Influence of triglyceride/high-density lipoprotein cholesterol ratio on the onset of primary liver cancer / 临床肝胆病杂志

ObjectiveTo investigate the influence of triglyceride （TG）/high-density lipoprotein cholesterol （HDL-C） ratio on the onset of primary liver cancer. MethodsA prospective cohort study was conducted. Physical examination data were collected from 99 750 cases of on-the-job and retired employees of Kailuan Group who participated health examination from July 2006 to December 2007， and they were followed up till December 31， 2021 to observe the onset of primary liver cancer. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups； the chi-square test was used for comparison of categorical data between groups. According to the tertiles of TG/HDL-C ratio， the subjects were divided into Q1， Q2， and Q3 groups， and the incidence density of primary liver cancer was calculated for each group. The Kaplan-Meier method was used to calculate the cumulative incidence rate of primary liver cancer in each group， and the log-rank test was used to compare the difference in cumulative incidence rate between groups. The Cox proportional hazards model was used to analyze the influence of TG/HDL-C ratio on the onset of primary liver cancer. ResultsThere were significant differences between the three groups in age， proportion of male subjects， waist circumference， body mass index， fasting blood glucose， systolic pressure， diastolic pressure， triglyceride， total cholesterol， HDL-C， low-density lipoprotein cholesterol， alanine aminotransferase， high-sensitivity C-reactive protein， chronic liver diseases， hypertension， diabetes， the family history of malignant tumor， drinking， smoking， physical exercise， and educational level （P<0.05）. During the mean follow-up time of 14.06±2.71 years， there were 484 cases of new-onset liver cancer， among whom there were 446 male subjects and 38 female subjects. The incidence density of primary liver cancer was 0.39/1 000 person-years in the Q1 group， 0.35/1 000 person-years in the Q2 group， and 0.30/1 000 person-years in the Q3 group， and the cumulative incidence rates of primary liver cancer in the three groups were 6.03‰， 5.28‰， and 4.49‰， respectively， with a significant difference between the three groups based on the long-rank test （χ2=6.06， P=0.048）. After adjustment for the confounding factors considered， the Cox proportional hazards model showed that compared with the Q3 group， the Q1 group had a hazard ratio of 2.04 （95% confidence interval ［CI］： 1.61‍ ‍—‍ ‍2.58， Pfor trend<0.05）， and the Q2 group had a hazard ratio of 1.53 （95%CI： 1.21‍ ‍—‍ ‍1.92， Pfor trend<0.05）. ConclusionThe reduction in TG/HDL-C ratio is associated with an increase in the rask of primary liver cancer， especially in people with chronic liver diseases.

Preliminary study on Beijing norm of Memory and Executive Screening scale / 中华神经科杂志

Objective:To develop a Beijing norm of Memory and Executive Screening (MES) scale to facilitate its further promotion and application in the future.Methods:Study subjects were selected based on the inclusion and exclusion criteria, including patients who visited the memory clinic of Xuanwu Hospital of Capital Medical University from March 20, 2017 to January 6, 2021, and normal people recruited simultaneously from community, and trained and qualified investigators conducted questionnaire surveys through face-to-face interviews. Then strict quality control, data collection and statistical analysis were performed.Results:A total of 607 participants were included, including 239 normal people, 293 individuals with subjective cognitive decline (SCD), and 75 individuals with mild cognitive impairment (MCI). There was a negative correlation between the scores of MES and age ( r=-0.19, P<0.001), but a positive correlation between scores of MES and education level ( r=0.29, P<0.001). The optimal cut-off value of this scale in Beijing was 86 points, the area under curve (AUC) of the cut-off value to distinguish MCI was 0.847 (normal people vs MCI) and 0.826 (SCD vs MCI), and after adding demographic variables, AUC showed slight increase (0.847 to 0.850 and 0.826 to 0.847), whereas the differences were not statistically significant ( Znormal peoplevsMCI=0.49, ZSCDvsMCI=1.21, P>0.05). And there was no statistically significant difference between MES and Montreal Cognitive Assessment scales in diagnostic power for normal people and people with MCI ( Zscale alone=1.03, Zafter adding demographic variables=1.13, P>0.05). Conclusions:The MES scale has a better distinguishing power for MCI, and its optimal cut-off value in Beijing is 86 points, which is different from previous studies. In the future, the sample size needs to be further expanded to verify this norm.

Needs and requirements for general practice department in general hospitals from the perspective of grassroots: a qualitative study / 中华全科医师杂志

Objective:To survey the needs and requirements of the general practice department in general hospitals from the perspective of grassroots health care personnel.Methods:From July 2020 to February 2022, a qualitative study on needs and requirements for the general practice department in general hospitals was conducted. Twenty eight participants from community health service centers in Beijing, Xi′an and Guangzhou were selected for the in-depth interviews.Results:The participants expressed their opinions and suggestions on the community needs and requirements for general practice department in general hospitals as follows. (1) The necessity of establishing department of general practice in general hospitals: the general hospitals had advantages to meet the medical needs of the community; the teaching and training should be focus on the way of thinking in the general practice, while the training needs for research ability was less required. (2) The cooperation between general hospital and its community teaching base: to implement the joint teaching rounds and joint home visits were effective ways for collaboration, which may ensure the quality of clinical faculty in the community bases. (3)The training needs of the community: rational use of drugs was most required, sub-specialty training was another concern for general practitioners in grassroots level. (4) The requirements for general practice department in the general hospital: in addition to complete organizational structure, daily teaching work needs to be implemented, and horizontal and vertical connection to relevant health institutions also need to be strengthened. Meanwhile, the teaching work should be a considerable part in the department performance assessment, and excellent clinical ability was also required to facilitate the effective referral of patients from the community.Conclusions:The study shows the necessity of establishing department of general practice in general hospitals, and various needs from the community teaching base, which providing reference for improving the construction of general practice department in the future.

Survey on knowledge status of Alzheimer′s disease and influencing factors among community medical and nursing staff in Beijing / 中华全科医师杂志

Objective:To investigate the knowledge status of Alzheimer′s disease (AD) and its influencing factors among community medical and nursing staff in Beijing.Methods:By using a convenient sampling method, 5 community health service centers in Beijing (3 in the urban area and 2 in the suburbs) were selected for survey sites from September 2016 to December 2017. A face-to-face questionnaire survey on the awareness and knowledge of AD was conducted among 270 health care staff of above 5 centers. The Alzheimer′s Disease Knowledge Scale (ADKS, 7 dimensions) and the self-designed questionnaire (influencing factors) were used for survey.Results:The mean score of 270 participants was 19.6±2.7, and the passing rate (≥18) was 80.7% (218/270). The scores of the seven dimensions ranged from low to high were care 45.4±22.7, symptoms 57.0±22.3, risk factors 60.7±19.4, life effects of AD 65.6±24.9, assessment and diagnosis 66.9±18.3, duration of disease 77.9±20.6, treatment and management 82.5±18.2. Multivariate analysis showed that the experience of caring for patients with dementia (β=1.072, P=0.03) was the influencing factor of the total ADKS scores. For single dimension of AKDS, the experience of caring for patients with dementia (β=0.348, P=0.01) and participating in dementia training (β=0.233, P=0.03) were the influencing factors of the dimension "life effects of AD"; the experience of caring for patients with dementia (β=0.459, P=0.01) and the visiting frequency of patients with dementia (β=0.154, P=0.02) were the influencing factors of the dimension "symptoms". Finally, the working years (β=0.124, P<0.01) of the staffs was the influencing factor of the dimension "duration of disease". Conclusion:In Beijing community health service centers, the knowledge of AD among medical and nursing staff is not sufficient, which are associated with the lack of the experience of taking care for dementia patients, not participating in dementia training, low visiting frequency of dementia patients and the less working years. Targeted training should be taken to improve their knowledge of AD.

Research progress on the clinical application of brain-derived neurotrophic factor and its Val66Met gene polymorphism in Alzheimer's disease / 中华老年医学杂志

Increasing evidence indicates that brain-derived neurotrophic factor(BDNF), especially its BDNFVal66Met gene polymorphism, plays an important role in cognitive function of Alzheimer's disease(AD), with its effects on cognition function confirmed by a large number of studies.Therefore, this article reviews the clinical application of BDNF and BDNFVal66Met for Alzheimer's disease(AD), aiming to examine their practical value and effects on AD.

Development and discussion of the collaborative mode of resident standardized training base / 中华医学教育探索杂志

Resident standardized training is the indispensable way to develop the medical and health services in China, and the construction of resident standardized training base is the basis of this work. Under the current situation of the supply and demand of the resident standardized training base and the resident who need to participate in the standardized training, the cooperative base development plays a very good auxiliary role in the work of the national standardized training base for residents. In the process of coordination, the hospital leaders should attach great importance to the development, and we also should promote effective communication among base managers, integrate the training base management system, improve the teaching quality, establish the mechanism of training and supervision, and build a systematic construction bridge between the bases. The most important part of the base coordination is to integrate the advantageous residential training base, professional base, department and professional group, explore the new management model, actively learn from the excellent experience of other bases, as well as increase the training quality and the number of residents.

Comparison of clinical characteristics of severe hyperlipidemic pancreatitis and severe acute gallstone pancreatitis / 中华全科医师杂志

Objective To compare the clinical characteristics and the outcomes of severe hyperlipidemic pancreatitis (SHLP) and severe acute gallstone pancreatitis (SAGP).Methods The clinical data of 22 patients with SHLP and 91 patients with SAGP admitted from January 2009 to December 2015 were retrospectively reviewed.The clinical manifestations,laboratory tests,organ dysfunction,medical treatment,complications and outcomes in 30 d after admission were analyzed and compared between two groups of patients.Results There were 16 males and 6 females with a mean age of (60.5 ± 9.1) years in SHLP group;while 32 males and 59 females with a mean age of (54.3 ± 5.4) years in SAGP group.The blood and urine amylase levels in SHLP group were significantly lower than those in SAGP group [(715 ±99) U/L vs.(1 551 ± 107) U/L,t =4.65,P =0.00;(382 ±56) U/L vs.(773 ± 66) U/L,t =4.52,P =0.00,respectively].The incidence of circulation insufficiency,respiratory insufficiency,renal dysfunction,and long-term puhnonary infection in SHAP patients was significantly higher than that in SAGP patients [36 ％ (8/22) vs.14 ％ (13/91),x2 =5.22,P =0.01;41％ (9/22) vs.7 ％ (6/91),x2 =9.46,P =0.01;23％(51/22) vs.5％ (5/91),x2 =4.20,P=0.03;55％(12/22) vs.32％ (29/91),x2 =7.02,P =0.01].Two cases died in the SHLP group and 9 cases died in SAGP group due to critical infection,cardiac events and bleeding.Conclusion Compared to SAGP patients,the blood and urine amylase levels are usually not remarkably high in SHLP patients,and the prevention and management of multi-organ failure and lung infection are more important for SHLP patients.

Observation of vascular surgery residency program in Northwestern Memorial Hospital / 中华医学教育探索杂志

This paper introduced vascular surgery residency program in Northwestern Memorial Hospital including application process,training mode,program content and scientific training.This paper also made comparison in surgical residency program between United States and China and put forward the proposal for the implementation of Chinese main land vascular surgery residency training program.

Early goal-directed therapy in severe acute pancreatitis / 中华肝胆外科杂志

Objective To study the difference in outcomes between two treatment regimens of goal-directed fluid therapy in patients with severe acute pancreatitis. Methods From January 2000 to January 2010, 80 patients with severe acute pancreatitis were assigned into 2 groups. In group A,patients received fluid therapy aiming at the following goals in 24 hours: (1) Blood pressure >90/60 mm Hg;(2) CVP between 8-12 mm Hg;(3) Urine output >0. 5 ml · kg-1 · h-1. In group B, patients received fluid therapy aiming at the following goals in 6 hours (according to SSC guideline,2004): (1) mean arterial blood pressure >65 mm Hg;(2) CVP between 8-12 mm Hg;(3) Urine output >0. 5 ml · kg-1 · h-1 ;(4) central venous oxygen saturation >70%. After therapy for 3 days we measured the Marshall score, APACHE Ⅱ score, and the peri-pancreatic infection and mortality rates. Results The Marshall score was 6. 82±4. 69 and 4. 48±3. 78 in group A and B, respectively (P=0. 02). The APACHE Ⅱ score was 11. 35±5. 96 and 8. 22±4. 53 in group A and B, respectively (P=0. 01). The peri-pancreatic infection rate was 44% and 37% in group A and B, respectively, and there was no significant difference between the 2 groups (P = 0. 65). The mortality rate was 24% and 17% in group A and B. There was no significant difference between the 2 groups(P=0. 57). Conclusion Goal-directed fluid therapy in patients with severe acute pancreatitis according to the SSC guideline improved organ function but it did not reduce peri-pancreatic infection and mortality rates.

Laying emphasis on detail management to enhance the resident training quality / 中华医学教育探索杂志

Resident training is an important part of after-graduation education for medical students,and is also an important way to cultivate qualified medical talents.With 20 years management experience of resident standardized training,Xuan-Wu Hospital has found 8 aspects,including leaders'attention and implement,process management,base construction,test assessment,24-hour system,guiding teacher system,rewards and punishment system,and scientific research were related to the quality of the resident standardized training.

The current medical education of the Feinberg school of medicine in Northwestern University:introduction and reflections / 中华医学教育探索杂志

The present article introduced the current medical education of the Feinberg School of Medicine in Northwestern University.Thmugh the comparisons on edueation system and carriculums design between United States of America and China,advices were made to the medical education in China.The article shed light on the current reform of medical education in China.

Risk factors and early indicators for misplacement of subclavian vein catheter into ipsilateral internal jugular vein / 中华临床营养杂志

Objective To identify the risk factors and early indicators for misplacement of subclavian vein catheter into ipsilateral internal jugular vein.Methods From August 2008 to July 2009,subclavian vein catheterization was successfully performed with Seldinger method in 167 patients in Department of General Surgery,Xuanwu Hospital of Capital Medical University.The paraeentesis side,pameentesis site,direction of puncture needle.and the perceptions of both patients and operators during catheter placement were recorded.The correlation of these factors,age,and gender with the misplacement of subclavian vein catheter into internal jugular vein was analyzed.Results Sixteen patients(9.58%)experienced misplacement of subclavian vein catheter into ipsilateral internal jugnlar vein,which was not significantly correlated with age(P=0.375),gender(P=0.259),paraeentesis side (P=0.175),or paracentesis site(P=0.061).Misplacement of subclavian vein catheter into internal jugular vein was significantly more frequent when the direction of puncture needle was toward the midpoint of suprasternal fossa and laryngeal prominence(P=0.002).When the paracentesis site was located at a point at the junction of medial one-third and lateral two-tllirds of the clavicle.it was more frequent that the puncture needle was toward the midpoint of suprasternal fossa andlaryngeal prominence(P=0.010).There were more misplacement events when the patients feel ears pain(P=0.000)and when the operator felt resistance when inserting gnidewire during catheter placement(P=0.000).Conclusions Misplacement of subclavian vein catheter into ipsilateral internal jugnlar vein occurs more frequently when the direction of puncture needle is towards the midpoint between suprasternal fossa and laryngeal prominence.Patients feel ears pain and operators feel resistance when inserting guidewire during catheter placement are early indicators of misplacement.

Determination of energy expenditure in mechanically ventilated patients / 中华临床营养杂志

Objective To investigate the energy expenditure of mechanically ventilated patients,compare the measured energy expenditure (MREE) with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors (PREE). Methods Twenty-four critically ill adult patients who were mechanically ventilated in the intensive care unit were enrolled in this study. Data during the 72 hours of mechanical ventilation were collected for computation of severity of illness. Resting energy expenditures were derived at 72hours after mechanical ventilation by indirect calorimetry. Predicted basal energy expenditure was obtained at the same time using the Harris-Benedict equation and predicted resting energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for illness. Results The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)scores and Marshall scores were 14 ± 5 and 6 ± 3, respectively. MREE and PREE were (6 793.64 ± 1 197.15) and (8 041.02 ± 1 971.54) kJ/day, respectively. There was no correlation between MREE and PREE (r2 = 0. 28, P = 0. 07), and the difference between MREE and PREE was statistically significant (t = 7.62, P = 0.04). No statistically significant correlations were observed between both MREE or PREE and APACHE Ⅱ score or Marshall score (r2 = 0. 14, P = 0. 08; r2= 0. 08, P = 0. 63; r2 = 0. 05, P =0. 65; r2 = 0.03, P = 0. 87, respectively). Conclusions In mechanically ventilated patients, the energy expenditure is not correlated with the severity of illness. The Harris-Benedict prediction modified with correction factors for severity of illness systematically overestimates the total energy expenditure.

Results of surgical skill assessment in general practitioners in Beijing / 中华全科医师杂志

Nine hundred and forty nine general physicians in Beijing urban area received surgical skill assessment in 2008.The assessment results of five surgical skills (taking out stitches,changing dressings,skin suture,knot with gloves and wearing isolation gown) were analyzed with the relations of different gender,age,educational background,professional title,specialty,hospital grade,length of service and times of test taking.The average score of the total assessment was 71.The score was lower in the practitioners who were male,older than 50 years,higher educational background,lower professional tide,more than 2 times of test taking,and who were specialized in traditional Chinese medicine,ophthalmology and otorhinolaryngology and emergency medicine.Results suggest that the levels of surgical skills in general practitioners are generally low and periodical training is needed.

Clinical study of insulin resistance for patients during elective abdominal surgery / 中国综合临床

Objective To investigate the relative factors of insulin resistance(IR)during elective abdominal surgery and the mechanism of IR induced by surgery.Methods Fourteen patients underging elective abdominal surgery were studied.Fasting blood glucose(FBG),fasting plasma insulin(FPI),plasma TNF-α,IL-6 and CRP were tested for elective surgery patients on the day before,during operation and on one day after surgery.Insulin resistance index(HOMA-IR)and the index of insulin secretion(HOMA-β)were ealculated with homeostasis model assessment(HOMA).Insulin receptor and GLUT4 mRNA expression in skeletal muscle were assessed before operation and at the end of operation by use of RT-PCR.Results Significant differences were found in fasting blood glucose (5.95±1.08)mmol/L vs(8.92±2.41)mmol/L,fasting plasma insulin(19.95±3.33)mU/L vs(25.44±5.36)mU/L,IL-6(33.98±5.01)ng/L vs(45.29±7.81)ng/L and plasma TNF-α(86.70±9.27)ng/L vs(114.46±15.33)ng/L during and after operation(P＜0.01).A significant elevation of HOMA-IR levels was found after operation compared with that before operation[(9.59±2.89)vs(4.111.86)](P＜0.001).However there wag no significant difference in HOMA-β among three points(groups)of time(P=0.103).The result of RT-PCR showed that the expression of GLUT4 in muscle of patients at the end of operation reduced significantly compared with preoperation(t=12.488,P＜0.001)but there was no significance in INSR mRNA expression(P=0.165).ISI showed negative correlation with opermive time(r=-0.736、P＜0.001),blooding during operating (r=-0.594、P=0.032)and post-operative TNF-α(r=-0.641、P=0.018).Conclusion Insulin resistance occurs in elective abdominal surgery patients.The defective site is at postreceptor.To shorten the operation time,control the intensity of surgery and reduce the bleeding is helpful for decreasing IR.

Clinical profiles of hyperlipidemic pancreatitis / 中华胰腺病杂志

event and treat circular,respiratory and renal insufficiency.

Effect of low-dose glucocorticoids in septic shock / 中华急诊医学杂志

Objective To study retrospectively the effects of low-dose glucocorticoids in outcomeof septic shock.Method The present stray was carried out by analysis of septic shock patients treated with norepinephrine or dopamine.A total of 46 patients with a confirmed diagnosis of septic shock admitted from January 2000 to October 2006 were divided into two groups:(1)ghcocorticoids treatment group(n=22),treated with glucocorticoids in addition to conventional treatment from November 2002 to October 2006;(2)conlrol group(n =24),only treated with routine treatment from January 2000 to October 2002.The differences in outcome were compared between the two groups.Results The duration of of vasopressor support was significantly shorter in treatment group com0~ed with control group.The percentage of shock reversal at 7 days was higher in treatment group than that in control group(72.73%vs.41.67%,P=0.034).Furthermore,a reduction in C-reactive protein(CRP)indicated inhibition of inflammatory response due to the effect of glucocorticoids in treatment group within 48-72 hours from admission to ICU(20.05±4.06 mg/dl vs.23.55±4.93 mg/dl,P=0.015).Therefore,APACHE Ⅱ score on 3rd day was significantly lower in treatment group than that in control group(16.76±4.87 vs.21.45±4.02,P=0.001).However,there were no statistical signifieances in the duration of mechanical ventilation,the length of ICU stay,the incidence of multiple organ dysfunction syndrome(MODS)and hospital-mortality between the two groups(P＞0.05).Conclusions Tmatmeut with low-dose gheocorticoids could effectively accelerate the recovery from refractory septic shock and the early withdrawal of vasopressor.It seems to be associated with the reduced production of CRP,suggesting the effects of low-dose glucocorticoids on both stabilization of hemodynamics and inhibition of inflammatory response.The beneficial effects of low-dose steroids regimens on long-term outconm of patients with septic shock have not determined.

Application of low-dose glucocorticoids In septic shock / 中国综合临床

Objective To study the role of low-dose glucocorticoids in improving prognosis and adjusting septic shock. Methods A total of 46 patients with a confirmed diagnosis of septic shock were retrospaetivley analyzed. 24 patients without glucocorticoids treatment were taken as control group; 22 patients with glucocorticoids as therapy group (n = 22). The two group received standard treatment for septic shock. Results The percentage of shock reversal on day 7 was higher in therapy group than that in control group (P <0.05). However,there were notstatistical significances in the duration of mechanical ventilation, the length of ICU stay, the incidence of multiple or-gan dysfunction syndrome (MODS) and mortality between the two groups (P > 0.05). Conclusion Low-dose glucocorticoids can effectively accelerate refractory septic shock reversal and vasopreasor withdrawal. This seems to be related to the reduced production of CRP but the beneficial effects of low-dose steroids regimens on long-term outcome have not yet be determined.

Clinical characteristics and treatment of severe hyperlipidemic pancreatitis / 中华全科医师杂志

Objective To summarize clinical characteristics and experiences in treatment of severe hyperlipidemic pancreatitis (SHLP). Methods A retrospective analysis for 22 cases of SHLP and 91 cases of severe acute biliary pancreatitis (SABP) hospitalized during January 1, 2000 to December 31, 2006 was carried out to compare their clinical characteristics and treatment outcomes. Results Activities of serum and urine amylase in SHLP patients at admission were (715 ± 99) and (382 ± 56) U/L, respectively, significantly lower than those in SABP patients (1551 ± 107) and (773 ± 66) U/L, respectively (P < 0.01). About 55% (12/22) of SHLP patients had pulmonary infection, 36% (8/22) with circulatory failure, 41% (9/22) with respiratory failure and 23 % (5/22) with renal failure, all significantly higher than those in SABP patients SABP [32% (29/91), 14% (13/91), 7% (6/91) and 5% (5/91), respectively, P < 0.01]. Two died of SHLP and 11 of SABP, respectively. Conclusions In diagnosis of SHLP, it should be noticed that no remarkable elevation of activities in serum and urine amylase usually, so during the course of treatment for SHLP, it is important to prevent and treat multi-organ failure, respiratory failure and renal failure in an active way.

Survey and analysis on the teaching of elective course: flow cytometry and its application to clinical medicine / 中华医学教育探索杂志

To explore the necessity of teaching of elective course:Flow Cytometry and its application to clinical medicine in medical students,sixty nine medical students including sevenyear program undergraduate,master and Ph.D candidates were surveyed with a community questionnaire. More than 95% students thought it was very necessary to set up the course because they knew little about the course and it would be very helpful in their future clinical and research work.