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August 2013, Volume 16, No.23 Abstracts

 Performance Management System of National Health Service in UK and Its Enlightenment for China

LIU Jian-chun, HAO Xiao-ning,BO Tao,et al.School of Public Health,Harbin Medical University,Harbin 150086, China

Abstract After 20 years development,UKs National Health Service(NHS) performance management has formed a relatively complete system. Based on the analysis of the background, history and the core elements of the UKs NHS performance management, the paper summarizes and extracts the mirror and inspiration on performance management of health service system in China.

Key words National health service;Performance management;Performance assessment;The United Kingdom

Relationship of C-peptide Level to Diabetic Retinopathy in T2DM Patients

LIU Wei, HUA Lin, ZHANG Xue-lian, et al.Department of Endocrinology, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China

Abstract Objective To investigate the relationship of C-peptide(CP)to diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM).

Methods Totally 327 T2DM patients admitted to this hospital from January 2006 to March 2007 were divided, according to thyroid stimulating hormone(TSH) level, into groups A(with normal thyroid function,0.4 mU/LTSH4.0 mU/L, n=200),B(with mild SCH,4.0 mU/LTSH10.0 mU/L, n=107),C(with severe SCH,TSH10.0 mU/L, n=20),and according to whether receiving insulin therapy(IT),into groups IT(n=281), non-IT (n=46).Levels of basic CP(CP0)and 1-,2-,3-hour postprandial CP(CP1, CP2, CP3) were detected. TOPCON eyeground photographical equipments were used to recheck.

Results There was significant difference in CP0,CP3 among the 3 groups(P0.05),not in CP1, CP2(P0.05).By Spearman rank correlation analysis,only CP0 in group A was negatively correlated with right eye lesions(P0.05),but by coefficient of partial correlation results after correction of diabetic duration and HbA1c ,CP level was not correlated linearly with DR in the 3 groups(P0.05).By multiple coefficient of partial correlation after correction of age and diabetic duration, CP level was not correlated linearly with lesions of right,left eyes in groups IT,non-IT(P0.05).

Conclusion CP level may be correlated with occurrence and development of DR,but under the influence of many factors,role of CP may be weakened.The relationship between CP and DR in T2DM patients needs discussing further.

Key words Diabetes mellitus, type 2; C-peptide; Diabetic retinopathy

Correlation of Diabetes Control with Benign Prostatic Hyperplasia in T2DM Patients

CHU Lin, CHEN Ling-xia, MIAO Yi-de, et al.Department of Geriatrics, Peoples Hospital of Peking University, Beijing 100044, China

Abstract Objective To evaluate the relationship between diabetes control and benign prostatic hyperplasiaBPHin type 2 diabetes mellitus(T2DM).

Methods Totally 154 male T2DM patients were divided into groups A(control group, n=67),B(blood glucose controlled to standard, n=46),C(blood glucose controlled not to standard, n=41).Blood pressure, body weight, body height were measured, body mass indexBMIcalculated, levels of serum fast glucoseFPG, total cholesterolTC, triglyceridesTG, low-density lipoprotein cholesterolLDL-C, high-density lipoprotein cholesterolHDL-C, glycosylated hemoglobinHbA1c and prostate-specific antigenPSAdetected.Total prostate volumePVwere measured by ultrasound.

Results PV increased significantly in group C as compared with groups A and B q =-3.02, -2.00, P0.05; Annual PV growth rate was significantly higher in group C than in groups A,B q =-3.19, -2.48, P0.05; By Pearson correlation analysis,PV was positively correlated with HbA1c ,FPG, PSAr=0.260, 0.195, 0.363, P0.05, negatively with HDL-Cr=-0.192, P0.05; Annual PV growth rate was positively correlated with HbA1c , FPG, LDL-C and PSAr=0.272, 0.219, 0.164, 0.348, P0.05, negatively with HDL-Cr=-0.216, P0.05.

Conclusion Well controlling blood glucose can slow down effectively the growth rate of PV and delay BPH progression.

Key words Prostatic hyperplasia; Diabetes mellitus, type 2; Blood glucose

Influencing Factors of Vasodilation in Elderly Type 2 Diabetic Patients with Subclinical Hypothyroidism

FU Xiu-li,ZHAO Shi,MAO Hong,et al.Department of Endocrinology,Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China

Abstract Objective To explore the influencing factors of vasodilation in elderly type 2 diabetic patients with subclinical hypothyroidism.Methods A total of 241 elderly type 2 diabetic patients admitted to our department between April 2009 and October 2011 were selected and divided into an observation group(with subclinical hypothyroidism,n=97)and a control group(without subclinical hypothyroidism,n=144).The color Doppler was used to detect the brachial artery flow-mediated dilation(FMD).Results The patients in the observation group had higher levels of thyroid stimulating hormone(TSH),triglyceride(TG),total cholesterol(TC),low density lipoprotein-cholesterol(LDL-C),high sensitivity-C reactive protein(hs-CRP),interleukin-6(IL-6),but lower FMD than those in the control group(P0.05).Pearson correlation analysis results showed that FMD was negatively correlated with TSH,hs-CRP,IL-6,TG,and TC in the observation group(P0.01).Multiple Logistic regression analysis results showed that TSH,hs-CRP,and IL-6 had significant impact on the regression equationP0.01.Conclusion Subclinical hypothyroidism aggravates endothelial damage in elderly type 2 diabetic patients.Increases of TSH,hs-CRP,and IL-6 are the risk factors for the damage.

Key words Diabetes mellitus, type 2; Subclinical hypothyroidism; Vascular diastolic function

Relationship between Blood Pressure Circadian Rhythm,Variability and Brachial-ankle Pulse Wave Velocity in Patients with Essential Hypertension

XIE Wei, WANG Ming-jian, LIU Jun-ming, et al.Department of Cardiovascular,General Hospital of Xinjiang Production & Construction Corps,Urumqi 830002,China

Abstract Objective To explore the relationship of blood pressure circadian rhythm and variability with brachial-ankle pulse wave velocity(baPWV) in patients with essential hypertension,and the influencing factors for blood pressure circadian rhythm.Methods The 252 patients stayed in the Department of Cardiology of our hospital between May 2011 and May 2012 diagnosed with essential hypertension were tested for office blood pressure,ambulatory blood pressure,and blood biochemical parameters.The baPWV was also determined using automatic arteriosclerosis detector.The subjects were divided into a scoop-shaped group(n=127),a non-scoop-shaped group(n=71),and a reverse scoop-shaped group(n=54) according to the circadian rhythm.Results The age,24 h systolic blood pressure(24 hSBP),nocturnal diastolic blood pressure(nDBP),baPWV,and pulse pressure of patients in the reverse scoop-shaped group were greater than that of the scoop-shaped group(P0.05).The reverse scoop-shaped group had lower daytime diastolic blood pressure(dDBP),but higher age and nSBP than the non-scoop-shaped group(P0.05).Non-scoop-shaped group had higher nSBP and pulse pressure than the scoop-shaped group(P0.05).Stepwise multiple Logistic regression analysis showed that 24 hSBP,dDBP,nSBP,and baPWV significantly affected the circadian rhythm.Age, duration of hypertension,diastolic blood pressure coefficient of variation(DBP-CV),and pulse pressure were positively correlated with baPWV(r=0.405,0.296,0.260,0.271; P0.05).

Conclusion Blood pressure circadian rhythm in patients with essential hypertension is closely related with 24 hSBP,dDBP,nSBP,as well as baPWV.Therefore,abnormalities in circadian rhythm might be an indicator for arterial stiffness.

Key words Hypertension; Blood pressure circadian rhythm; Blood pressure variability; Brachial-ankle pulse wave velocity; Blood pressure monitoring, ambulatory

Correlation Analysis on the Patients with Essential Hypertension in the Degree of Depression and Serum Homocysteine Level

LIU Mei-Yan, DUAN Xiao-chun.Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China

Abstract Objective To study degree of depressive state in patients with hypertension and the relationship between the serum homocysteine level.Methods 165 cases of essential hypertension with continuing instability of blood pressure after being treated for nearly a week have been analysed with PHQ-9 and GAD-7 evaluation scale for depression and anxiety state.Grouped according to depression status, Group Ⅰ(34 cases without depression, GroupⅡ(88 cases of mild to moderate depression, group Ⅲ(43 cases with severe depression.Results 1Compared 3 groups of patients with general information, the difference was not statistically significantP0.05.2Compared 3 groups of patients in the GAD-7 anxiety scale and Hcy levels, the difference was statistically significantP0.05.And the results showed that, GAD-7 Anxiety Scale in group level was the highest, followed by group and group ; Hcy level in group was the highest, followed by group and group .The differences were statistically significantP0.05.3Correlation analysis showed, the PHQ-9 Depression Scale score related with age, GAD-7 anxiety scale, Hcy levelP0.05.GAD-7 Anxiety Scale score and Hcy levels are correlatedP0.05.4Multiple stepwise regression shows that GAD-7 anxiety scale, Hcy level and age entered the regression equation, while PHQ-9 Depression Scale score as the dependent variable, using the GAD-7 anxiety scale, Hcy level, age, LDL, HDL, FIB, hs-CRP independent variable.Conclusion Hcy level is a risk factor for hypertension patients with depression, there is correlation with the severity of depression.Mental health should be paid attention to patients with essential hypertension.

Key words Hypertension; Depression; Homocysteine

Relationship between Cardiovascular Reactivity and Perceived Stress Scale in Kazakh Hypertension Patients

YAN Xiang-hua,ZHANG Lan.Department of Nursing,Medical College of Shihezi University, Shihezi 832002,China

Abstract Objective To explore the relationship between cardiovascular reactivity (CVR) and Perceived Stress Scales in Kazakh hypertension patients,to provide a theoretical basis for clinical prevention and treatment of hypertension.

Methods A questionnaire combined with experimental study was performed in Kazakh hypertension or non-hypertension patients from March to September of 2012.Perceived Stress Scales were used to observe systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),oxygen saturation (SPO2).The relationship between CVR and Perceived Stress Scales were analyzed with descriptive statistics,correlation and linear regression analysis.

Results (1)There was significant difference in SBP,DBP during periods of baseline,task,recovery between 2 groups (P0.05),and in SPO2 during periods of task,recovery (P0.05).(2) Feeling of control was positively correlated with SBP,DBP during periods of baseline, task, recovery in hypertension group (P0.05);In control group,predictive sense,feeling of control negatively with SPO2 during periods of baseline, task, recovery, negatively with baseline-task HR(P0.05);Feeling of overload positively with HR during periods of baseline, recovery, negatively with recovery SPO2 and baseline-task HR fluctuation (P0.05).(3) By stepwise regression analysis, there was significance in effect of baseline SBP on feeling of control in Perceived Stress Scales in hypertension group (P=0.003),and in effect of recovery SPO2 on predictive sense, feeling of control and feeling of overload in control group (P=0.001,0.001,0.014,respectively).

Conclusion Kazakh hypertension patients are susceptible to the impact of psychological factors,the fluctuation of BP being big.Regulation of predictive sense,feeling of control,feeling of overload is beneficial to control of their BP.

Key words Hypertension; Kazakh; Blood pressure; Heart rate; Stress, psychological; Perceived Stress

Clinical Characteristics of Multivessel CAD Combined with LVD and Its Risk Factors

LIU Zi-dong,ZHANG Zhi,FU Wei.Department of Cardiovascular, the Third Affiliated Hospital of Liaoning Medical College, Jinzhou 121001, China

Abstract Objective To discuss the clinical characteristics of multivessel coronary artery disease(CAD) combined with left ventricular dysfunction(LVD) and its risk factors.

Methods A total of 384 multivessel CAD patients diagnosed by coronary angiography from June 2009 to September 2012 were divided, according to echocardiography results,into groups A left ventricular ejection fraction(LVEF) 50%,n=266, B(LVEF50%,n=118).The clinical data were recorded and univariate and multivariate Logistic regression analysis performed.

Results The proportion of male, history of myocardial infarction(MI),incidence of diabetes and unstable angina(USA) were higher in group B than in group A,and incidence of hypertension and dyslipidemia lower, the difference was significant(P0.05).By univariate Logistic regression analysis, male, MI history, diabetic history, hypertension, dyslipidemia and USA were taken into regression equation,odds ratio(OR) and 95% confidence interval(95%CI)were 1.808(1.070, 3.057),3.289(2.094, 5.165),1.641(1.028, 2.620), 0.556(0.359, 0.861),0.497(0.292, 0.844),1.579(1.005, 2.479), respectively.By multivariate Logistic regression analysis,OR(95%CI) of MI history, diabetic history, hypertension, dyslipidemia were 3.314 (2.048,5.363), 2.415 (1.346,4.332), 0.597 (0.366,0.973), 0.364 (0.197,0.675), respectively.

Conclusion Histories of MI and diabetes are risk factors of multivessel CAD combined with LVD, and hypertension, dyslipidemia are protective factors.

Key words Coronary disease; Blood vessels; Left ventricular ejection fraction; Myocardial infarction; Diabetes mellitus; Risk factots

Correlation between HbA1c Level and Coronary Artery Disease Severity

ZHENG Xue-qin, YANG Zhi-cai, WANG Shu-ling.Qingzhou Rongjun Hospital of Shandong Province, Qingzhou 262500, China

Abstract Objective To investigate the relationship of glycosylated hemoglobinHbA1c to the severity of coronary artery diseaseCAD.Methods A total of 2 336 CAD patients from February 2009 to October 2011 were divided, according to level of glucose metabolism, into groups ACAD with normal glucose tolerance, n=970, BCAD with abnormal glucose tolerance, n=781, CCAD with diabetes, n=585.General information was compared in the 3 groups, correlation of HbA1c level, coronary artery stenosisCAS with the number of damaged coronary arteries and the risk factors of CAD were analyzed.Results There was significant difference in CAS, number of damaged coronary arteries, age, fasting plasma glucoseFPG, 2h postprandial glucose, glycosylated hemoglobinHbA1c , triglycerideTG in the 3 groupsP0.05.By Spearman correlation analysis, HbA1c level was positively correlated with CAS and CAS positively with number of damaged coronary arteriesrs=0.705, 0.120; P0.01.By Logistic regression analysis, age, gender, hypertension, HbA1c , FPG, TC, HDL-C were risk factors of CAD.

Conclusion HbA1c , remarkably correlated with CAS and number of damaged coronary arteries, is an important indicator influencing severity of CAD.

Key words Diabetes mellitus, type 2; Glycosylated hemoglobin; Coronary artery disease; Coronary angiography

Risk Factors for Cardiac Involvement in Primary Sjogrens Syndrome

YIN Fang-rui, WANG Yong-fu.Department of Rheumatology, Baotou Medical College, Baotou 014010, China

Abstract Objective To investigate the clinical features of primary Sjogrens syndrome(pSS) with cardiac involvement and to examine the clinical risk factors for cardiac involvement.Methods Seventy-five pSS patients admitted to the Department of Rheumatology of the First Affiliated Hospital of Baotou Medical College between January 2008 and October 2011 were divided into a cardiac involvement group(n=28) and a non-cardiac involvement group(n=47) based on the results of color Doppler flowing imaging.The clinical manifestations, general information, and laboratory test results were compared between the two groups.Logistic regression analysis was used to explore the clinical risk factors for cardiac involvement in pSS patients.Results 1No significant difference was observed in the incidence of fatigue, dry mouth, dryness of eyes, parotid gland enlargement, rampant caries, arthritis, and rashes between the two groups(P0.05).2Compared with non-cardiac involvement group, patients in the cardiac involvement group had longer disease course(106.8±37.5)months vs.91.5±22.5)months, higher levels of C-reactive protein(CRP)(27.4±36.1)g/L vs.14.1±15.0g/L and total cholesterol(TC)(4.84±1.93)mmol/L vs.4.04±1.20mmol/L, and lower level of high density lipoprotein(HDL)(1.46±0.37)mmol/L vs.1.81±0.56mmol/L(P

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