January 2014, Volume 17, No.2 Abstracts
GP Commissioning Service:Evaluation and Analysis of Reforms of Cameron Government
CHEN Xiao-chang,WU Chuan-jian.School of Humanities and Management of Guangdong Medical College,Dongguan 523808，China
【Abstract】 The Cameron Government launched the greatest reform of National Health Service(NHS) in July 2010 since its establishment,the core of which was to enhance the right of speaking and decision-making power of patients and General Practitioners(GP).The implement of GP clinical service commissioning mode and the establishment of a new GP Commissioning Consortia(renamed Clinic Commissioning Groups,CCGs) and NHS commissioning Board have put GPs in the core position of decision making in NHS from providing medical service passively,thus to lead to great adjustments in clinical service decision-making mode of NHS.China′s new medical reform needs reconstruction of medical service system,especially set-up of primary health care service system and training of GPs.This paper analyzes the reforms of Cameron Government in GP commissioning service system to provide reference for China′s new medical reform.
【Key words】 National health service，British；Commissioning service；Commissioning board；Monitor
Metabolic Syndrome:Research Progress in Risk Predictors
ZHANG Hui-min.Basic Medicine College,Beijing University of Traditional Chinese Medicine,Beijing 100029，China
【Abstract】 Metabolic syndrome(MS) is a combination of inter-related risk factors in metabolism,the clinical consequences of which are cardiovascular diseases and type 2 diabetic Mellitus (T2DM).MS,having spread over the world,is a major public health problem threatening human health.Prevention is better than treatment.MS onset risks can be predicted by its related risk predictors and risk assessment models.At present,there are many studies on MS onset risk prediction.This paper reviews MS onset risk predictors from the indicators of anthropometric measuring,biochemical detection,ultrasonic measurement,lifestyle,psychological factors,and scores of Phlegm-dampness Questionnaire,to provide reference predictors for establishment of MS onset risk assessment models.
【Key words】 Metabolic syndrome X；Forecasting；Risk factors
Metabolic Syndrome in Young and Middle-aged Patients with CKD 3-4
WU Ge，JIA Xiao-yuan，HUANG Bo，et al.Department of Nephrology,the First Affiliated Hospital of Zhengzhou University，Institute of Kidney Disease of Zhengzhou University，Zhengzhou 450052,China
【Abstract】 Objective To investigate the prevalence,clinical features and risk factors of metabolic syndrome(MS) in young and middle-aged patients with CKD 3-4,and the risk factors of CKD.Methods This study selected the clinical datas of 132 cases of young and middle-aged patients with CKD 3-4 and 140 cases as normal control who were hospitalized in the Department of Nephrology of our hospital over the same period of December 2009 to December 2012 and were aged of 35~60 years old.Comparatively analyzed the incidence of MS between two groups,and these clinical datas of CKD patients with MS or nMS.Multivariate Logistic regression analysis was used to test the risk factors of CKD.Results The incidence of MS in the CKD patients and the control group was respectively of 25.8%（34 cases) and 11.4%(16 cases).The smoking rate,drinking rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),triglyceride(TG),serum creatinine(Scr),serum uric acid(UA),BMI of CKD patients with metabolic syndrome group(MS group) were significantly higher than those in the CKD patients without metabolic syndrome group(nMS group),while the HDL and eGFR-MDRD of MS group were significantly lower than nMS group(P＜0.05).Multivariate Logistic regression analysis prompted BMI≥25 kg/m2（OR=2.648，P=0.000 2）,the rise of FBG（OR=6.828，P=0.000 1）,UA（OR=2.711，P=0.002 1）,TG（OR=1.723，P=0.020 4）and blood pressure（OR=1.531，P=0.001 3）were the risk factors of CKD.Conclusion The prevalence of metabolic syndrome in young and middle-aged patients with CKD 3-4 was high.Smoke and alcohol affect it.BMI≥25 kg/m2,FBG,UA,TG and blood pressure were the risk factors of CKD.
【Key words】 Metabolic syndrome X；Renal insuffiency，chronic；Youth；Aged
Relationship of Metabolic Syndrome Components to Peptic Ulcer Disease
LI Juan,ZHAI Shu-na,JIANG Teng-xuan,et al.Department of Gastroenterology,the Third Affiliated Hospital of Liaoning Medical University,Jinzhou 121000,China
【Abstract】 Objective To investigate the association between metabolic syndrome(MS) components and the risk of peptic ulcer disease(PUD).Methods A hospital-based case-control study was conducted in 256 PUD patients(study group),256 non-PUD subjects(control group).Univariate and multivariate Logistic regression analyses were performed on every components of metabolic syndrome.Results By multivariate Logistic regression analysis based on univariate analysis,the risk of PUD was higher in males aged ≤45 years,WC＞85 cm and females aged ＞45 years,WC＞80 cm than in control group〔OR=2.869，95%CI(1.245,2.546)；OR=2.402，95%CI(1.623,3.154）〕,and higher in patients with reduced HDL-C,increased SBP and FBG than in control group〔OR=2.702，95%CI(1.630,4.477)；OR=1.657，95%CI(1.116,2.462)；OR=2.485，95%CI(1.559,3.963）〕.The results did not change after age stratification.Conclusion WC,HDL-C,SBP,hyperglycemia can increase the risk of PUD.
【Key words】 Metabolic syndrome X；Peptic ulcer；Cholesterol,HDL；Blood pressure；Waist circumference
Relationship between Metabolic Syndrome and ba-PWV
TAN Shi-cheng，TANG Zhong-min，LIAO Hong，et al.Liuzhou People′s Hospital,Liuzhou 545006,China
【Abstract】 Objective To explore the relationship between metabolic syndrome（MS） and brachial ankle pulse wave velocity(ba-PWV) in healthy subjects.Methods A total 3 200 healthy subjects,2 112 males,1 088 females,aged 35-64 years,were enrolled in this study.Height,weight,and blood pressure(BP) were measured,fasting blood glucose(FBG),lipids,ba-PWV detected.The standards of MS proposed by Chinese Diabetes Society(CDS) of Chinese Medical Association.Taking ba-PWV＜14 m/s as normal,14- m/s as slightly fast,16- m/s as moderately fast,18- m/s as severely fast.The ba-PWV of groups MS,non-MS was analyzed comparatively.Results In 3 200 subjects,MS total detection rate was 11.5%(368 cases),there into 14.6%(309/2 112) in males,5.4%(59/1 088) in females.There was significant difference in ba-PWV between patients aged 35-,45-,55- years in 2 groups(P=0.000).ba-PWV was faster in patients aged 55- years than in those aged 45- years,faster in those aged 45- years than in those aged 35- years(P＜0.05).The ba-PWVs of males in groups MS,non-MS were （15.7±2.4）m/s,（13.9±1.8） m/s;those of females were （16.2±3.1） m/s,（13.2±2.1）m/s;the difference was significant(P＜0.05).The ba-PWV was faster in MS group than in non-MS group in any age group(P＜0.05).The detection rates of fast ba-PWV of groups MS,non-MS were 79.0%(244/309) and 40.3%(76/1 803) in male,76.3%（45/59） and 28.6%（294/1 029） in female,respectively,the difference was significant(P＜0.05).The detection rates of fast ba-PWV were higher in male than female both in MS group and non-MS group(P＜0.05).Conclusion MS is closely associated with arterial stiffness.Detection of ba-PWV,MS and intervention should be paid attention to in middle-aged,elderly patients with cardiovascular risk factors.
【Key words】 Metabolic syndrome X；Cardiovascular disease；Pulse wave velocity；Risk factors
Relationship of ba-PWV to HbA1c and hs-CRP in Newly Diagnosed T2DM Patients
HUANG Ying- rui,WANG Xiao-yan.Community Health Service Center,Posts and Telecommunications University of Beijing,Beijing 100876,China
【Abstract】 Objective To investigate the relationship between brachial-ankle pulse wave velocity(ba-PWV) and glycosylated hemoglobin(HbA1c) and high sensitivity c-reactive protein(hs-CRP) in newly diagnosed type 2 diabetes mellitus(T2DM) patients.Methods A total of newly diagnosed T2DM patients,55 males,45 females,averagely aged （56.9±7.5）years,were divided,according to HbA1c level,into groups normal(HbA1c≤6.5%,n=42),elevated(HbA1c＞6.5%,n=58),and another 40 healthy subjects enrolled as control group(NC group).Height,weight,blood pressure(BP),body mass index(BMI) were measured,levels of fasting blood glucose(FPG),serum total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),HbA1c,hs-CRP and ba-PWV determined.The changes of the above indexes were compared among the 3 groups,the relationship of ba-PWV to HbA1c and hs-CRP analyzed.Results There was no significant difference in age,sex,systolic blood pressure(SBP),diastolic blood pressure(DBP) among the 3 groups(P＞0.05).Weight,BMI were higher in groups normal,elevated than in NC group(P＜0.05),but there was no difference between groups normal,elevated(P＞0.05).There was difference in FPG,TC,TG,HbA1c,LDL-C among the 3 groups(P＜0.05).FPG,TG,HbA1c were higher in groups normal,elevated than in NC group(P＜0.05),lower in normal group than in elevated group(P＜0.05).TC,LDL-C lower in groups normal,elevated than in NC group(P＜0.05),but there was no difference between groups normal,elevated(P＞0.05).By correlation analysis,ba-PWV was positively correlated with BMI,SBP,HbA1c,LDL-C,hs-CRP （r=0.407,0.414,0.597,0.418,0.649;P=0.044,0.040,0.000,0.038,0.000）.Conclusion The level of hs-CRP is elevated,hs-CRP and HbA1c positively correlated with ba-PWV in T2DM patients.Poor glycemic control leads to severity of atherosclerosis.So positive blood sugar control is of great significance for prevention of macrovascular complications in T2DM patients.
【Key words】 Diabetes mellitus,type 2;Hemoglobin A,glycosylated;Brachial-ankle pulse wave velocity;C-reactive protein
The Level of N-Terminal Pro-Brain Natriuretic Peptide in Patients with Community-acquired Pneumonia Associated with or without Systemic Inflammatory Response Syndrome
MENG Ai-hua,LIN Rui-yan,ZHANG Hong-xia,et al.Department of Respiratory and Critical Care Medicine,Capital Medical University Luhe Teaching Hospital,Beijing 101149,China
【Abstract】 Objective To explore the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with community-acquired pneumonia (CAP)associated with our without systemic inflammatory response syndrome (SIRS) and its clinical significance.Methods One hundred and forty-eight CAP patients treated in our hospital between January 2012 and March 2013 were included in this study.Based on the presence of SIRS,the patients were divided into non-SIRS group (n=78) and SIRS group (n=70).The serum level of NT-proBNP was determined by ELISA test,and pneumonia severity index (PSI) score were determined.Results The serum level of NT-proBNP in SIRS group was significantly higher than that in non-SIRS group〔188.0(471.8) vs.62.5（135.3），P=0.009〕.The level of NT-proBNP was positively correlated with the PSI score (r=0.292,P=0.001).Conclusion The level of NT-proBNP was high in CAP patients with SIRS.The level of NT-proBNP may be the indicator of SIRS in CAP patients,which could be used to evaluate the severity or prognosis of CAP.
【Key words】 Community-acquired infections；Pneumonia；System inflammatory response syndrome；N-terminal pro-BNP
Value of the COPD and Asthma Prognostic Score in Long-term Prognosis Evaluation in AECOPD Patients with Mechanical Ventilation
WANG Zheng-guang，ZHANG Mu-cheng，FANG Xiang-qun，et al.ICU Department，Huangshan People′s Hospital Affiliated to Wannan Medical College，Huangshan 245000，China
【Abstract】 Objective To explore the value of the COPD and Asthma Prognostic Score(CAP score)in the long-term prognosis evaluation of acute exacerbation of chronic obstructive pulmonary dissease(AECOPD)patients with mechanical ventilation(MV).Methods A CAP score was performed in 64 AECOPD patients with MV hospitalized in ICU of this hospital from August 2009 to September 2012.With ICU check-in as starting point,patients′death or 180-day ICU stay as ending point,the actual fatality rate and survival time were calculated.Results A total of 55 patients were enrolled at last,in whom 30 died,25 survived,the actual fatality rate was 55%,which was not significantly different from the predicted death risk of CAP score(60%)(P=0.244).The CAP score was higher in death group(129±30)than in survival group(108±19)(t=-2.977，P=0.004).By Spearman correlation analysis,CAP score was positively correlated with actual fatality rate(r=0.893，P=0.007).By ROC curve,the area under curve of CAP score predicting AECOPD with MV patients′death was 0.734〔95%CI（0.600，0.868），P=0.003〕,Youden index(0.4)was the biggest when CAP score was 110.Kaplan-Meier curve showed that the mean survival time was 102 d〔95%CI（82，122）〕,median survival time was 114 d〔95%CI（31，197）〕.Conclusion CAP score can evaluate the severity of AECOPD patients with MV and predict their long-term prognoses.
【Key words】 Pulmonary disease，chronic obstructive；Prognosis；Ventilators，mechanical；The COPD and Asthma Prognostic Score
Hormone Receptor and CerbB-2 Coexpression：Value in Predicting Recurrence of High-level Serous Ovarian Cancer
WU Peng,ZHU Jian-qing，ZHENG Zhi-guo.Department of Pathology,Zhejiang Cancer Hospital,Hangzhou 310022,China
【Abstract】 Objective To investigate the relationship of the expressions of P53,human epidermal growth factor receptor 2(CerbB-2),estrogen receptor(ER) and progesterone receptor(PR) to recurrence of high-level serous ovarian cancer(SOC).Methods Thirty-two high-level SOC patients were divided,according to FIGO staging,into groups stages Ⅲ(n=30),IV(n=2).Taking 12 months as a time boundary,patients divided into groups A〔recurrence free survival(RFS)≥ 12 months,n=18〕,B〔RFS＜12 months(n=14)〕.Immunohistochemistry method was used to detect the expressions of P53,CerbB-2,ER,PR,and their relationship to recurrence risks of high-level SOC was analyzed.Results P53，ER and PR expression was mainly located in the nucleus,CerbB-2 expression was mainly located in the cell membrane.The positive expression rates of P53,CerbB-2,ER,PR were 62.5%（20/32）,43.8%（14/32）,68.8%（22/32）,34.4%（11/32）,respectively.No significant difference was noted in positive expression rates of P53,ER，PR between SOC patients at different RFSs(P＞0.05).CerbB-2 positive expression rate was higher in group B than in group A(P＜0.05),and positive coexpression rate of CerbB-2,ER,PR higher in group A than in group B(P＜0.05).Conclusion Combined detection of CerbB-2,ER,PR can be used as a potential biomarker predicting recurrence risks of high-level SOC.
【Key words】 Ovarian neoplasms;Recurrence;Human epidermal growth factor receptor 2;Receptors,estrogen;Progesterone receptor
Blood Pressure Variability and Central Aortic Pressure in Mongolian and Han Hypertension Patients
HUANG Guan-hua,SUN Gang,YANG Xiao-min,et al.Department of Cardiology,the Second Affiliated Hospital of Baotou Medical College,Baotou 014030,China
【Abstract】 Objective To investigate the feature and clinical significance of ambulatory blood pressure (ABP) and central aotric pressure (CAP) in Mongolian and Han patients with essential hypertension (EH).Methods A total of 342 hypertension patients were divided into groups Mongolian〔n=168,including 87 males,81 females,aged (58.3±9.2) years〕,Han〔n=174,including 85 males,89 females,aged (57.6±9.7) years〕.Fasting plasma glucose (FBG),body mass index (BMI),total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),24 h ABP including daytime diastolic blood pressure (dDBP),daytime systolic blood pressure (dSBP),nighttime systolic blood pressure (nSBP),nighttime diastolic blood pressure (nDBP),24 h SBP,24 h DBP were compared between 2 groups;CAP checks included central diastolic pressure (CDP),central systolic pressure (CSP),central pulse pressure (CPP),augmentation index (AI).Results BMI,TG,dSBP,dSBP coefficient of variability,CSP were higher in Mongolian group than in Han group,the difference was significant (P＜0.05).CSP,dSBP increased with the augment of age,and higher in Mongolian group than in Han group in varying age groups(P＜0.05).Conclusion CSP,dSBP are higher in Mongolian hypertension patients than in Han,increasing with the augment of age.So 24 h ABP and CAP tests play an important role in preventing hypertensive complications in Mongolian high-prevalence areas.
【Key words】 Hypertension;Blood pressure variability;Central aortic pressure
Effect of Iron Deficiency Anemia on P Wave Dispersion and Left Ventricular Diastolic Function
WANG Yi-wen,LIU Li-na,HAN Xu,et al.Cardiac Function Room,the First Hospital of Hebei Medical University,Shijiazhuang 050031,China
【Abstract】 Objective To evaluate the correlation of P wave dispersion(PWD) with echocardiography(ECG) indicators in patients with iron deficiency anemia(IDA),to determine the effects of IDA on PWD and left ventricular diastolic function.Methods One hundred and sixty-seven people in our hospital between March 2012 and August 2013 were included in this study.The height,weight,blood pressure(BP) were measured,auxiliary examinations of blood cells,12-lead ECG,transthoracic ECG carried out,and mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH),mean corpuscular-hemoglobin concentration(MCHC),sideroblasts,serum iron,serum ferritin,left ventricular rapid filling E-peak and left atrial contraction A-peak,E/A ratio,deceleration time(DT) of E-peak,isovolumic relaxation time(IVRT),left ventricular ejection fraction(LVEF),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septal thickness(IVS),posterior wall thickness(PW),P-wave maximum width(Pmax) and P-wave minimum width(Pmin) and other indicators were detected in 107 IDA patients and 60 healthy controls.Results DT,IVRT and incidence of left ventricular diastolic dysfunction were higher in IDA group than in control group(P＜0.05),and hemoglobin(Hb),hematocrit(HCT),serum iron,serum ferritin,transferrin saturation lower(P＜0.05).PWD and heart rate(HR) were higher in IDA group than in control group(P＜0.05),but there was no significant difference in Pmax,Pmin between 2 groups(P＞0.05).By correlation analysis,PWD was positively correlated with IDA,IVRT,DT,and HR(r=0.475,0.348,0.326,0.322,P＜0.05),negatively with Hb(r=-0.452,P＜0.05),not correlated with gender,age,LVEF,SBP,DBP.Conclusion IDA can make PWD increase and lead to left ventricular diastolic dysfunction.So timely ECG examination and early diagnosis and treatment of left ventricular diastolic dysfunction can reduce the incidence of heart failure effectively to improve patients′ quality of life.
【Key words】 Anemia,iron-deficiency；P wave dispersion；Ventricular dysfunction,left
Time to Positivity of Blood Culture:Application Value in Prognosis Evaluation in Patients with Bloodstream Infection Caused by Escherichia Coli
HUANG Lei，SUN Li-ying，YAN Yan.Department of Clinical Laboratory，the First Hospital of Peking University，Beijing 100034，China
【Abstract】 Objective To investigate the prognostic value of time to positivity（TTP）of blood culture in patients with bloodstream infection（BSI）caused by Escherichia coli（E.coli）.Methods A total of 174 adult inpatients，who had blood culture and from whom E.coli were isolated from 2008 to 2012，were divided，taking P25（7.13 h） of TTP as cutoff point，into groups low-TTP（n=43），high-TTP（n=131）.The clinical features，prognoses were compared between 2 groups.Results There was no significant difference in proportion of elderly patients，that of males，incidence of hospital-acquired infection，proportion of poor basic state，rate of strain-produced extended-spectrum β-lactamase（ESBL