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February 2017, Volume 20, No.5 Abstracts

 Thematic Discussions on "Improvement of Service Capabilities of Community Health Service Centers"  GENG Wen-jin,XU Zheng-hai,CHEN Ling,FU Dai-jia,CAO Song-hua,YU Ting-yuan,WU Sheng-li,CAO Guo-jian
    【Abstract】  With the implementation of hierarchical medical treatment in China,there is an urgent need to improve the service capabilities of community health service centers(CHSCs).As Nanjing has achieved some excellent performances in this aspect,we specially invited several general practice experts from Nanjing to share their experience on improving the service capabilities of CHSCs.GENG Wen-jin from Nanjing Municipal Commission of Health and Family Planning expounded that the development of CHSCs in Nanjing is promoted by featured departments construction,and he illustrated several measures taken by Nanjing for improving the community-level medical quality.XU Zheng-hai,Nanjing Xuanwu District Bureau of Health and Family Planning introduced that the comprehensive service capabilities of CHSCs in Xuanwu District have been improved by institutionalized supplementing budgeted posts under the premise of being not overstaffed,talent introduction mechanism,investigating the needs of the residents and delivering corresponding services they needed,and bettering the management of the CHSCs.CHEN Ling from Nanjing Qinhuai District Bureau of Health and Family Planning illustrated that they improve the comprehensive service capabilities of CHSCs in Qinhuai District by strengthening the institutional construction,perfecting the service capabilities,and consolidating the skills training for the community health workers.FU Dai-jia from Nanjing Jianye District Nanhu Community Health Service Center described that the development of hierarchical medical treatment mode in their center has been promoted by improving the construction of family doctor service system.CAO Song-hua from Nanjing Qinhuai District Chaotiangong Community Health Service Center narrated that they have improved their service capabilities through strengthening the construction of intension development by providing medical diagnostic services for common diseases,chronic diseases and frequently occurring diseases,delivering community rehabilitation services,constructing featured departments,participating in the medical management projects sponsored by the government.YU Ting-yuan from Nanjing Qinhuai District Zhimaying Community Health Service Center,elaborated that they take traditional Chinese medicine as the breakthrough point to improve the service capabilities of their center.WU Sheng-li from Nanjing Yuhuatai District Tiexinqiao Community Health Service Center,set forth the experience in constructing their center as one characterized by "small in size but delivering high-quality and excellent comprehensive services" by implementation of talent training project,carrying out appointment services for chronic disease management,grid management of executive doctors and so on.CAO Guo-jian from Nanjing Jiangning District Dongshan Street Community Health Service Center,introduced that they deliver services meeting the growing health needs of the masses based on scientific investigation of the health demands of them.It is expected that the above experiences can provide a reference for bettering the development of hierarchical medical treatment,and improving the service capabilities of CHSCs,so that the health demands of people can be satisfied.
    【Key words】  Community health services;Health services administration;Hierarchical medical treatment;Medical quality
 
Research Progress of Long-term Prognosis of Patients with Sepsis  QIAN Song-zan,PAN Jing-ye*
Department of ICU,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China
*Corresponding author:PAN Jing-ye,Professor;E-mail:panjingye@wzhospital.cn
    【Abstract】  Patients with sepsis are still associated with a high risk of death after discharge,and thus how to improve the long-term prognosis of patients with sepsis has got more and more attention.The paper briefly describes recent researches on the long-term prognosis of patients with sepsis,and introduces epidemiological characteristics,mechanisms,long-term damages of target organs and the corresponding intervention measures of the long-term prognosis of sepsis.
    【Key words】  Sepsis;Prognosis;Review
 
Expression of Serum Procalcitonin and Its Impact on Prognosis in Sepsis  TAN De-min*,TAN Meng-yuan,CHEN Jun,MENG Zhen-fa,WANG Yu-lin
Intensive Care Unit,Danzhou City People′s Hospital,Danzhou 571799,China
*Corresponding author:TAN De-min,Attending physician;E-mail:xiaohuan232565650@163.com
    【Abstract】  Objective   To investigate the expression of serum procalcitonin(PCT)level and impact on prognosis in sepsis.Methods  A total of 216 patients who were hospitalized the Intensive Care Unit,Danzhou City People′s Hospital and definitely diagnosed with sepsis from March 2012 to March 2016 were enrolled in this study.And they were divided into the survival group (n=134) and death group(n=82) based on the treatment outcome showed by a 28-day follow-up.Other 188 non-sepsis patients hospitalized in the hospital during the same period were selected as the subjects,too.We recorded all the subjects′ Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score,Sequential Organ Failure Assessment (SOFA) score,levels of serum PCT,C-reactive protein(CRP) and brain natriuretic peptide(BNP).The factors affecting the prognosis of sepsis were analyzed with a multivariate Logistic regression model and their roles in predicting the prognosis of sepsis were investigated.Results  Compared with the non-sepsis patients,sepsis patients had higher APACHEⅡ score,SOFA score,serum PCT level,CRP level and BNP level(P<0.01).The serum PCT levels on the 1st,3rd and 5th days of admission,and both the serum CRP and BNP levels on the 3rd and 5th days of admission were higher in the death group than those in the survival group(P<0.05).Patients in the death group were older,and they had higher APACHEⅡ,SOFA scores and AST compared with those in the survival group(P<0.05).Results of multivariate Logistic regression analysis demonstrated that the factors affecting the prognosis of sepsis were age〔OR=7.284,95%CI(3.605,14.727),P<0.05〕,APACHEⅡ score〔OR=3.162,95%CI(1.528,10.629),P<0.05〕,SOFA score〔OR=3.015,95%CI(1.054,9.582),P<0.05〕,serum PCT〔OR=1.046,95%CI(1.002,1.516),P<0.05〕,CRP〔OR=0.863,95%CI(0.715,0.985),P<0.05〕 and BNP〔OR=0.795,95%CI(0.653,0.952),P<0.05〕.ROC curve analysis indicated that the area under curve (AUC) and optimal threshold of age,APACHEⅡ scoring,SOFA scoring,PCT,CRP and BNP levels for predicting death in sepsis respectively was 0.803(63.0 years),0.826(22.3 points),0.765(7.1 points),0.849(6.9 μg/L),0.684(49 mg/L),0.626(825 ng/L).Pearson correlation analysis revealed that in the death group,the level of serum PCT was positively correlated with age,APACHE Ⅱ score,SOFA score,CRP and BNP levels(P<0.05).Conclusion  The level of serum PCT is significantly elevated in patients with sepsis.Older age,higher APACHE Ⅱ and SOFA scores,higher PCT,CRP and BNP levels are independent risk factors for prognosis in sepsis.
    【Key words】   Sepsis;Procalcitonin;Intensive care unit;Risk factors
 
Value of Acute Gastrointestinal Injury Grading Combined with Sequential Organ Failure Assessment Scoring Systems in Prognosis Assessment of Severe Sepsis  DONG Ke-qi1*,DENG Jie1,PAN Jing-ye2,JIANG Kai1
1.Department of Intensive Care Unit,Zhoushan Hospital,Zhoushan 316021,China
2.Department of Intensive Care Unit,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China
*Corresponding author:DONG Ke-qi,Associate chief physician;E-mail:dongkeqi2008@163.com
    【Abstract】  Objective   To evaluate the value of acute gastrointestinal injury (AGI) grading combined with sequential organ failure assessment (SOFA) scoring systems in prognosis assessment of severe sepsis.Methods  Forty-six patients with severe sepsis admitted in the Department of Intensive Care Unit,Zhoushan Hospital from July 2012 to July 2013 were selected as the subjects and divided into survival group(n=26) and death group(n=20) based on they survived or died within 4 weeks after admission.In the 1st week after admission,the AGI of enrolled patients was evaluated daily according to the diagnostic criteria of AGI and scored.At the same time,SOFA scoring,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scoring and MODS (2004) scoring and modified SOFA scoring(adding AGI and SOFA scores together) were performed.Receiver-operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test were used to analyze the resolution and calibration of modified SOFA scoring system and other 4 scoring systems in prognosis assessment of severe sepsis.Multivariate Logistic regression model was used to evaluate the values of these systems in prognosis.Results  Compared with the death group,the survival group had lower modified SOFA,AGI,SOFA and MODS (2004) scores on the 2nd,3rd,5th and 7th days after admission(P<0.05),as well as lower highest scores of modified SOFA,AGI,SOFA and MODS (2004) during this period (P<0.05).The daily and highest APACHEⅡ scores on the 1st,2nd,3rd,5th and 7th days after admission in the survival group were lower than those in the death group,respectively (P<0.05).The AUC values of modified SOFA scoring in daily scoring and the highest scoring for prognosis assessment on the 1st,2nd,3rd,5th and 7th days after admission were 0.60,0.84,0.92,0.93,0.97,0.86.AUC values of AGI scoring were 0.56,0.84,0.95,0.96,0.99,0.85.AUC values of SOFA scoring were 0.59,0.82,0.87,0.86,0.92,0.83,respectively.AUC values of APACHEⅡ scoring were 0.74,0.88,0.92,0.96,0.97,0.83,respectively.AUC values of MODS(2004) scoring were 0.61,0.85,0.87,0.87,0.92,0.80,respectively.Hosmer-Lemeshow goodness-of-fit test showed that the results of prognosis assessment of the 5 scoring systems did not differ significantly from the clinical outcomes of the patients(all P>0.05),which demonstrated that the goodness-of-fit of these 5 scoring systems was relatively good.Results of the analysis with a multivariate Logistic regression model indicated that modified SOFA scoring≥ 8.1(OR=3.167),AGI scoring ≥1.3(OR=6.000),SOFA scoring ≥7.7(OR=3.600),APACHE Ⅱ scoring≥11.8(OR=6.333),MODS(2004)scoring≥8.6(OR=5.000)were independent predictors of poor outcome of patients with severe sepsis(P<0.05).Conclusion  The resolution and calibration of SOFA scoring in the prognosis assessment of severe sepsis can be improved through modified SOFA scoring.Modified SOFA scoring≥8.1 is a predictor for death in patients with severe sepsis.
    【Key words】   Sepsis;Acute gastrointestinal injury;Sequential organ failure assessment;Prognosis;Forecasting
 
Value of Neutrophil to Lymphocyte Ratio in Predicting the Prognosis of Patients with Sepsis  CHEN Jie*,ZHOU Xiao-jie,WANG Xiao-rong,PAN Jing-ye,HUANG Yue-yue,MA Ji-hong,HE Jie,HUANG Hui-ya
Intensive Care Unit,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China
*Corresponding author:CHEN Jie,Attending physician;E-mail:chenjie991300@163.com
    【Abstract】  Objective  To assess the value of neutrophil to lymphocyte ratio (NLR) in predicting the prognosis of patients with sepsis,and to explore the way to improving prediction efficiency of the prognosis in septic patients.Methods  Two hundred and twenty-six patients with sepsis who were treated in ICU of the First Affiliated Hospital of Wenzhou Medical University from July 2012 to January 2015 were selected as research objects.According to the living condition during 28 days after the onset,these patients were divided into survival group (n=167) and death group (n=59).The blood samples were taken from peripheral blood of patients within 2 hours after admission.The blood lactate(Lac),procalcitonin (PCT),blood platelet count and white blood cell count (WBC) were measured and the differential white blood cell count was made,then NLR was calculated.The scores were measured according to APACHE Ⅱ with 24 hours after admission.Results  There was no significant difference in the PCT,blood platelet count,WBC,and neutrophil count between the survival group and the death group (P>0.05).There were significant differences in Lac,lymphocyte,NLR and APACHE Ⅱ score between the two groups (P<0.05).The ROC area under the curve was 0.693〔95%CI(0.609,0.777)〕 and the cutoff value was 3.05 mmol/L predicted a 28-day mortality by Lac of patients with sepsis with sensitivity of 75.0% and specificity of 64.2%.The ROC area under the curve was 0.642 〔95%CI (0.556,0.728)〕and the cutoff value was 14.4 predicted a 28-day mortality by NLR of patients with sepsis with sensitivity of 75.0% and specificity of 51.9%.While by APACHEⅡ score,the ROC area under the curve was 0.742 〔95%CI (0.659,0.825)〕 and the cutoff was 16,the sensitivity was 71.2% and the specificity was 66.9% in predicting a 28-day mortality of patients with sepsis.With a prediction of a 28-day mortality by Lac +NLR+APACHEⅡ score of patients with sepsis,the ROC area under the curve was 0.780 〔95%CI (0.702,0.859)〕,and the cutoff was 0.288 7,the sensitivity was 67.3% and the specificity was 80.0%.The ROC area under the curve of Lac +NLR+APACHEⅡ score predicted a 28-day mortality of patients with sepsis was higher than that of NLR(Z=2.321,P<0.05).Conclusion  It is difficult to evaluate the prognosis of septic patients with single marker,and NLR combined with Lac and APACHE Ⅱ score can improve the predicted efficiency of the prognosis of septic patients.
    【Key words】  Sepsis;Neutrophils;Lymphocyte count;Lactic acid;APACHE Ⅱ;Prognosis
 
Efficacy and Mechanism of Action of Fasudil in the Treatment of Elderly Patients with Chronic Pulmonary Heart Disease:A Randomized Controlled Study  BU Li-na*,SONG Ai-ling,JIA Wei-hong,YANG Dong-cai,HAN Yan-yan
Department of Respiratory Medicine,Second Hospital of Xi′an,Xi′an 710003,China
*Corresponding author:BU Li-na,Associate chief physician;E-mail:2479140923@qq.com
    【Abstract】  Objective  To evaluate the efficacy and mechanism of action of fasudil in the treatment of elderly patients with chronic pulmonary heart disease (CPHD).Methods  The subjects enrolled in this study were 76 elderly patients with CPHD admitted to Department of Respiratory Medicine,Second Hospital of Xi′an from October 2014 to March 2015 by a prospective method.And they were divided into the treatment group(n=38) and the control group(n=38) by random number table method.Based on the conventional medical therapy,the treatment group additionally received intravenous drip of fasudil injection,and the control group received intravenous drip of 0.9% sodium chloride injection.And the treatment for both groups lasted for 14 days.Blood pressure,heart rate(HR),blood gas analysis〔partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2)〕,systolic pulmonary arterial pressure(sPAP) were measured before and after treatment.Levels of hypersensitive C-reactive protein(hs-CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured before,at the 7th and 14th days after treatment,respectively.And adverse events occurred during treatment were observed.Results  Of the patients in the control group,1 died of heart failure,and 1.3% dropped out of the study.No significantly statistical differences were found in terms of systolic and diastolic blood pressure and HR between the two groups before and after treatment (P>0.05).Before treatment,no significant differences were observed in PaO2,PaCO2 and sPAP between the two groups(P>0.05),but after treatment,PaO2 was elevated and PaCO2 and sPAP were decreased in the treatment group(P<0.05).Treatment method and time exerted interaction effect on levels of hs-CRP and NT-proBNP (P<0.05).Treatment method led to remarkable main effect on levels of hs-CRP and NT-proBNP (P<0.05).Treatment time also had significant main effect on levels of hs-CRP and NT-proBNP(P<0.05).Before treatment,levels of hs-CRP and NT-proBNP in the treatment group did not differ from those in the control group significantly(P>0.05),but at the 7th and 14th days after treatment,levels of hs-CRP and NT-proBNP in the treatment group were lowered (P<0.05).During the treatment,only a few patients had some side effects such as dizziness(3 in treatment group and 2 in control group) and headache(1 in treatment group and 1 in control group),but the symptoms disappeared when the medicine was stopped.Conclusion  The treatment of fasudil in regular doses can effectively improve the PaO2,reduce PaCO2,sPAP,levels of hs-CRP and NT-proBNP in elderly patients with CPHD,do not increase adverse reactions.
    【Key words】  Pulmonary heart disease;Fasudil;C-reactive protein;Natriuretic peptide,brain;Randomized controlled trial
 
Characteristics and Risk Factors of Cognitive Dysfunction in Different Types of Cerebral Small Vascular Diseases  KONG Xiang-zeng,WANG Yan-yong,WANG Xiao,WANG Ming-wei,LIU Na*
Department of Neurology,the First Hospital of Hebei Medical University,Shijiazhuang 050030,China
*Corresponding author:LIU Na,Associate chief physician;E-mail:25461570@qq.com
    【Abstract】  Objective   To investigate the characteristics and risk factors of cognitive dysfunction due to different types of cerebral small vascular disease(CSVD).Methods  One hundred and eighteen patients who hospitalized in the Department of Neurology,the First Hospital of Hebei Medical University from 2012 to 2013,were selected.They were divided into 3 groups according to the manifestations of MRI:white matter lesion(WML) group(40 cases),lacunar infarction(LI) group(38 cases),WML+LI group(40 cases).Meanwhile,39 people who had normal MRI findings from the outpatient were selected as control group.We recorded and measured the patient′s gender,age,education years,as well as the medical history(smoking,drinking,hypertension,diabetes,hyperlipidemia,stroke) and the hs-CRP level,respectively.All cases were scored by Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),and Clinical Dementia Rating(CDR).Furthermore,the risk factors for cognitive dysfunction in CSVD patients were evaluated by multivariate Logistic regression analysis.Results  There were significantly statistical differences in the total score of MMSE and scores in the domains of memory,recall,attention and calculation among the four groups(P<0.05).Compared with the control group,WML group had lower total score of MMSE and scores in domains of memory and recall(P<0.05),LI group had lower total score of MMSE and scores in domain of recall(P<0.05).WML+LI group had lower total score of MMSE and scores in the domains of memory,recall,attention and calculation than other groups(P<0.05).In addition,the differences in total score of MoCA and scores in domains of visual space and executive function,memory,language and calculation among the four groups were statistically significant(P<0.05).Compared with the control group,the total score of MoCA,scores in the domains of visual space and executive function,memory,language were lower in the WML group(P<0.05),the total score of MoCA,scores in the domains of visual space and executive function,language were lower in the LI group(P<0.05).WML+LI group had lower total score of MoCA,lower scores in the domains of visual space and executive function,language and calculation compared with other groups(P<0.05),however,only the score in the memory were lower than LI group and control group(P<0.05).The degree of dementia was more severe in WML and LI groups than that in the control group(P<0.05);however,it was the most severe in the WML+LI group(P<0.05).Results of multivariate Logistic regression analysis showed that longer years of education was a protect factor〔OR=0.684,95%CI(0.561,0.835)〕,while advanced age〔OR=1.092,95%CI(1.022,1.168)〕,smoking〔OR=3.732,95%CI(1.058,13.164)〕,drinking〔OR=4.615,95%CI(1.094,19.465)〕,diabetes〔OR=2.937,95%CI(1.016,8.491)〕,hyperlipidemia〔OR=3.207,95%CI(1.024,10.045)〕 and high level of hs-CRP〔OR=1.245,95%CI(1.040,1.492)〕 were risk factors for cognitive dysfunction in CSVD patients(P<0.05).Conclusion  The characteristics of cognitive dysfunction are different in various types of CSVD,the differences mainly showed in domains of visual space and executive function,memory,language and calculation cognitive,furthermore,WML combined with LI will aggravate cognitive impairment and dementia.Advanced age,smoking,drinking,diabetes,hyperlipidemia and high level of hs-CRP are risk factors of cognitive dysfunction in CSVD patients.
    【Key words】  Cerebral small vessel diseases;Stroke,lacunar;Leukoencephalopathies;Cognition disorders;Risk factors
 
Predictive Value of Blood Glucose Level on the Prognosis of Patients with Pulmonary Embolism  GUO Chun-yue1,HU Bo1,YIN Su-feng1*,LIU Xiao-yu2*,ZHANG Qi3,XU Chun-jie1,ZHANG Xiao-ya1,XUE Ling1,FENG Fu-min1,FAN Hong-min1
1.School of Public Health,Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province,North China University of Science and Technology,Tangshan 063000,China
2.Department of Respiratory Medicine,Kailuan General Hospital,North China University of Science and Technology,Tangshan 063000,China
3.Department of Cardiology,Tangshan Gongren Hospital,Tangshan 063000,China
*Corresponding author:YIN Su-feng,Professor,Master supervisor,Mainly research in the disease statistics and burden of disease;E-mail:susan.me@163.com
LIU Xiao-yu,Associate chief physician,Mainly research in the pathogenesis of pulmonary embolism and chronic obstructive pulmonary disease;E-mail:hb_lxy007@126.com
    【Abstract】  Objective  To explore the predictive value of blood glucose level at the admission on the prognosis of patients with pulmonary embolism.Methods  The medical records of 376 patients who were firstly confirmed pulmonary embolism in the Affiliated Hospital of North China University of Science and Technology,Tangshan Gongren Hospital and Kailuan General Hospital,North China University of Science and Technology from 2011 to 2015 were retrospectively collected.According to the quartiles of blood glucose level,they were divided into four groups:group Ⅰ (n=97),blood glucose less than 5.10 mmol/L,group Ⅱ (n=99),blood glucose between 5.10 and 5.88 mmol/L,group Ⅲ (n=97),blood glucose between 5.89 and 7.25 mmol/L and group Ⅳ (n=83),blood glucose greater than 7.25 mmol/L.After 30-day follow-up for the enrolled patients,the primary outcome was all-cause mortality.Kaplan-Meier method was used to draw the survival curve and the Log-rank test and Cox proportional hazards regression model were adopted to analyze the predictive value of blood glucose level on the prognosis of patients with pulmonary embolism.Results  A total of twenty pulmonary embolism patients died within 30 days after discharge and the all-cause mortality was 5.32%.The mortality rate of patients with pulmonary embolism in group Ⅰ within 30 days after discharge was 3.09% (3/97),group Ⅱ was 1.01% (1/99),group Ⅲ was 3.09%(3/97),and group Ⅳ was 15.66%(13/83).After the adjustment of gender,age,BMI,smoking,drinking,hospitalization days,pulse,breathing rate,systolic blood pressure,changes in mental status,underlying disease at the admission,the Cox  proportional hazards regression model analysis concluded that the death risk of patients with pulmonary embolism within 30 days after discharge increased when the blood glucose was greater than 7.25 mmol/L〔HR=7.31,95%CI (1.16,46.15),P<0.05〕.The Log-rank test showed that the mortality rate of the four groups of patients with pulmonary embolism within 30 days after discharge was significantly different (χ2=23.490,P<0.01),and the mortality rate in group Ⅳ within 30 days after discharge was higher than that in group  Ⅰ,Ⅱ and Ⅲ(P<0.007).Conclusion  The elevated blood glucose level at the admission is associated with increased death risk of patients with pulmonary embolism within 30 days after discharge,and it can effectively predict the prognosis of patients with pulmonary embolism.The clinicians should help to control the blood glucose level of patients with pulmonary embolism,and improve their survival rate.
    【Key words】  Pulmonary embolism;Prognosis;Blood glucose
 
Effect of Early Mechanical Ventilation Intervention on Prognosis of Patients with Hypoxemia after Hemorrhagic Stroke Surgery  YANG Xue-hui*,ZHU Ning,LI Xiao-wei,TONG Li,ZHANG Wen-chao
Department of Neurosurgery,Harrison International Peace Hospital Attached to Hebei Medical University,Hengshui People′s Hospital,Hengshui 053000,China
*Corresponding author:YANG Xue-hui,Chief physician,Main research directions:neurosurgical critical care;E-mail:YXH1069@163.com
    【Abstract】  Objective   To study the effect of early mechanical ventilation on the prognosis of patients with hypoxemia after hemorrhagic stroke surgery.Methods  By prospective randomized controlled study design,144 patients with hypoxemia after hemorrhagic stroke surgery admitted into Harrison International Peace Hospital Attached to Hebei Medical University from January 2010 to March 2013 were selected.With random number table method,the patients were randomly assigned to three groups and each group had 48 cases.Group A (active intervention group of mechanical ventilation in early stage) was given continuous monitoring of SpO2 and blood gas analysis after operation.When the average SpO2 continued for two hours was between 93% and 95% and/or the average PaO2 between 71 and 80 mm Hg(1 mm Hg=0.133 kPa),that was the active early stage to perform mechanical ventilation.Group B (intervention group of mechanical ventilation in early stage) was given mechanical ventilation when the average SpO2 continued for two hours was between 91% and 92% and/or the average PaO2 between 61 and 70 mm Hg.Group C (control group,conservative mechanical ventilation group) was not given mechanical ventilation until the average SpO2 continued for two hours was equal to or less than 90% and/or the average PaO2 equal to or less than 60 mm Hg.The incidence rate of ventilator-associated pneumonia (VAP),postoperative rebleeding and hydmcephalus,the duration of mechanical ventilation,the score of Glasgow Outcome Scale (GOS) at the sixth month of the follow-up and case fatality rate of patients were recorded in the study.Results  There was no significant difference in the incidence rate of VAP,postoperative rebleeding and hydmcephalus and case fatality rate of patients in three groups (P>0.05).There was significant difference in the duration of mechanical ventilation and GOS score of patients in three groups (P<0.05);and the duration of mechanical ventilation of patients in group A and B was shorter than that in group C,and their GOS score was higher than that in group C (P<0.05);there was no significant difference in the duration of mechanical ventilation and GOS score of patients in group A and B (P>0.05).Conclusion  Early mechanical ventilation can shorten the duration of mechanical ventilation of patients with hypoxemia after hemorrhagic stroke surgery and improve their prognosis.
    【Key words】  Cerebral hemorrhage;Continuous positive airway pressure;Prognosis
 
Survival Situation in Patients with Persistent Vegetative State and Its Influencing Factors  WU Kun-peng1,CHEN Ying2*,YAN Cai-hong1,HUANG Zhi-jia1,GUI Pei-gen1,WU Zheng-mao1,ZHANG Qun-feng1,XIAO Hong1
1.Department of Intensive Care Unit,the Second Hospital,University of South China,Hengyang 421001,China
2.Department of Anesthesia,the Second Hospital,University of South China,Hengyang 421001,China
*Corresponding author:CHEN Ying,Attending physician;E-mail:157456259@qq.com
    【Abstract】  Objective  To investigate the survival situation in patients with persistent vegetative state(PVS) after brain trauma and to explore the factors associated with their prognosis.Methods  From January 2009 to June 2014,we selected 196 patients with PVS(108 were due to brain trauma and 88 due to stroke) admitted to Department of Intensive Care Unit,the Second Hospital,University of South China as the subjects of this study.We collected the clinical data of the subjects and gave them a follow-up,the latter including the following:length of hospital stay,alimentation mode,family economic conditions,family care status,incidence of lung infection,nutritional status,survival state and so on.The survival rate of patients was analyzed.And the factors influencing the prognosis of PVS patients were analyzed by Cox proportional hazards regression model.Results  The median survival time was 12.5 months,1-year overall survival rate was 53.5% and 2-year overall survival rate was 20.0% for the 196 PVS patients.No difference in the prognosis was observed between PVS patients with different gender and type of disease(P>0.05).Age,length of hospital stay,stomach colostomy,family economic conditions,family care status,incidence of lung infection,nutritional status were the factors causing the statistically significant difference in the prognosis between the PVS patients(P<0.05).Results of Cox proportional hazards model analysis demonstrated that advanced age,no stomach colostomy,poor family care,lung infection and poor nutrition status were risk factors for the poor prognosis of PVS patients(P<0.05).According to the number of poor prognosis factors,the patients were divided into:group with 0 or 1 poor prognosis factor(109 cases,the median survival time was 18.9 months;1-year,2-year survival rates were 80.5%,30.0%,respectively);group with 2 or more poor prognosis factors(87 cases,the median survival time was 7.8 months;1-year,2-year survival rates were 14.8%,0,respectively ),which showed that the differences in the 1-year,2-year survival rate between the two groups were statistically significant(χ2=92.781,P<0.001;χ2=26.073,P<0.001).Conclusion  Almost 50.0% of the PVS patients died within 1 year.Advanced age,no stomach colostomy,poor family care,lung infection,poor nutritional status are the independent adverse factors influencing the prognosis of PVS patients.
    【Key words】  Persistent vegetative state;Prognosis;Risk factors
 
Association between Hypertension and IgG N-glycome in Xinjiang Kazakh Population  GAO Qing1,2, WANG Hao1,2, ZHAO Fei-fei1,2, DUOLIKUN·Maimaitiyusufu3, PENG Hong-li1,2, LIU Jiao-nan1,2, ZHANG Jie1,2, WANG You-xin1,2, WU Li-juan1,2, GUO Xiu-hua1,2, SONG Man-shu1,2*
1.School of Public Health,Capital Medical University,Beijing 100069,China
2.Beijing Municipal Key Laboratory of Clinical Epidemiology,Beijing 100069,China
3.College of Life Science and Technology,Xinjiang University, Urumqi 830046, China
*Corresponding author:SONG Man-shu,Associate professor;E-mail:songms@ccmu.edu.cn
    【Abstract】  Objective  To analyze the association between hypertension and IgG N-glycome in Xinjiang Kazakh population,and to explore the potential biomarkers of the state of hypertension disease.Methods  Ninety-two Kazakh participants who had established health records in health center of Qapqal County,Xinjiang Yili Kazakh Autonomous Prefecture from February to June 2014 were recruited as research objects by simple random sampling method.According to the diagnostic criteria of hypertension,the subjects were divided into normal blood pressure group (n=35),normal high-value group (n=27) and hypertension group (n=30).The plasma IgG N-glycome was detected by liquid chromatography-electrospray ionization mass spectrometry.Results  Twenty glycans (G0,G0F,G0FN,G0N,G1,G1F,G1FN,G1FNS,G1FS,G1N,G1NS,G1S,G2,G2F,G2FN,G2FNS,G2FS,G2N,G2NS,G2S) were all detected in various IgG subtypes of each subject.Except for G0,there were significant differences in each N-glycome levels of different IgG subtypes (P<0.05).The level of G0F,G0FN and G1FS of IgG1 subtypes in hypertension group was higher than that in normal blood pressure group,while the levels of G2 and G2FS was lower;the level of G2F of IgG1 subtypes in normal high-value group was lower than that in normal blood pressure group,the level of G2F of IgG1 subtypes in hypertension group was lower than that in normal blood pressure group and normal high-value group (P<0.05).In normal high-value group,the level of G0FN and G0N of IgG2/3 subtypes was higher than that in normal blood pressure group,and the level of G2 and G2S was lower;in hypertension group,the level of G0,G0F,G0FN and G0N of IgG2/3 subtypes was higher and the level of G2,G2F,G2FS,G2NS and G2S was lower than that in normal blood pressure group,and the level of G2FN and G2FNS was lower than that in normal blood pressure group and normal high-value group(P<0.05).The levels of G0FN of IgG4 subtypes in hypertension group was higher than that in normal blood pressure group and normal high-value group(P<0.05).The level of galacosylation of IgG1 subtypes in normal high-value group was significantly lower than that in normal blood pressure group,and the level of galacosylation of IgG1 subtypes in hypertension group was significantly lower than that in normal blood pressure group and normal high-value group (P<0.05).The levels of galacosylation and sialylation of IgG2/3 subtypes in normal high-value group and hypertension group were significantly lower than those in normal blood pressure group,and the level of galacosylation of IgG2/3 subtypes in hypertension group was significantly lower than that in normal high-value group (P<0.05).Conclusion  The different states of blood pressure is associated with its plasma IgG N-glycome changes of Xinjiang Kazakh population,the changes in the levels of G2F of IgG1 subtypes and galactosylated levels of IgG1 and IgG2/3 subtypes may be the potential biomarkers and novel therapeutic targets for hypertension status among this population.
    【Key words】  Hypertension;Immunoglobulin G;Glycosylation;Biological markers
 
Frequency Distribution of SLC22A1 Gene Polymorphism and Effects of Family History of Diabetes on Mutation in Xinjiang Uygur Population  ZHANG Li1,ZHAN Qiong2,ZHAO Jun3,LI Jian-guang4,ZHOU Yuan1,YANG Huan-jie1,WANG Ning5*
1.The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China
2.Department of Postgraduate Management,Graduate School of Xinjiang Medical University,Urumqi 830011,China
3.Department of Pharmacy,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China
4.University Hospital,Xinjiang Medical University,Urumqi 830011,China
5.Department of the First Internal Medicine in the Cadre Wards,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China
*Corresponding author:WANG Ning,Chief physician,Associate professor,Master supervisor;E-mail:wnlsdr@163.com
    【Abstract】  Background   Transport protein is a drug transporter that has attracted much attention in recent years.It is encoded by SLC22A1 gene.SLC22A1 gene has significant genetic polymorphism,and its multiple mutations have been found in many races.It is an important cause of metformin bioavailability differences in patients with type 2 diabetes mellitus (T2DM).Objective  To study the frequency distribution of alleles and genotypes of rs34059508 and rs4646277 sites of SLC22A1 gene in Xinjiang Uygur young men,explorer the effects of family history of diabetes on mutation,and provide theoretical basis for individualized treatment of metformin with gene orientation of T2DM patients.Methods  From September 2014 to September 2015,276 Uygur male healthy volunteers in Xinjiang were recruited.The 5 ml peripheral blood was collected,and DNA were extracted.The alleles and genotypes of rs34059508 and rs4646277 sites of SLC22A1 gene and nutation among the subjects were analyzed by Snapshot technology platform.Results  The frequency distribution of the alleles of rs34059508 and rs4646277 sites of SLC22A1 gene was consistent with the genetic equilibrium of Hardy-Weinberg,which presents group representativeness (χ2=0.009,P=0.976;χ2=0.246,P=0.620).There were significant differences in the frequency of alleles and genotypes of rs34059508 sites of SLC22A1 gene in the Asian population,Caucasian population,African American population,Xinjiang Uygur population (P<0.05);the frequency of allele A of rs34059508 sites of SLC22A1 gene in the Xinjiang Uygur population was lower than that of the Caucasian population(P<0.001).There were significant differences in the frequency of alleles and genotypes of rs4646277 sites of SLC22A1 gene in the Asian population,Han population,Xinjiang Uygur population (P<0.05);the frequency of allele T of rs4646277 sites of SLC22A1 gene in the Xinjiang Uygur population was higher than that of the Han population (P<0.017).SLC22A1 gene mutation occurred in 12 cases(63.2%) among the 19 patients with family history of T2DM,the mutation rate of SLC22A1 gene was 77.9%(162/208) in the 208 cases without family history of T2DM,the difference was not statistically significant (χ2=1.367,P=0.242).Conclusion  The mutation rate of rs34059508 and rs4646277 sites of SLC22A1 gene among Xinjiang Uygur men is 0.4% and 5.8% respectively.No effects of family history of T2DM are found on SLC22A1 gene mutation.
    【Key words】   Diabetes mellitus,type 2;Biological availability;SLC22A1 gene;Polymorphism,single nucleotide;Uygur nationality
 
Research of Children Reception in Community Health Service Centers in Beijing:A Cross-sectional Telephone Questionnaire Study  PAN Zi-han1,2,3,QI Jian-guang1,2,3*,YAO Mi3,4,YU Guo1,LIU Ya-jun5
1.Department of Pediatrics,Peking University First Hospital,Beijing 100034,China
2.Department of General Practice,Peking University First Hospital,Beijing 100034,China
3.Department of GP,Peking University Health Science Center,Beijing 100191,China
4.Xinjiekou Community Health Center,Beijing 100035,China
5.Beijing Community Health Service Management Center,Beijing 100000,China
*Corresponding author:QI Jian-guang,Chief physician,Associate professor;E-mail:qjg2006@126.com
    【Abstract】  Objective  To investigate the current situation of children reception in community health service centers(CHSCs)in Beijing,so as to provide a reference for the further improvement of children′s primary health care system in Beijing and implementation of hierarchical diagnosis and treatment.Methods  The 325 CHSCs registered by the end of December 31st,2013 monitored by the conventional monitoring system of community health in Beijing were enrolled in the study.In April 2015,a cross-sectional telephone questionnaire survey was conducted in the 325 CHSCs which covered the following aspects:whether the CHSCs give treatment to children with common diseases,specific conditions of the children treated in the CHSCs(visiting time of outpatient,outpatient visits,age requirement,and whether the CHSCs have wards for children),types of doctors practicing children reception and so on.Results  Of the 325 CHSCs,79(24.3%) did not answered the telephone for questionnaire survey,246(75.7%)answered it,and 210(85.4%)of them answered all the questions with a response rate of 64.6%(210/325).Of the 210 CHSCs,79(37.6%)were in the urban area,131(62.4%)were in the suburban area;123(58.6%)received children,while 87(41.4%)did not;46(21.9%)had set up department of pediatrics;36(17.1%)had pediatricians.The rate of children reception was 34.2%,73.3% in the urban and suburban CHSCs,respectively.The difference in rate of children reception were statistically significant between urban and suburban(χ2=31.057,P<0.001),and between CHSCs with or without department of pediatrics(χ2=5.713,P=0.017),while it was not between CHSCs with or without pediatricians(χ2=1.173,P=0.279).Between the urban and suburban CHSCs,the difference in children reception time(after 17:00,on weekend,24 h)showed statistical significance(P<0.05),that in the number of outpatients(<20/d)also demonstrated statistical significance(P<0.05),as well as that in the types of doctors practicing children reception exhibited statistical significance(χ2=30.088,P<0.001),but the difference in received <6 years old children did not(P>0.05),and that in the setting up of a ward for children did not(P>0.05).Conclusion  The general situation of children reception in CHSCs in Beijing currently is not satisfactory;suburban CHSCs do much better than urban CHSCs in children reception.Both general practitioners and pediatricians but mainly the formers receive children in CHSCs.
    【Key words】  Community health centers;Office visits;Children;Questionnaires;Beijing
 
Existing Circumstances Research of Diabetic Peripheral Neuropathy of Type 2 Diabetes Mellitus Patients Based on Community Population in Shanghai  YANG Hui1,SHI Rong1*,ZHU Jing-fen1,JIA Li-li2,LOU Jie-qiong1,LONG Wen1,FENG Yi1,LIANG Chen1,ZHANG Sheng-bing3,SONG Dao-ping4,JIANG Yu-li5,GU Wen-juan6,PENG Yun7,CHENG Hui-qin8,QIN Fei1
1.School of Public Health,Shanghai Jiao Tong University,Shanghai 200025,China
2.Shanghai No.6 People′s Hospital,Shanghai 200233,China
3.Huamu Community Health Service Center,Pudong New Area,Shanghai 201204,China
4.Jinyang Community Health Service Center,Pudong New Area,Shanghai 200120,China
5.Yinhang Community Health Service Center,Yangpu District,Shanghai 200433,China
6.Siping Community Health Service Center,Yangpu District,Shanghai 200433,China
7.Sanlin Community Health Service Center,Pudong New Area,Shanghai 200120,China
8.Daqiao Community Health Service Center,Yangpu District,Shanghai 200433,China
*Corresponding author:SHI Rong,Professor;E-mail:shirong61@163.com
    【Abstract】  Objective  To investigate the prevalence of diabetic peripheral neuropathy(DPN)of patients with type 2 diabetes mellitus in Shanghai community and its influencing factors.Methods  With cluster random sampling method,5 053 patients with type 2 diabetes mellitus of six communities in Pudong New Area and Yangpu District in Shanghai accepted questionnaires survey,physical examination and laboratory tests from October 2014 to April 2015, DPN was screened by Toronto Clinical Scoring Scale(TCSS),and divided into nonexistent DPN,mild DPN,moderate DPN,and severe DPN.Multivariate Logistic regression analysis was used to analyze the influence factors of developing DPN.Results  The positive rate of DPN screening was 16.0%(810/5 053),of which 612(12.1%)were mild DPN,158(3.1%)were moderate DPN,and 40(0.8%)were severe DPN.There were no significant differences in the prevalence of DPN among subjects of different gender,subjects with or without abdominal obesity and subjects smoking or not(P>0.05);there were significant differences in the prevalence of DPN among subjects with different ages,disease durations,body mass index(BMI)(P<0.001).There were no significant differences in the prevalence of DPN among subjects of different FPG levels and subjects combined with or without hypertension(P>0.05);there were significant differences in the prevalence of DPN among subjects of different levels of 2-hour postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),low density lipoprotein cholesterin(LDL-C),high density lipoprotein cholesterol(HDL-C),urinary albumin to creatinine ratio(ACR)and different severity degree of diabetic retinopathy(DR)(P<0.05).Multivariate Logistic regression analysis showed that age≥65,disease duration≥15 years,HbA1c≥8.5%,HDL-C≤0.9 mmol/L,combining with moderate or severe DR were the risk factors of type 2 diabetes mellitus patients′ DPN being positive(P<0.05).Conclusion  The prevalence rate of DPN is low in type 2 diabetes mellitus patients in Shanghai community,and mild lesions are the main manifestation.Age≥65,disease duration≥15 years,HbA1c≥8.5%,HDL-C≤0.9 mmol/L,combining with moderate or severe DR are the risk factors of DPN in type 2 diabetes mellitus patients in community.
    【Key words】  Diabetes,type 2;Diabetic neuropathies;Prevalence;Screening;Root cause analysis
 
Correlation of Major Air Pollutants and the Hospital Rate of Respiratory Diseases among Children  HU Ji-hong1*,JIN Li-mei1,ZHAO Yi1,CHEN Li1,LI Jin-juan1,LI Xin1,MA Yan-ping1,WEI Jin-lin2,LIU Jia-ji2
1.Department of Epidemiology,School of Public Health,Gansu University of Chinese Medicine,Lanzhou 730000,China
2.Lanzhou Municipal Center for Disease Control,Lanzhou 730030,China
*Corresponding author:HU Ji-hong,Associate professor,Master supervisor;E-mail:hujihonghappy@163.com
    【Abstract】  Background  As the prevalence of respiratory diseases in children presents an upward trend,the influence of air pollution on children′s health is being taken more seriously.Objective    To compare the influence of major air pollutants on the hospitalization rate of respiratory diseases among children aged 1-5 years between 2014 and 2015 in Lanzhou city.Methods  From May to June 2016,we collected the data of monthly level of major air pollutants(PM2.5,PM10,SO2,NO2 and O3) of Lanzhou in 2014 and 2015 from China′s Air Pollution Online Monitoring Platform,and the data of hospitalization rate for respiratory diseases among children aged 1-5 years in Lanzhou during the same two years from the Information Platform of Health System from CDC into Hospital in Gansu province.The Pearson correlation was used to test the correlation of major air pollutants with hospitalization rate,and that between the major air pollutants.The linear regression was used to analyze the influence of major air pollutants on hospitalization rate.Results  The differences in the levels of PM2.5,PM10,SO2 and O3 in Lanzhou between 2014 and 2015 showed no statistical significance(P>0.05).The level of NO2 was significantly higher in 2015 than it in 2014(P<0.05),and the hospitalization rate of respiratory diseases among 1-5 years old children was significantly higher in 2015 than it in 2014(P<0.05).Results of Pearson correlation showed that in 2014,PM2.5,PM10,SO2,NO2 were positively correlated with the hospitalization rate(P<0.05),while O3 was negatively correlated with it(P<0.05);in 2015,PM10 and NO2 had no linear correlation with hospitalization rate(P>0.05),PM2.5 and SO2 were positively correlated with the hospitalization rate(P<0.05),and O3 was critically negatively correlated with hospitalization rate(P=0.050).The results of multivariate linear regression analysis showed that in 2014,PM2.5(t=3.79,P=0.004,VIF=1.45)and NO2(t=2.64,P=0.027,VIF=1.45)were significant risk factors for hospitalization rate(P<0.05);in 2015,SO2(t=3.01,P=0.013,VIF=1.00)was the significant risk factor for hospitalization rate(P<0.05).Conclusion  The different air pollutants(PM2.5 and NO2 in 2014,and SO2 in 2015) might lead to the higher hospitalization rate of respiratory diseases among children aged 1-5 in Lanzhou in 2015 than it in 2014.
    【Key words】  Respiratory tract diseases;Air pollutants;Children,preschool;Hospitalization rate
 
Risk Prediction of Cardiovascular and Cerebrovascular Diseases on Community Patients with Chronic Disease in Beijing  ZHANG Yan-chun1*,QIN Jiang-mei1,YANG Xiao-qian2,ZHANG Li-fang1,LIN Chun-mei2
1.Health Development Research Center,NHFPC of the People′s Republic of China,Beijing 100191,China
2.Shihezi University School of Medicine,Shihezi 832003,China
*Corresponding author:ZHANG Yan-chun,Associate researcher,Researching in community health,chronic disease management and health economics;E-mail:zhangyc@nhei.cn
    【Abstract】  Objective  To measure the risk of developing cardiovascular and cerebrovascular diseases,analyze the situation and challenges of chronic disease management,compare the difference between urban and rural areas,and put forward strategies to strengthen the community chronic disease management based on risk factors of community chronic disease in Beijing.Methods  With stratified clustering sampling method,field research was conducted in two community health service centers,which was selected from a city street in Xicheng District and a rural township in Pinggu District in Beijing respectively in September 2015.Patients with hypertension and diabetes mellitus (7 535 cases) under the management of these two community health service centers were included as research objects in the study.The risk prediction charts of cardiovascular and cerebrovascular disease of World Health Organization (WHO)/International Society of Hypertension (ISH) were used to estimate the risk of cardiovascular and cerebrovascular disease in the future 10 years of patients without such diseases.Results  A total of 7 215 effective questionnaires were collected with an effective response rate of 95.75%.There were 3 589 urban cases and 3 626 rural cases.The number of patients not suffering from cardiovascular and cerebrovascular diseases was 4 378,of which 1 796 in urban area and 2 582 in rural.There were significant differences in age,smoking rate,distribution of chronic disease,prevalence of hyperlipidemia and the proportion of BMI greater than or equal to 23 kg/m2 between patients in urban and rural areas (P<0.05).The number and proportion of the risk of patients without cardiovascular and cerebrovascular diseases developing such diseases less than 10% (low risk),between 10% and 19% (medium risk),between 20% and 29% (high risk),between 30% and 40% (high risk),and greater than 40% (high risk) were 2 342 (53.49%),953 (21.77%),815 (18.62%),186 (4.25%) and 82 (1.87%),respectively.The risk of developing such diseases in urban area was significantly higher than that in rural area (χ2=171.665,P<0.05).The number of low-risk patients,medium-risk patients and high-risk patients,and patients with cardiovascular and cerebrovascular diseases was 2 342 (32.46%),953 (13.21%),1 083 (15.01%) and 2 837 cases (39.32%) respectively.Among the urban patients,the number of patients developing cardiovascular and cerebrovascular diseases was 1 793(49.96%).Conclusion  Community health service institutions play an important role in the management of high-risk patients.The situation of community cardiovascular and cerebrovascular diseases is serious and the task in cities is more arduous.Therefore,we should strengthen hierarchical diagnosis and treatment and the coordination and distribution of responsibilities,deepen the management of community chronic disease,and improve the awareness of risk management of both doctors and patients in community.
    【Key words】  Community health services;Chronic disease;Risk prediction charts of cardiovascular and cerebrovascular disease of WHO/ISH
 
Effect of Comprehensive Management Mode Based on One-day Care in Outpatient on Women with Gestational Diabetes Mellitus  CHENG Xian-ying1*,LI Wen-juan2,QIAN Lin-hua2,XU Chun-jing2,ZHANG Yong-qing2
1.Department of Obstetrics and Gynaecology,Zhejiang University International Hospital,Hangzhou 310022,China
2.Department of Obstetrics and Gynaecology,Women′s Hospital,School of Medicine,Zhejiang University,Hangzhou 310008,China
*Corresponding author:CHENG Xian-ying,Attending physician;E-mail:logancxy@tom.com
    【Abstract】  Objective  To explore the effect of comprehensive management mode based on one-day care in outpatient on the body mass,blood glucose and maternal-neonatal complications of women with gestational diabetes mellitus (GDM).Methods  A total of 1 870 pregnant women diagnosed with GDM in Department of Obstetrics and Gynaecology,Women′s Hospital,School of Medicine,Zhejiang University from December 2013 to December 2015 were included as the research objects.According to the voluntary principle,920 cases were included in the control group,and 950 in the research group.The control group was intervened by conventional management mode.The research group was intervened by the comprehensive management mode that based on one-day care in outpatient,of which the main contents included propaganda and education of relevant knowledge about GDM,knowledge about medical nutrition treatment,diet,exercise and blood glucose monitoring guidance.The cognition of relevant knowledge about GDM of women with GDM was evaluated by self-designed questionnaires.Pre-pregnancy and prenatal body mass and body mass index (BMI),and the levels of fasting blood glucose,preprandial blood glucose,two-hour postprandial blood glucose before and after intervention and the incidence of perinatal complications and perinatal fetus complications were recorded.Results  The pass rates of basic knowledge,maternal-neonatal risk,diet knowledge,exercise knowledge,blood glucose monitoring,and body mass management in the research group were higher than those in the control group (P<0.05).In the research group,the growth amount of body weight and BMI of women with GDM during gestation period were lower than those in the control group (P<0.05).After intervention,the levels of fasting blood glucose,preprandial blood glucose,two-hour postprandial blood glucose in the research group were lower than those in the control group (P<0.05);the levels of fasting blood glucose,preprandial blood glucose and two-hour postprandial blood glucose after intervention in the two groups were lower than those before intervention (P<0.05).The incidence rates of hypertensive disorder complicating pregnancy,polyhydramnios,postpartum hemorrhage,macrosomia,neonatal asphyxia,and neonatal hypoglycemia in the research group were lower than those in the control group (P<0.05).Conclusion  The comprehensive management model based on one-day care in outpatient can improve the cognition of the disease of women with GDM,control the growth of body weight,maintain the stability of blood glucose,and reduce the risk of adverse pregnancy outcomes of mothers and infants.
    【Key words】   Diabetes,gestational;Case management;One-day care;Blood glucose;Pregnancy outcome
 
High Risk Characteristics Analysis of Patients with Placement Difficulty of Ureteral Access Sheath in the First Retrograde Intrarenal Surgery  HU Zhi-yu,HAO Bin*,WANG Peng-sen
Department of Urology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China
*Corresponding author:HAO Bin,Chief physician,Foundation and clinical study on urological diseases;E-mail:binhao68@hotmail.com
    【Abstract】  Objective  To analyze the high risk clinical and imaging characteristics of patients with the placement difficulty of ureteral access sheath(UAS) in the first retrograde intrarenal surgery(RIRS).Methods  A total of 142 patients with calculus of upper urinary tract(119 with unilateral ureteral obstruction,23 with bilateral ureteral obstruction,165 sides),who underwent RIRS in the Second Affiliated Hospital of Zhengzhou University from September 2014 to May 2016,were selected.According to whether success placing UAS or not during treatment,patients were divided into success placement group and difficulty placement group.The clinical characteristics and imaging characteristics of patients were collected.Multivariate Logistic regression was used to analyze the influencing factors of the difficulty in placing UAS.Results  The success placement group had 118 patients,and 141 sides totally.While the difficulty placement group had 24 patients and 24 sides.There was significant difference in indwelling history of D-J tube,ureteroscopic surgery history,incidence of ureteral dilation,nephrarctia,and ureteral development degree of intravenous pyelogram(IVP) for 30 minutes in the affected side between two groups(P<0.05).Multivariate Logistic regression analysis showed that indwelling history of D-J tube in the affected side〔OR=0.111,95%CI(0.013,0.928)〕,the history of ureteroscopic surgery in the affected side〔OR=0.102,95%CI(0.012,0.867)〕 were the predictive factors of the placement success of UAS(P<0.05),no ureteral image in the 30-minute IVP〔OR=4.562,95%CI(1.388,14.992)〕 was the predictive factor of the placement difficulty in UAS(P<0.05).Conclusion   The indwelling D-J tube and history of ureteroscopic surgery can reduce the risk of the placement difficulty in UAS,and no ureteral iamge in the 30-minute IVP increases the risk of the placement difficulty in UAS.Therefore,pay attention to the clinical and imaging data of patients before RIRS can effectively assess the occurrence risk of the placement difficulty in UAS.
    【Key words】  Ureteral calculi;Ureteroscopy;Ureteral access sheath
 
Clinical Application and Medium- and Long-term Efficacy of Anterior Discectomy and Fusion by Using Bridged Self-locking PEEK Cage for Cervical Spondylosis  CAO Sheng-sheng*,RAO Min-jie,QIN Yu-hong,ZHANG Gong-heng,NIE Shao-ping,XIAO Bao-wei,GAN Xin-rong
Department of Orthopaedics,the People′s Hospital of Yichun City,Yichun 336000,China
*Corresponding author:CAO Sheng-sheng,Professor;E-mail:yichunhot@126.com
    【Abstract】  Objective  To evaluate the medium- and long-term efficacy of the anterior cervical discectomy and fusion(ACDF) with the bridged self-locking polyetheretherketone(MC+PEEK) cage for the treatment of cervical spondylosis.Methods  Between June 2011 and August 2015,41 consecutive patients with cervical spondylosis were treated by ACDF with MC+PEEK cages(n=67) in the People′s Hospital of Yichun City.The patients were followed up regularly after surgery.The nerve functional restoration at the last follow-up was evaluated by VAS and JOA scores,postoperative dysphagia was assessed by Bazaz Dysphagia Score,adjacent-segment ossification by Park adjacent-level ossification score,and intervertebral space degeneration by UCLA grading scale.All the patients underwent postoperative cervical spine X-ray,CT,and MRI examinations regularly for measuring the rate of fusion,whole the height of intervertebral space and  cervical spine curvature.Results  A total of 37 patients were followed up for an average of (47.8±5.0)months.VAS reduced from preoperative (5.7±0.3) to postoperative (1.4±0.8) (P<0.001).JOA scores ascended from preoperative (9.2±2.2) to postoperative (15.0±4.6) (P<0.001).The height of intervertebral space ascended from preoperative (5.8±1.5) mm to postoperative (8.3±0.9) mm (P<0.001).Whole cervical spine curvature ascended from preoperative (3.9±0.5) mm to postoperative (7.3±2.0) mm (P<0.001).Satisfactory intervertebral bony fusion rate was achieved in the patients during 3-6 months after surgery and the fusion rate reached 100.0% at the 6th month after surgery.Two of them(5.4%) had slightly postoperative dysphagia with no other complications showed during the whole follow-up period.Conclusion  The ACDF with MC+PEEK cage for cervical spondylosis is easy to operate with little bleeding,it can also improve and keep the cervical spine curvature and height of intervertebral space with good medium- and long-term efficacy and few complications.
    【Key words】  Cervical spondylosis;Bridged self-locking;Spinal fusion;Treatment outcome
 
Feasibility Study on Application of Tissue Adhesives in Scalp Laceration  CHEN Gui-hong1,LIU Shi-ping2*,CAO Xiao-ping2,ZHONG Wu1,CHEN Mu-hu1,CHEN Hong-sheng1,ZHANG Wen3
1.Department of Emergency Medicine,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China
2.Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China
3.Sichuan Luzhou TCM Hospital,Luzhou 646000,China
*Corresponding author:LIU Shi-ping,Associate chief physician;E-mail:liusp456@163.com
    【Abstract】  Objective  To investigate the feasibility of applying tissue adhesives in scalp laceration by comparing the advantages and disadvantages of tissue adhesives and conventional debridement and suture in the treatment of scalp laceration.Methods  A total of 152 patients with scalp laceration who received treatment in Department of Emergency Medicine of the Affiliated Hospital of Southwest Medical University from July 2015 to July 2016 were selected and randomly divided into control group(n=73) and observation group(n=79) by random number table method.Patients in control group received conventional debridement and suture under local anesthesia,while the observation group used hair weaving and tissue adhesives to glue the wound.The operation time,pain degree,total cost and satisfaction degree of the two groups were recorded.Results  The average operation time(9.5±2.7) min in the observation group was significantly shorter than(14.5±3.5) min in the control group,the visual analogue scale(VAS) 3(0,4) was significantly less than 5(2,8),and the total cost 560(560,588) yuan was significantly more than 318(300,330) yuan(P<0.05).In the control group,22 cases(30.1%) were dissatisfied,32 cases(43.8%) were quite satisfied and 19 cases(26.1%) were satisfied;in the observation group,5 cases(6.3%) were dissatisfied,20 cases(25.3%) were quite satisfied and 54 cases(68.4%)were satisfied.There was significant difference in the satisfaction degree between the two groups(U=30.064,P<0.001).Conclusion   Applying tissue adhesives in gluing the scalp has short operative time and mild degree of pain.Although its total cost is higher than that of conventional debridement,the patients′ satisfaction degree is relatively high.It is feasible to apply tissue adhesives in the treatment of scalp laceration,and tissue adhesives are suitable for clinical promotion.
    【Key words】  Wounds and injuries;Scalp laceration;Tissue adhesives;Wound closure techniques
 
Clinical Application of Content of Hemoglobin in Reticulocyte on Diagnosis Iron Deficiency of Women during Pregnancy  CHEN Zhe-zhou1*,LI Mei-yan2
1.Department of Clinical Laboratory,Shenyang First People′s Hospital,Shenyang 110041,China
2.Department of Clinical Laboratory,Chinese People′s Liberation Army No.202 Hospital,Shenyang 110003,China
*Corresponding author:CHEN Zhe-zhou,Laboratorian in charge;E-mail:chenzzczz@163.com
    【Abstract】  Objective  To investigate the application value of content of hemoglobin in reticulocyte(CHr) on the diagnosis iron-deficiency without anemia and iron-deficiency anemia of women during pregnancy.Methods  One hundred and nine pregnant women whose pregnancy test were made in Department of Obstetrical,Chinese People′s Liberation Army No.202 Hospital from November 2015 to March 2016 were selected.According to the levels of hemoglobin(Hb)and serum ferritin(SF),the women were divided into iron-deficiency without anemia group(34 cases),iron-deficiency anemia group(35 cases)and normal pregnant women group(40 cases).Blood analysis indicators in each group was detected,includ

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