participating in CTCAM. To participate in CTCAM, most wanted to get better treatment (78.8%). Potential risks during the trials (55.8%) and patients’ unwillingness to be treated as test subjects (37.3%) were the main reasons why the patients refused to participate. Their main issues were about the purpose and effects of the treatment (90.3%), their privacy (81.8%), and potential risks and adverse effects (81.8%). Predictive factors associated with “cancer patients knowing about CTs” included age (≤59 years, P = 0.006), ECOG-PS score (≤2, P < 0.001) and education background (college/university, P < 0.001). ConclusionsIn China, cancer patients do not appear to have a good knowledge of understanding about taking part in CTs. However, many cancer patients showed great interest in participating in CTCAM.

Retrospective sampling survey to the implementation situation of research projects in one large general hospital from Shanghai area

Objective To investigate the implementation situation of scientific research projects in large general hospital, analyze the quantitative evaluation parameters to explore the improvement measures. Methods Sampling survey of all levels of research projects from one general hospital in Shanghai. Based on parameter index quantization, the progress of projects in different levels was compared and analyzed. Results The progress index and achievement index are reliable quantitative indexes, and there is a linear correlation between these two indexes. Based on progress index, forecast for SCI publication of project can be carried out. There was no significant difference in the progress situation of all levels of projects. Higher level of project showed better SCI publication. Conclusions For the process management of scientific research projects at different levels, the quantitative indexes can be used to facilitate the early warning and supervision. Classified assessment should be implied to SCI publication for research projects at different levels. Key words: Scientific research project; Process management; Quantitative Index; SCI publication

Influencing factors analysis and modeling of hospital-acquired infection in elderly patients

Hospital-acquired infection threatens the patients’ health and life and also impacts medical quality by decreasing the bed turnover rate, prolonging hospitalization, increasing hospital costs and bringing the patients the huge economic losses. Therefore, hospital infection management is the focus of today’s hospital management and one of the most prominent public health problems. The elderly patients are a special group of nosocomial infections as they often suffer from a variety of serious underlying diseases and their immune function are low so their incidence of nosocomial infection is also higher than the average population. This paper establishes model by the statistical analysis tools and analyzes the influencing factors of all kinds of nosocomial infections in elderly patients based on the investigation of incidence of nosocomial infection in Shanghai General Hospital.

Emergence and establishment of KPC-2-producing ST11 Klebsiella pneumoniae in a general hospital in Shanghai, China

The aim of this study was to investigate the characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) collected during an outbreak in a Chinese teaching hospital and to provide insights into the prevention and control of nosocomial infection. We collected unique CRKP clinical isolates from 2009 to 2013. Antibiotic-resistant genes were identified by polymerase chain reaction (PCR) and sequencing. The isolates were typed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Plasmids were classified using a PCR-based incompatibility/replicon typing method and a replicon sequence typing method. Conjugation experiments were performed to evaluate the transferability of carbapenem-resistant genes. Whole genome sequencing (WGS) was conducted to further investigate the genetic background of the isolates. Infection control practices were reviewed throughout the study period. Klebsiella pneumoniae sequence type (ST) 11 emerged in 2010 and acquired the blaKPC-2 gene by 2011. From 2011 to 2013, ST11 KPC-2-producing CRKP (G type) prevailed as the most common CRKP in our hospital, causing a prolonged outbreak. The majority of these CRKP strains possess an IncFII plasmid, with Tn1721-blaKPC-2-ΔTn3-IS26 bearing the genetic structure for blaKPC-2. Infection prevention control measures available at the time contained the initial outbreak, but had no effect on the spread of CRKP later. This study demonstrated the seriousness concerning the spread of KPC-2-producing ST11 CRKP in a Chinese hospital, indicating that current prevention and control strategies for carbapenem-resistant Enterobacteriaceae (CRE) nosocomial infection need to be investigated and adjusted.

Clinical features of Parkinson\u2019s disease with and without rapid eye movement sleep behavior disorder

BackgroundRapid eye movement sleep behavior disorder (RBD) and Parkinson’s disease (PD) are two distinct clinical diseases but they share some common pathological and anatomical characteristics. This study aims to confirm the clinical features of RBD in Chinese PD patients.MethodsOne hundred fifty PD patients were enrolled from the Parkinson`s disease and Movement Disorders Center in Department of Neurology, Shanghai General Hospital from January 2013 to August 2014. This study examined PD patients with or without RBD as determined by the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ), assessed motor subtype by Unified PD Rating Scale (UPDRS) III at “on” state, and compared the sub-scale scores representing tremor, rigidity, appendicular and axial. Investigators also assessed the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Parkinson’s disease Sleep Scale (PDSS).ResultsOne hundred fourty one PD patients entered the final study. 30 (21.28%) PD patients had probable RBD (pRBD) diagnosed with a RBDSQ score of 6 or above. There were no significant differences for age, including age of PD onset and PD duration, gender, smoking status, alcohol or coffee use, presence of anosmia or freezing, UPDRS III, and H-Y stages between the pRBD+ and pRBD− groups. pRBD+ group had lower MMSE scores, higher PDSS scores, and pRBD+ PD patients had more prominent proportion in anxiety, depression, constipation, hallucination and a greater prevalence of orthostatic hypotension.ConclusionpRBD+ PD patients exhibited greater changes in non-motor symptoms. However, there was no increase in motor deficits.

A multicenter, retrospective study of pathogenic bacteria distribution and drug resistance in febrile neutropenic patients with hematological diseases in Shanghai

目的了解上海地区中性粒细胞缺乏（粒缺）伴发热血液病患者致病细菌的分布及耐药情况。方法回顾性分析2012年1月至2014年12月上海市12家医院血液科粒缺伴发热住院患者的临床分离菌株，用纸片扩散法进行药敏试验，WHONET 5.6软件分析病原菌分布及药敏数据。结果从上海地区粒缺伴发热患者中共分离出1 260株细菌，其中革兰阳性菌420株（33.3%），革兰阴性菌840株（66.7%）。排在前七位的分别是肺炎克雷伯菌158株（12.5%）、嗜麦芽窄食单胞菌120株（9.5%）、大肠埃希菌115株（9.1%）、铜绿假单胞菌109株（8.7%）、鲍曼不动杆菌83株（6.6%）、金黄色葡萄球菌70株（5.6%）和屎肠球菌63株（5.0%）。呼吸道分泌物标本中，非发酵菌占56.2%（350/623）。其中嗜麦芽窄食单胞菌占15.3%（95/623）。血液标本中，肠杆菌科细菌占42.3%（104/246），凝固酶阴性葡萄球菌占34.6%（85/246）。脓液标本中肠杆菌科细菌占39.4%（76/193），肠球菌属细菌占28.5%（55/193）。耐甲氧西林金黄色葡萄球菌葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为54.3%和82.5%，未发现耐利奈唑胺、万古霉素、替考拉宁葡萄球菌属菌株，耐万古霉素屎肠球菌的检出率为8.9%，肠球菌属未检出耐利奈唑胺的菌株。肠杆菌科细菌对碳青霉烯类药物高度敏感。铜绿假单胞菌对亚胺培南和美罗培南的耐药率已分别达34.1%和15.8%。嗜麦芽窄食单胞菌对米诺环素、左氧氟沙星、复方磺胺甲恶唑等药物敏感。鲍曼不动杆菌仅对头孢哌酮/舒巴坦的耐药率低于10.0%。肺炎克雷伯菌、嗜麦芽窄食单胞菌、铜绿假单胞菌、鲍曼不动杆菌等革兰阴性菌对大多常用抗菌药物的耐药率低于CHINET监测的数据。结论粒缺伴感染患者常见感染部位致病菌株分布有其特点，细菌耐药率整体低于CHINET全国医院大样本监测。

Patient Safety Climate in General Public Hospitals in China: A Multiregion Study.

This study aimed to analyze the potential difference in patient safety climate by region (Shanghai vs Hubei Province vs Gansu Province) and general public hospital level (tertiary vs secondary) in China. Using a stratified sampling method, employees from 54 public general hospitals in Shanghai, Hubei Province, and Gansu Province in China were surveyed in 2015. The Patient Safety Climate in Health Care Organizations tool and the percentage of "problematic responses" (PPRs) were used to measure and analyze the patient safety climate. A χ2 test and hierarchical linear modeling were applied for the analysis. In the study, 4121 valid questionnaires were collected. The psychometric analysis supported the validity and reliability of our Chinese version of the Patient Safety Climate in Health Care Organizations. The overall patient safety climate was relatively good and exhibited no significant differences among the surveyed hospitals by various regions (Shanghai vs Hubei Province vs Gansu Province) and diverse hospital levels (tertiary vs secondary) using hierarchical linear models. "Fear of blame and punishment" and "fear of shame" had the highest PPRs and were prevalent in various types of hospitals. "Provision of safe care" and "organizational resources for safety" also had notably high PPRs. There were 4 dimensions varied by region and hospital level in this survey. Fear of shame and fear of blame are the most important barriers to the improvement of patient safety in the hospitals of China. Facility characteristics contributed somewhat to hospital patient safety climate in some dimensions. The initiatives to improve hospital patient safety climate are necessary and its implementation strategies needs to be shared.

Clinical and pathologic predictors of central lymph node metastasis in papillary thyroid microcarcinoma: a retrospective cohort study.

To identify the clinical and pathological predictors of central lymph node metastasis (CLNM) in patients with clinically lymph node-negative papillary thyroid microcarcinoma (PTMC). Data pertaining to 541 clinically lymph node-negative PTMC patients who underwent thyroid surgery at the Shanghai General Hospital between January 2010 and December 2013 were retrospectively analyzed. According to histopathological evidence of central lymph node involvement, patients were divided into central lymph node metastasis (CLNM)-positive and CLNM-negative groups; risk factors for CLNM were identified statistically. LNM was found in 148 (27.4%) patients. Gender (P=0.002), age (P<0.001), tumor size (P<0.001), multifocality (P<0.001), and extrathyroidal extension (P<0.001) were significantly different between CLNM-positive and CLNM-negative groups. On multivariate analyses, male sex (odds ratio [OR]=2.656), age <45years (OR=4.184), tumor size >0.575cm (OR=2.105), gross extrathyroidal extension (OR=14.605) and multifocality (OR=2.084) were independent risk factors for CLNM. Among patients who did not have any of these five risk factors, only 3.9% were found to have CLNM. A relatively high prevalence of CLNM was observed in patients with clinically lymph node-negative PTMC. CLNM was associated with male sex, younger age, larger tumor size, extrathyroidal extension and multifocal PTMC.

Validation of Lymphocyte-to-Monocyte Ratio as a Prognostic Factor in Advanced Pancreatic Cancer: An East Asian Cohort Study of 2 Countries.

Although the prognostic value of lymphocyte-to-monocyte ratio (LMR) has been recently demonstrated in solid tumors, little is known of its impact on advanced pancreatic cancer (APC). This study evaluates and validates the cutoff value of LMR for predicting palliative chemotherapy outcome using a transnational cohort of APC patients. A total of 405 APC patients receiving first-line palliative chemotherapy were retrospectively reviewed. Of these, 153 patients were from Shanghai General Hospital (training set) and 252 patients were from Kyoto University Hospital (validation set). The optimal cutoff value of LMR was determined by a generating receiver operating characteristic curve for the training set. The association between LMR and survival was evaluated using log-rank tests, and a Cox regression model was used to validate the independent prognostic significance of LMR in APC patients. The optimal cutoff value of LMR was 2.8. Overall survival was significantly longer in patients with LMR of 2.8 or greater than those with LMR of less than 2.8 (P < 0.001). Cox regression analysis showed that LMR was an independent prognostic factor. The impact of LMR was widely observed in all subgroups except the performance status 2 subgroup. Lymphocyte-to-monocyte ratio may be considered as a promising prognostic marker for APC patients receiving palliative chemotherapy.

Clinical significance of early immunological paralysis in patients with severe H1N1 influenza A

To analysis the immunological characteristics of patients with severe H1N1 influenza A, and to provide theoretical basis for predicting the prognosis of the disease. A retrospective analysis was conducted. The clinical data of 15 patients diagnosed with severe H1N1 influenza A and admitted to Shanghai General Hospital of Nanjing Medical University from October 2015 to December 2016 were collected. All the patients were divided into survival and death groups according to 28-day survival. Clinical characteristics, treatment algorithm, organ function, inflammatory reaction and immune cell status were compared, and Cox regression was used to decide the risk factors of 28-day death in patients with severe H1N1 infection A. All 15 patients with severe H1N1 infection A were enrolled, most of who presented with cough (93.3%), fever (86.7%), sputum production (80.0%), shortness of breath (73.3%), myalgia (40.0%) and fatigue (40.0%). All had been received anti-virus, antibiotics, mechanical ventilation and anti-coagulation therapy; some were treated with prone position, neuromuscular blocker and extracorporeal membrane oxygenation (ECMO). The incidences of acute myocardial and kidney injury were high, and the acute physiology and chronic health evaluation II (APACHE II) score (14.1±6.1) and sequential organ failure assessment (SOFA) score (9.6±4.1) implicated the critical condition. Of 15 patients, 4 patients died in 28 days, while 11 were cured and discharged. Compared with survival group, the patients in death group had higher levels of APACHE II score (22.7±3.8 vs. 11.8±3.8), troponin [cTn (μg/L): 0.52 (0.07, 2.02) vs. 0.15 (0.10, 0.45)] and blood urea nitrogen [BUN (mmol/L): 11.9 (6.7, 29.1) vs. 3.9 (2.7, 6.8)] and a lower level of blood platelets count [PLT (×109/L): 76±33 vs. 146±49, all P < 0.05]. The levels of C-reactive protein (CRP) and interleukin-6 (IL-6) within 24 hours of admission in death group were significantly higher than those of survival group [CRP (mg/L): 172.2±88.5 vs. 74.8±33.1, IL-6 (ng/L): 283.3 (140.1, 711.0) vs. 18.5 (12.7, 71.4), both P < 0.01]. Compared with survival group, the expressions of CD3+, CD4+, CD8+ T cells and natural killer cell (NK cell) in death group were significantly decreased (CD3+ T cell: 0.348±0.119 vs. 0.573±0.106, CD4+ T cell: 0.135±0.046 vs. 0.344±0.098, CD8+ T cell: 0.089±0.057 vs. 0.208±0.054, NK cell: 0.124±0.057 vs. 0.252±0.182, all P < 0.05), but there were no significant differences in CD4+/CD8+ ratio and human leucocyte antigen-DR positive (HLA-DR+) T cell between death group and survival group (CD4+/CD8+ ratio: 1.57±0.26 vs. 1.83±0.54, HLA-DR+ T cell: 0.035±0.022 vs. 0.062±0.036, both P > 0.05). B lymphocyte in death group was significantly higher than that of survival group (0.477±0.136 vs. 0.229±0.121, P < 0.01). Cox regression analysis revealed that APACHE II score [risk ratio (RR) = 20.4, 95% confidence interval (95%CI) = 5.3-31.2, P = 0.017], CD4+ T cell (RR = 11.1, 95%CI = 5.1-20.0, P = 0.048) and CD8+ T cell (RR = 9.1, 95%CI = 4.3-16.7, P = 0.049) were independently risk factors of 28-day survival of patients with severe H1N1 influenza A. Immunological paralysis and severe inflammatory response were early complicated with severe H1N1 influenza A, and these were significantly associated with prognosis.

Correlation between psychological empowerment and occupational burnout of nursing students in clinical practice

Objective To explore the correlation between the psychological empowerment and occupational burnout of nursing students in clinical practice. Methods Totally 395 nursing students from 5 nursing schools who had graduation practice in 13 general hospitals in Shanghai between February and May 2015 were selected by cluster sampling, and investigated with nursing burnout scale (NBS) and psychological empowerment scale (PES) . Results The 395 nursing students′burnout score and psychological empowerment score were (135.31±21.74) and (3.56±0.65) , respectively, with a moderate level; Nursing burnout was negatively correlated with meaning at work, self-efficacy and psychological empowerment (r=-0.140, -0.127, -0.101; P<0.05) . Conclusions Clinical teaching should attach importance to nursing students′perception of psychological empowerment, and creates a favorable environment for them to foster psychological empowerment, thus reducing occupational burnout. Key words: Psychological empowerment; Occupational burnout; Nursing students

Expression of NF-κB in a degenerative human intervertebral disc model

Objective: To investigate the changes in the expression of NF-κB signaling pathway in human degenerative intervertebral discs. Methods: From October 2014 to March 2016, 55 nucleus pulposus of surgical patients with degenerative human intervertebral disc were collected for study in Department of Orthopedic Surgey, Hospital of Zaozhuang Mining Corporation, and Department of Orthopedics, Shanghai General Hospital Affiliated Shanghai Jiaotong University, School of Medicine.The collected nucleus pulposus tissues were divided into two groups: experimental group(30) and control group(25). Cell culture observed normal and degenerative nucleus pulposus cells morphological changes; immunofluorescence observed NF-κB p65 changes in the nucleus of nucleus pulposus cells.Real-time PCR was observed changes in aggregated proteoglycans and matrix metalloproteinase gene mRNA.Finally, the use of blockers of nucleus pulposus cells were treated 24 hours, Western blot analysis the changing of p65, ADAMTS-4, MMP-13, aggregate proteoglycans and collagen Ⅱ protein expression. Results: Compared with the experimental group, the nucleus pulposus cells in the control group had larger cell volume, abundant cytoplasm and faster growth rate.Cell immunofluorescence show Nondegenerative nucleus pulposus cells p65 protein was mainly localized in the cytoplasm, degeneration of nucleus pulposus cells p65 protein was mainly concentrated in the nucleus.RT-PCR showed degenerative group of matrix metalloproteinases (MMP-1, MMP-3, MMP-13), aggrecanase(ADAMTS-4, ADAMTS-5) and IL-6 mRNA expression was significantly higher than Nondegenerative group; aggrecan and type Ⅱ collagen expression than those without degeneration group was significantly lower.Expression of nucleus pulposus degeneration in nuclear protein p65 with the degenerative level increased gradually increased.BAY11-7082 blocked the activity of NF-κB signaling pathway, which could significantly down-regulate the expression of ADAMTS-4 and MMP-13 protein and significantly up-regulate the expression of Agg and COLⅡ protein.With the increase of BAY11-7082 concentration, gradually strengthened. Conclusion: The activation of the NF-κB signaling pathway in a degenerative intervertebral disc is gradually increased, regulating the over-expression of matrix-degrading enzymes.It plays an important role in the degradation of extra-cellular matrix.

Correlation between anatomical factors of spermatic vessels and varicocele

Objective: To analyze the correlation between anatomy of spermatic vessels and varicocele, providing reference for the preoperative assessment and treatment of varicocele. Methods: A total of 156 patients who underwent microsurgical left subinguinal varicocelectomy at Shanghai General Hospital between May 2015 and July 2016 were included in this study. The severity of varicocele and number of spermatic vessels detected in operations were recorded. According to the number of internal spermatic arteries (ISAs), the patients were divided into three groups: single-ISA group (55 cases), double-ISAs group (63 cases) and multi-ISAs group (38 cases), to analyze the correlation among spermatic vessels and to compare varicocele grade, the volume of testes, the parameter of semen analysis, serum reproductive hormone, surgery time, and hospital stay among the three groups. Results: The number of ISAs was positively correlated with the ipsilateral internal spermatic veins (ISVs) (r=0.210; P=0.008)and lymphatic vessels (r=0.224; P=0.005); the number of lymphatic vessels was positively correlated with the ipsilateral gubernacular veins (r=0.172; P=0.032)and ISVs (r=0.296; P=0.000) . The number of ISVs in the multi-ISAs group (10.58±4.28) was significantly larger than that in the single-ISA group (8.22±3.10, P=0.003). The number of lymphatic vessels in the multi-ISAs group(4.11±1.90)was also significantly larger than that in the double-ISA group(3.76±1.40, P=0.020) and the single-ISA group(3.13±1.52, P=0.007). The number of ISVs in grade 2 varicocele patients (9.74±3.90) was significantly higher than that in grade 3 varicocele patients (8.33±3.10, P=0.013). No significant differences in varicocele grade, change of pre- and post-operative semen analysis, serum reproductive hormone, the volume of ipsilateral testes, surgery time, and hospital stay were observed among the three groups. Conclusions: There is a correlation among various kinds of spermatic vessels. Patients with grade 2 varicocele, especially who have multiple ISAs, are likely to have more ISVs and lymphatic vessels. For these patients, surgeons should pay more attention to protect spermatic arteries and lymphatics carefully while ligating varicose veins completely to prevent recurrence and complications.

A combination of Yiqiqubai granule and 308-nm excimer laser in treatment of segmental vitiligo: a prospective study of 233 patients

Objective: To study the effect of Yiqiqubai granule combined with 308-nm excimer laser treatment for segmental vitiligo (SV).Methods: A prospective research was performed in 233 patients with SV treated in Shanghai General Hospital from 11 February 2015 to 25 August 2016, they were divided into group A (n = 75), group B (n = 78) and group C (n = 80) according to the random number table. Group A was treated with Yiqiqubai granule, group B treated with 308-nm excimer laser and group C treated with combined treatments. The treatment time lasts for 6 months. The clinical efficacy, color-reverse rate and quality of life of the three groups were assessed.Results: After treatment, the effective rate and markedly effective rate of group C (87.5%, 51.3%) were significantly higher than group A (74.7%, 42.7%) and group B (80.8%, 47.4%) (p < .05). Color-reverse rate of group C (66.5 ± 17.6%) was much higher than group A (47.2 ± 16.4%) and group B (49.9 ± 24.2%) (p < .05). Significant differences were found among three groups after treatment in terms of embarrassment, social and work (p < .05).Conclusions: The combination of 308-nm excimer laser and Yiqiqubai granule in the treatment of SV has good clinical effect.

Effects of transitional care on the QOL and compliance of patients with glaucoma

Objective To explore the effects of transitional care on the quality of life (QOL) and compliance of patients with glaucoma. Methods Totally 100 cases of patients with glaucoma from Ophthalmology of Shanghai General Hospital of Shanghai Jiao Tong University were selected from October 2014 to October 2015. By simple sampling method, patients were divided into the experimental group (patients admitted in odd-number week) and the control group (patients admitted in even-number week) with 50 cases in each group. Patients in the control group were given routine education and discharge guidance, and they went to the routine clinics for return visit; patients in the experimental group were given transitional care, education and discharge guidance based on health education handbook, in addition, two telephone follow-up and two outpatient follow-up were took at one month and three months after discharge. Chinese low vision quality of life (CLVQOL) scale, compliance scale and disease-related knowledge questionnaire were used to investigate patients' situation. The QOL, compliance and master degree of disease-related knowledge of patients before and after intervention were compared. Results The scores of CLVQOL of patients in two groups at different time-points were statistically significant different (P 0.05) . The RAM scores of patients in two groups at different time-points were statistically significant different (P>0.05) . The differences of RAM score between two groups were statistically significant (P 0.05) . After admission, there was no significant difference in the scores of disease-related knowledge questionnaire between two groups (P>0.05) ; before discharge, the total score of disease-related knowledge questionnaire and the scores of risk factors, susceptible population, treatment methods, precautions between two groups were statistically significant different (P<0.05) . Conclusions Transitional care intervention can improve the compliance of patients with glaucoma after discharge, as well as the QOL of patients. Key words: Glaucoma; Quality of life; Transitional care; Compliance

Cost-utility analyses of cataract surgery in vision-threatening diabetic retinopathy

To explore the cost utility of cataract surgery in patientswith stabilized vision-threatening diabetic retinopathy (DR). Department of Ophthalmology, Shanghai General Hospital,Shanghai Jiao Tong University, Shanghai, China. Prospective case series. Patients diagnosed with cataracts combined with stabilized vision-threatening DR had successful phacoemulsification with foldable posterior chamber intraocular lens implantation. The corrected distance visual acuity (CDVA) and utility value obtained using the time tradeoff method at 3-month postoperative intervals were compared with those preoperative values. The cost per quality-adjusted life year gained was calculated using the bootstrap method. Sensitivity analyses were performed to test the robustness of the results. The study comprised 126 patients (153 eyes). All surgeries were successful. The weighted logMAR CDVA changed from 0.82 logMAR ± 0.34 (SD) to 0.58±0.30 logMAR (P<.001). The utility values increased from 0.58±0.14 to 0.72±0.14 (P<.001). The gain in utility values was correlated with the postoperative weighted logMAR CDVA, the change between the postoperative and preoperative weighted logMAR CDVA, performance of bilateral cataract surgery,and duration of DR or diabetic macular edema. The patients gained 1.50 quality-adjusted life years by cataract surgery. The cost per quality-adjusted life year was US $768. This surgery was cost-effective at the threshold of US $22 526 per quality-adjusted life year in China. The cost per quality-adjusted life year varied from US $630 to US $8707 in sensitivity analyses. Cataract surgery was a cost-effective intervention for patients with coexisting, stabilized, vision-threatening DR.

Clinical effects of different methods of the proximal fusion for long segmental lumbar vertebrae fusion in treatment of degenerative lumbar scoliosis

Objective: To explored the clinical effects of different methods of the proximal fusion for long segmental lumbar vertebrae fusion in treatment of degenerative lumbar scoliosis(DLS). Methods: From January 2007 to March 2014 fifty-five cases of DLS treated by the posterior proximal fusion of long segmental lumbar vertebrae fusion were analyzed in Department of Orthopaedics, Shanghai general Hospital of Nanjing Medical University (35)HuaiAn The First Hospital Affiliated to Nanjing Medical University(20). According to various upper instrumented vertebra(UIV) the patients were divided into Group A(upper horizontal vertebra, UHV, n=17), Group B (upper natural vertebra, UNV n=18 ), and Group C(upper end vertebra, UEV, n=20). The VAS, ODI, spinal balance parameters and postoperative complications in each group were assessed. Results: Except for 1 case death of serious lung infection in early postoperative, 54 cases were received 2-4 years follow-up. No statistical differences in improvements and fusion rates were found among 3 groups (P>0.05). The improvements of the coronal Cobb's angle in the A group were significantly more than the C group (75.8%±12.8%, 69.6%±11.8%, 63.4%±15.3%, P<0.05). The incidences of early postoperative complications in A group were the highest, next in B group, and lowest C group (52.9%, 22.0%, 15.0%, P<0.05). The incidences of proximal ASD in the C group were significantly more than the A group (12.5%, 22.2%, 50.0%, P=0.045). Conclusion: UHV, UNV and UEV had similar clinical outcomes for treatment of degenerative lumbar scoliosis in short term. Correction of the coronal deformity of UHV was superior to UEV. UEV was beneficial to reduce early complications, but more likely to happen proximal adjacent segment degeneration in the long run.

Aetiological characteristics of adult acute diarrhoea in a general hospital of Shanghai.

Epidemic surveillance is an effective means to determine the characteristics of acute diarrhoea and the benefits of disease control and prevention. The epidemiological, clinical, and aetiological data of adult (aged ⩾15 years) acute diarrhoea in a general hospital in Shanghai were collected and analysed. Out of 2430 acute diarrhoea patients, 162 subjects were sampled (sample ratio 15:1). The sampled subjects had an average age (±s.d.) of 44 ± 18 years; 142 (87·7%) had a history that indicated ingestion of contaminated food; and 40 (24·7%), 54 (33·3%), and 73 (45·1%) patients had diarrhoea that was attributed to viral, bacterial, and unknown aetiological origins respectively. Viral diarrhoea is mainly prevalent during the winter and spring months, while bacterial and diarrhoea of unknown aetiology occur mainly in the summer months. The average age of the unknown aetiology group (48 ± 19 years) was significantly older than that of the viral diarrhoea group (39 ± 16 years). The number of patients with vomiting in the viral group (30·6%) was significantly higher than that in the bacterial (17·1%) and unknown aetiology (8·2%) groups. Viral and bacterial infections are the main cause of acute diarrhoea in Shanghai. However, further effective technological means are needed to improve the surveillance, control, and prevention of acute diarrhoea.

Prognosis for recipients with hepatocellular carcinoma of salvage liver transplantation versus those of primary liver transplantation: a retrospective single-center study.

PurposeThe prognosis for recipients with hepatocellular carcinoma (HCC) of salvage liver transplantation (SLT) versus those of primary liver transplantation (PLT) remains controversial. The objective of this study was to evaluate the clinical features and survival rate of SLT recipients.MethodsThree hundred seventy-one patients with HCC transplanted at Shanghai General Hospital, China, between October 2001 and October 2011 were separated into PLT (n = 295) and SLT (n = 76) groups. Patient characteristics and survival curves were studied by univariate and multivariate analysis. A Milan criteria-stratified survival analysis was conducted.ResultsThe proportions of reoperation (11.8 vs. 5.4 %, P = 0.047) and early postoperative mortality (11.8 vs. 4.7 %, P = 0.032) were higher in the SLT group than in the PLT group. Recurrence free survival (RFS) rate and overall survival (OS) rate had no statistically significant differences after stratification using Milan criteria between the PLT group and SLT group. Alphafetoprotein >400 ng/mL (P = 0.011), microscopic vascular invasion (MVI) (P < 0.001), tumor node metastasis (TNM) staging (P = 0.006), and out of Milan criteria (P < 0.001) were independent risk factors for RFS, while MVI (P < 0.001), TNM staging (P = 0.009), and out of Milan criteria (P = 0.003) were factors for OS. In the multivariate logistic regression analysis, HCC recurrence was associated with MVI (OR = 4.196 [2.538–6.936], P < 0.001), and out of Milan criteria (OR = 2.704 [1.643–4.451], P < 0.001).ConclusionsOur retrospective, single-center study demonstrated that SLT increases surgical difficulty; however, it has good post-transplantation OS and is a feasible alternative after HCC recurrence within Milan criteria.