Dear Dr. Pulec

Objective To investigate the current status analysis the risk factors of medical adhesive related skin injury(MARSI) in neonates in NICU, in order to provide guidance in prevention and nursing of the skin injury. Methods Convenience sampling five NICU in Shenyang, prospective investigate the incidence of MARSI of neonates during the NICU stay, and analysis the incidence, injury type distribution and risk factors. Results The incidence of MARSI in neonates in NICU was 12.8%(53/413); the major injury type of MARSI was epidermal stripping (47.2%,25/53) and skin tear (35.8%,19/53) in mechanical injury; Logistic analysis showed that the independent risk factors of MARSI were the use of stomach tube, dehydrate skin and blue light therapy (χ2=5.953, 9.806 and 7.568, P < 0.05). Conclusions MARSI is frequency interrupted in neonates during the NICU stay, correct selection of medical adhesive products, application of suitable paste and remove skills are helpful to reduce the incidence of MARSI in neonates during the NICU stay. Key words: Neonatal intensive care unit; Neonates; Medical adhesive related skin injury; Risk cause analysis

Objective To provide possible evidences for the medical reform by analyzing the survey data of medical insurance and key cardiovascular diseases among rural residents in Tongnan, Chongqing City. Methods The survey data, collected in Tongnan, Chongqing from Chinese important cardiovascular disease prevalence survey and key technology research which was a multi-stage stratified random sampling questionnaire survey research, was selected to discover the status of medical insurance, cardiovascular dis-eases and medical care among local residents through inputting the data by the Excel 2007 software and through generally descriptively analyzing the data by SPSS 17.0 statistical software. Results Of 1 035 resi-dents, male 534, female 501, total average age was (61.25±13.74)years old, the coverage rate of new rural cooper-ative medical insurance was 93.91% and commercial medical insurance was 0.39%; the total morbidity rate of hypertension or diabetes and both was 26.67% (276 patients). Within one year, 94.57% of the 276 patients were not hospitalized but were covered by the medical care and were followed up in the primary health institutions. And only the rest 15 ones (5.43%) were under hospitalization, among which 7 were in primary, 5 were in secondary and 3 were in tertiary medical care institutions; the average hospitalization frequency was 2.93 times in one year and 6.53 days for each time. The average hospitalization cost was 4 362 yuan each time for each patient after insurance reimbursement. Conclusion It was recommended to continue to implement the new rural cooperative medical insurance in rural areas, to promote the commer-cial medical insurance appropriately, to set up and carry out the hierarchical medical system and the first medical care in community, to adjust medical insurance reimbursement proportions and patterns, to strengthen the cultivation of general practitioners, to establish hospital supports and dual referral system. Key words: Medical insurance; Cardiovascular disease; Medical reform; Rural areas

Objective To explore the common causes and associated risk factors for unintentional injuries among inpatient children from Yuying Children's Hospital of Wenzhou Medical College during 2007～2008.Methods This retrospective study involved 2 672 children of 0～18 years of age treated for unintentional injuries in Yuying Children's Hospital of Wenzhou Medical Collge from 2007 to 2008.Statistical evluation included x2 analysis and computation of relative risk(RR)with a 95％ confidence interval(CI).Results The top five types of unintentional injury were falls from one level to another(e.g.from playground equipment,chair,bed,stationary vehicle,and so on.)or falls on same level(e.g.from slipping,tripping,stumbling,collision,and so on)(30.84％),traffic accident(25.15％),falls from height(e.g.from balcony,bridge,building,window,and so on)(11.56％),foreign body ingestion/inhalations(6.89％),open wounds including cut,lacerarion and puncture wound(6.51％).The types of unintentional injury were not uniform among different age groups(x2 =602.12,P ＜0.01).Boys had a higher incidence of injury than did girls with a ratio of 2.34∶ 1.Unintentional injury rates varied considerably by age(x2 =583.90,P ＜0.01).The most prevalent age group was 1～4 years old.The most common body part injuried was the extremity region(54.00％).20.40％ of cases had injuried to the neck and head,15.27％ had thorax and abdomen injuries,3.78％ had vertebral column injuries and 1.87％ had pelvis injuries.Significant differences existed in injuried body site among different age children(x2 =315.21,P ＜0.01).The discharge departments were traumatic department(42.07％),hand surgery and spinal department(22.16％),department of otorhinolaryngology(6.89％),orthopaedic department(6.32％),neurosurgical department(5.84％),and the other discharge departments included pediatric surgical department,chest surgery department,stomatology department,ophthalmic department,pediatric intensive care unit and pediatric internal department.The number and rate of unintentional injury were the highest in summer(July-September),accounting for 28.63％.The estimated days and cost of unintentional injuries were 1 1.72 d and 9 617.96 yuan RMB each child,respectively.Conclusion Injury prevention efforts should include consideration of the substantial differences in the leading causes of unintentional injuries,in regard to sex,age and type of injury.Unintentional injuries lead to a threat to health and well-being and waste a majory source of medical spending in China for children and youth 0 to 18 years age.Making efforts to prevent child injury and establishing a complete emergency medical system are very important. Key words: Children; Trauma and injury; Injury prevention

With the full coverage of the universal insurance coverage, people's health awareness has been continuously improving, and the demand for medical security has been increasing, which has led to the continuous growth of the medical income of public hospitals. In public hospitals, the increase in income has brought large troubles for hospital financial management, traditional financial management mode have been unable to meet the needs of hospital financial management work. To this, to improve the level of financial management, the hospitals must innovate financial management methods based on reality, take feasible targeted measures. This paper analyzes how to improve the financial management level of public hospitals under the new medical reform. Key words: New medical reform; Public hospital; Financial management; Improvement

Objective To study the risk factors of the needlestick injury and its impact on anxiety state of the medical staff. Methods From 2008 to 2012, we collected the data of sharp instrument wound of medical staff and surveyed the Self-Rating Anxiety Scale (SAS), to analyze the risk factors of needlestick injury and its impact on anxiety. Results The cumulative exposure rate of needlestick injury of the nurses (43/120, 35.8%) was higher than the doctors’ (7/55, 12.7%). The difference was statistically significant (χ2=9.87, P<0.01). The SAS score of doctors was (49.7±11.3), which was significantly higher than (45.2±9.3) of the nurses (t=12.39, P<0.05). Polluted scalp needle was the most frequent source of needlestick injury. The risk link of needlestick injury was in and after the operation. Conclusions The high risk of sharp injuries can cause the psychological anxiety of medical staff. For medical staff, targeted psychological counseling is a useful measure for occupational protection. Key words: Anxiety; Sharp injury; Risk factors; Occupational protection

OBJECTIVE: Spinal injuries are among the most important injuries in motorcyclists accounting for 1 to 5% of all injuries in this group with the frequency rising as high as 11% in severe and fatal cases.The most commonly involved areas are thoracic and cervical spines. Injuries to these areas can lead to significant morbidities with life-long complications. In this study, we aim to evaluate the relation of some risk factors including speed of motorcycle at the crash, the type and the mechanism of collision and using helmet with the rate and severity of cervical injury in motorcyclists. PATIENTS AND METHODS: We retrospectively analyzed the medical files of patients with the cervical spinal injury due to motorcycle crash, diagnosed according to ICD10, who were admitted to Shahid Kamyab Trauma Center in Mashhad, Iran from January 2011 to January 2012. Medical files involved in motorcycle crashes were selected and patients who met the inclusion criteria were enrolled to the study. Characteristics of each motorcycle collision for each patient were determined by a traffic specialist from Traffic Police Department. Finally, the medical records were evaluated by a neurosurgery resident to identify the type of the neck injury and determine the Injury Scale Score to assess the severity of the injury. Data was analyzed using SPSS software version 18. RESULTS: A total of 176 patients (mean age: 31.4, 97% male) met the inclusion criteria. Most of the accidents had occurred in rural and suburb roads outside the cities. Of the studied patients, 25 (14.2%) were found to have cervical spine fractures, 27 (15.3%) had neck strain or sprain and 153 (58.5%) had simply neck pain with no sever injuries. Neck fracture was significantly more common among the motorcyclists who had helmet when compared with nonhelmeted.... Language: en

Objective To explore the risk factors of VAP among multiple injury patients in comprehensive ICU so as to provide the basis for prevention and cure of VAP. Methods The retrospective analysis was made to the clinical data from 126 patients with mechanical ventilation for over 48 hours in ICU at the Third People's Hospital of Zhenjiang, the Affiliated Hospital of Jiangsu University, from January 2014 to December 2015. The Logistic regression analysis was performed to research related data in order to identify the risk factors of VAP. Results In 126 patients, there were 37 (29.37%) patients with VAP. Single factor analysis showed that the risk factors were the time of mechanical ventilation, score of the injury severity scale (ISS) , time of being admitted to ICU, coma, sedation and analgesia, hormone use, medical history of chronic lung disease, combined antibiotic (>2 kinds) , craniocerebral trauma, thoracic injury, spinal injury with significant differences (t/χ2=3.382, 20.241, 4.212, 29.837, 7.616, 5.322, 4.384, 8.246, 5.677, 15.394, 4.864; P 2 kinds) , medical history of chronic lung disease, craniocerebral trauma, thoracic injury (OR=3.897, 6.697, 5.506, 5.104, 10.984, 4.911, 6.046; P<0.05) . Conclusions The incidence of VAP is high among multiple injury patients in comprehensive ICU. The monitor of risk factors of VAP in multiple injury patients should be enhanced. Moreover, the effective intervention on prevention and cure of VAP should be taken for patients with long time of mechanical ventilation, high score of ISS, coma, combined antibiotic (>2 kinds) , medical history of chronic lung disease, craniocerebral trauma, thoracic injury and so on so as to reduce the incidence of VAP. Key words: Intensive care units; Pneumonia, ventilator-associated; Multiple injury; Risk factors

Objective To investigate the epidemiological characteristics of the in-patients with femoral supracondylar fracture in the Third Hospital of Hebei Medical University from 2009 through 2018. Methods The medical imaging computer archiving and transmission system and the medical record inquiry system were used to collect the data of all the in-patients with femoral supracondylar fracture who had been treated from January 2009 through December 2018 in The Third Hospital of Hebei Medical University. Their gender and age distribution, basic sociological data and cause of injury were characterized. The in-patients from January 2009 to December 2013 were assigned into group A while those from January 2004 to December 2018 into group B. The 2 groups were compared to find out the epidemiological characteristics and trends of the in-patients with femoral supracondylar fracture in the 10 years. Results Of the 508 in-patients with femoral supracondylar fracture, 279 (54.9%) were male and 229 (45.1%) female. Their age ranged from 1 to 94 years, averaging 44.3 years. The age group from 41 to 50 years accounted for the largest proportion (104 cases, 23.9%). In males, the age group from 41 to 50 years accounted for the largest proportion (33.3%, 80/279); in females, the age group from 51 to 60 years the largest proportion (30.3 %, 59/229). The proportion of females in the in-patients under 50 years of age (37.1%) was significantly lower than that (62.9%) in the in-patients over 50 years of age (P<0.05). According to the AO classification, there were 193 cases (38%) of type 33-A1, 117 ones (23%) of type 33-A2 and 198 ones (39%) of type 33-A3. There were 270 farmers (53.1%), 164 workers (32.4%) and 74 students (14.5%). Most injuries were caused by high energy (56.5%). The age of in-patients with low-energy injury (50.5±20.7 years) was significantly higher than that of in-patients with high-energy injury (39.5±19.6 years) (P< 0.05). The proportions of urban residents (30.0%), patients with low energy injury (37.9%) and type 33-A1 fractures (23.9%) in group A were significantly lower than in group B (43.3%, 46.9% and 32.3%, respectively) (P<0.05); the age of group A (41.9±21.8 years) was significantly younger than that of group B (45.9±19.9 years) (P<0.05); type 33-A3 fractures in group A (46.5%) were significantly more than in group B (36.3%)(P<0.05). Conclusions Femoral supracondylar fractures were more common in farmers. Most of the fractures were type 33-A3. The fractures were common in males from 41 to 50 years old and in females from 51 to 60 years old. There were more males than females in the junior patients but more females than males in senior patients. There were more young patients in complex fractures but there were more old patients in simple fractures and there were more very old patients in low-energy injuries. In the past 10 years, the patients with femoral supracondylar fracture increased year by year. Compared with the first 5 years, the late 5 years witnessed significant increases in age of patients and proportions of low-energy injury and simple fracture. Key words: Femoral fractures; Epidemiology; Sex factors; Age factors

Objective To investigate the clinical features of unintentional injuries in children, and to provide the theoretical basis for preventing and intervening the occurrence. Methods We collected the data of children aged from 0 to 14 years old and hospitalized in the First Affiliated Hospital of Guangxi Medical University from January 2013 to December 2015. Results There were 2 286 cases of children including 1 507 boys(65.92%) and 779 girls(34.08%). The high incidence age was 1 to 3 years with a total of 896 cases(39.19%). The first five causes of unintentional injuries were burns/scalds 840 cases(36.71%), fall/drop 464 cases(20.30%), blunt force injury 290 cases(12.68%), foreign bodies(in the esophagus, airway, etc) 253 cases(11.07%), and sharp object injury 153 cases(6.68%). The unintentional injuries of different age group were varied, for example, the common causes of 1 to 3 years old group were burns /scalds and foreign bodies(in the esophagus, airway, etc), and the main injuries in 6 to 14 years old group were fall/drop and blunt force.Furthermore, the proportion of unintentional injuries in rural children was 1 547 cases (67.67%), and in the urban children was 739 cases(32.33%). Unintentional injury with serious consequences included burns/scalds 55 cases(26.96%), sharp object injury 45 cases(22.06%), burns/scalds 26 cases (12.75%), blast injury of 23 cases(11.27%) and fall/drop 20 cases(9.80%). Disable/sequel happened in 204 cases(8.92%). Ten cases died(0.44%) including fall/drop in 4 cases, traffic accident in 3 cases(30%). Conclusion Young children aged 1 to 3 years are the most vulnerable to unintentional injuries.Burns/scalds and foreign bodies(in the esophagus, airway, etc) are the most common causes of injuries, and the boys are more common than girls.Moreover, the incidence rate of unintentional trauma in rural children was higher than that in the urban children.Unintentional injury complicated serious consequences are burns/scalds, sharp object injury, blast injury and fall/drop.Death cases in the majority are fall/drop and traffic accident.The key to reduce the occurrence of unintentional injuries is to strengthen propaganda of prevention knowledge about the children′s unintentional injuries. Key words: Children; Unintentional injury; Clinical analysis; Trauma,

Objective To understand the clinical features of drug-induced kidney injury (DIKI) in inpatients. Methods The medical records data of inpatients diagnosed as DIKI from January 31, 2010 to January 31, 2017 were retrospectively analyzed. The main analytic indicators included general conditions of patients, degree of renal damage, outcomes, and suspected drugs causing acute kidney injury (AKI), and so on. Results A total of 20 patients were entered into this study, including 16 males (80.0%) at age 8 to 80 years and the average age of (44±20) years, 4 females (20.0%) at age 27 to 71 years and the average age of (49±22) years. Eleven patients (55.0%) were ≤44 years old (young people), 4 patients (20.0%) were 45-59 years old (middle-aged people), 5 patients (25.0%) were ≥60 years old (old people). The kinds of diseases were 2 to 6 in each patient in the 20 patients. Of them, 3 patients (15.0%) had 2 kinds of diseases at the same time, 7 patients (35.0%) had 3 kinds of diseases, 5 patients (25.0%) had 4 kinds of diseases, 4 patients (20.0%) had 5 kinds of diseases, 1 patient (5.0%) had 6 kinds of diseases. The serum creatinine (Scr) and blood urea nitrogen (BUN) values in the 20 patients were 56.0-132.5(89.1±22.1)μmol/L and 2.9-8.5(4.9±1.6)mmol/L before medication, respectively and significantly increased to 128.0-506.0 (241.8±112.8) μmol/L and 4.3-28.0 (13.0±5.9) mmol/L after medication, respectively. After treatments with hemodialysis or renal protective drugs, the Scr and BUN values were significantly reduced to 52.0-439.0(174.8±97.5) μmol/L and 1.0-27.6(9.3±7.1)mmol/L, respectively. The differences of Scr and BUN levels between before medication and after medication, before treatment and after treatment were statistically significant (all P<0.05). All DIKI during hospita-lization were AKI. Six patients (30.0%) were in AKI stage 1, 10 patients (50.0%) in AKI stage 2, and 4 patients (20.0%) in AKI stage 3 (acute renal failure). By the time of discharge, 5 patients were cured, in 12 patients the condition was improved, 1 patient had no change, in 1 patient the condition was deteriorated, and 1 patient died. The effective rate of treatments was 85.0%. A total of 29 kinds of drugs were used in combination in the 20 inpatients, and 6-24(14±5) kinds of drugs were used in each patient. Five categories and 12 drugs were found to induce kidney injury in this study, involving antibacterial drugs(15 patients), chemotherapeutic drugs (2 patients), antiviral drugs (2 patients), immunosupp-ressants (3 patients), and anti-gout drugs(1 patient). Kidney damage was clearly documented in the instructions of all above-mentioned drugs. The time from medication to onset of DIKI was 1-56 days and the median time was 9 days. Conclusions Antibacterial drugs, especially antifungal drugs such as amphotericin B, were the main drugs causing kidney injury in hospital. The DIKI was AKI during hospitalization, and the treatment effect for AKI was good. Key words: Acute kidney injury; Drug-related side effects and adverse reactions; Inpatients

Objective To investigate the epidemiological features and trends of upper cervical spine injury in The Third Affiliated Hospital to Hebei Medical University from 2003 to 2012. Methods The clinical data of upper cervical spine fractures treated between January 2003 and December 2012 at our hospital were collected through the PACS system and case reports checking system. The fractures treated from January 2003 through December 2007 were assigned into group A while those from January 2008 through December 2012 into group B. Analytic items included gender, age and fracture type. Results A total of 201 upper cervical spine fractures were treated during the 10 years, accounting for 1.6% (201/12,427) of the spinal fractures and 0.2% (201/107,648) of all human fractures. They were 125 males and 76 female, with a male to female ratio of 1.64∶1. Their ages ranged from 16 to 97 years, with a mean age of 42 years. The age distribution showed that the peak age was from 21 to 50 years (65.2%, 131/201). Sixty cases were atlas fractures and 141 axis fractures, most of which were both males. Sixteen upper cervical spine fractures were complicated with lower cervical spine injury, accounting for 8.0% of all the upper cervical spine fractures (16/201). In group A, the upper cervical spine injury accounted for 2.3% (106/4,676) of the contem-porary spinal injury and 0.2% (106/55,423) of the contemporary human fractures; in group B, the upper cervical spine injury accounted for 1.2% (95/7,751) of the contemporary spinal injury and 0.2% (95/52,225) of the contemporary human fractures. Compared with group A, the proportion of type C atlas injury in group B increased by 39.6%. Conclusions The upper cervical spine fractures during the 10 years accounted for 1.6% of the spinal fractures and 0.2% of all human fractures. Most of the patients were young male adults. The axis fractures accounted for 70.1% of the upper cervical spine injury, most of which (62.4%) were dens fractures. 8.0% of the patients were complicated with lower cervical spine injury. Comparisons between the former and latter 5 years showed no significant difference in gender constituent ratio, a significant difference in age constituent ratio and an increasing trend in type C atlas injury. Key words: Cervical vertebrae; Atlas; Axis; Fractures, bone; Epidemiology

Objective To analyze the injury characteristics in 2004-2009 road traffic accidents （RTAS） of 0-25 years old adolescents treated in Beijing ＂120＂ Emergency Center so as to provide scien- tific basis for making effective measures in prevention and control of RTAs. Methods The data of all the adolescents with traffic injuries treated in Beijing ＂120＂ Medical Emergency Center were collected for a retrospective analysis on sex, age, traffic injury time, wound regions, injury characteristics and death condition of the injured adolescents. Results （ 1 ） There were 17 232 injuries and 259 deaths accord- ing to the traffic reports from 2004 to 2009. Among the total injury cases, there were 4 229 cases of 0-25 years old adolescents （24.5%） , at （20.13 ±4.43） years of age. The injury number showed a sig- nificant rising trend with the increase of age and the injury number of 20 years old group were obvious more than that of other age groups. （2） There were 2 252 males and 1 677 females, with ratio of males to females for 1.5 ： 1 （ P 〈0. 05 ）. （3） Total number of patients was decreased yearly. The high incidence of adolescent RTAs could be seen in September, October and May in one year; Friday, Saturday and Sunday in one week; and between 8：00 am and 11：00 pm in one day. The low incidence of adolescent RTAs could be seen in Tuesday in one week, and 3：00-6：00 am in one day （P 〈 0.05 ）. （4） Cases of limb and arthrosis wounds （53.4%） were more than those of head and neck wounds （35%）. Most of thecases were pedestrians （49.1%）. （5） There were 38 deaths, including 28 males and 10 females, at age of （19.29 ±5.30） years. The death were mainly resulted from eranioeerebral injuries （87%） , which mainly concentrated in July （ 13.2% ） and August （ 15.8% ）. Conclusions The present condition of adolescent traffic injuries is not good enough. We should strengthen traffic security education, increase executive powers in the traffic rush and promote cooperation and communication in pre-hospital emergen- cy, as may be beneficial for decreasing adolescent RTA. Key words: Accidents, traffic; Adolescent ; Emergency medical services; Beijing

Objective To access the clinical effect of medical radiation protective ointment compared with trolamine cream to prevent acute radiation-induced skin injury in breast cancer patients undergoing radiotherapy after modified radical mastectomy. Methods Between February 2017 and February 2018, a total of 120 stage T1-4N1-3M0 eligible patients received intensity modulated radiation therapy were enrolled and matches into two groups: study group (60 cases) was administered medical radiation protective ointment from the first irradiation fraction, and control group (60 cases) received trolamine cream. When 3 grade reaction was observed, patients in control group start to administer medical radiation protective ointment until a month after radiation. Results The occurrence rate of acute breast dermal radiation reaction was 100%.Most patients in study group only underwent 1 grade radiation reaction (82%), while 2 and 3 grade radiation reaction (47% and 13%) in control group were common (P=0.000). Both pruritic degree and pain degree were higher in control group compared with study group (both P=0.000). In study group, the occurrence of 2 grade acute radiation-induced skin injury was obviously later than in control group with significant difference (P=0.000). Patients observed with 3 grade reaction relieved to certain reaction after administering medical radiation protective ointment. Conclusions Medical radiation protective ointment can effectively both alleviate and delay acute radiation-induced skin injury compared with trolamine cream. It also has therapeutic effect on 3 grade radiation reaction. Key words: Breast neoplasms/intensity modulated radiation therapy; Medical radiation protective ointment; Acute radiation-induced skin injury

Objective To investigate the value of the acupuncture with Medicinal herbs in the treatment of the intractable hiccup after severe craniocerebral injury. Methods Sixty patients diagnosed of intractable hiccup after severe craniocerebral injury were randomly recruited into a therapeutic group and a control group. The therapeutic group was treated with acupuncture and medicinal herbs, while the control group was treated with western medicine. The therapeutic course for both groups was one week. The efficacy was evaluated by observing the cure rate, improvement rate and non effective rate respectively. Results In the therapeutic group :23 patients were cured and the total effective rate was 96.67%;While in the control group: 12 patients were cured and the total effective rate was 70.00%. The effective rate of therapeutic group was obviously better than the control group. Conclusion Acupuncture with medicinal herbs in the treatment of the intractable hiccup after severe craniocerebral injury has good efficacy. Key words: Acupuncture; Medicinal herbs; Intractable hiccup; Severe craniocerebral injury

This study was conducted in order to examine the quantity of health and medical statistics survey in Medical Records Offices which was required by outside institutions and whether it is profitable for the hospitals or not. The thirteen outside institutions required health and medical statistics of the 24 types of the survey to Medical Records Offices. 16.7% of health and medical statistics of the survey was paid to medical records offices such as the National Cancer Registration Survey, Patient Survey, Tuberculosis Patient Survey, and Hospital Discharge Patients Injury Survey. Medical Records Offices' total length of time for the health and medical statistics survey was over 200 hours per year like the National Cancer Registration Survey, Healthcare Accreditation System and Hospital Discharge Patients Injury Survey. The Medical Record Administrators in the hospitals with fewer than 500 beds work full time from 1 to 3. It is indicated in the study that it is necessary to improve the health and medical statistics survey system in Medical Records Offices required by the outside institutions and to employ additional Medical Record Administrator for more accurate Health and Medical Statistics Survey.