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ObjectiveTo investigate the status and influencing factors of medication adherence in patients with severe mental disorders in Zhengzhou， so as to provide references for the formulation of prevention and treatment measures for severe mental disorders. MethodsFrom March to June 2021， a stratified multistage cluster sampling method was applied to select 342 patients from the National Information System for Severe Mental Disorders in Zhengzhou. The general demographic data of patients were collected via self-designed questionnaire， and the medication status was investigated， then the influential factors were summarized. The differences in influential factors of medication adherence were compared between the medication adherence group and the medication non-adherence group. Thereafter， Logistic regression analysis was applied to explore the factors influencing medication adherence. ResultsA total of 320 patients were included in the final analysis， altogether 76.56% of patients （n=245） complied with medication. The differences between patients in the medication adherence group and those in the medication non-adherence group were statistically significant in terms of residence， occupation， and outpatient chronic disease reimbursement （χ2=14.015， 7.502， 13.106， P<0.05 or 0.01）. In the questionnaire of influential factors on medication adherence， there were statistically significant differences in the scores of lack of insight， stigma and drug-related factors between the two groups （Z=7.588， 2.379， 2.893， P<0.05 or 0.01）. Outpatient chronic disease reimbursement was a protective factor for medication adherence （OR=2.727， 95% CI： 1.320~5.634， P<0.01）， while rural residence （OR=0.465， 95% CI： 0.221~0.977， P<0.05） and lack of insight （OR=0.398， 95% CI： 0.286~0.553， P<0.01） were risk factors for medication adherence. ConclusionPatients with severe mental disorders in Zhengzhou have a high rate of medication adherence， moreover， the outpatient chronic disease reimbursement， lack of insight and residence may be influencing factors for medication adherence in patients with severe mental disorders.
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Objective:To investigate the occurrence and influencing factors of perioperative complications after robotic gynecologic surgery.Methods:The clinical data and occurrence of perioperative complications in 1 000 cases robotic surgery completed in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results:(1) Clinical data: the average age of the patients was (50.2±10.4) years old, and the average body mass index (BMI) was (24.4±3.6) kg/m 2. Among 1 000 cases, 811 cases of them were malignant tumors, including 405 cases of cervical cancer, 279 cases of endometrial carcinoma, 112 cases of epithelial ovarian cancer (EOC), 15 cases of vulvar cancer; 189 cases of them were benign diseases, including 43 cases of uterine prolapse, 57 cases hysterectomy of uterine leiomyoma and adenomyosis of the uterus ≥12 weeks, 84 cases myomectomy of uterine leiomyoma, and 5 cases of fallopian tubal ligation requiring anastomosis. Surgical methods: in patients with malignant tumors, cervical cancer, hysterectomy plus salpingectomy or salpingo-oophorectomy for stage Ⅰa1, and radical hysterectomy plus pelvic lymphatic dissection plus salpingectomy or salpingo-oophorectomy for stage Ⅰa2-Ⅱb. Endometrial carcinoma, performed by staging surgery. Staging surgery for EOC with early stage and cytoreductive surgery with advanced EOC. Vulvar cancer, extensive vulvar resection plus inguinal lymphadenectomy. In patients with benign diseases, uterine prolapse, hysterectomy plus salpingectomy or salpingo-oophorectomy plus sacrocolpopexy. Uterine leiomyoma or adenomyosis with uterus ≥ 12 weeks, hysterectomy plus salpingectomy or salpingo-oophorectomy. Myomectomy for patients requiring uterine preservation with uterine leiomyoma. Tubal anastomosis for patients with fallopian tubal ligation. (2) Surgical complications: intraoperative complications occurred in 25 patients (2.5%, 25/1 000), including 11 patients with vascular laceration, 11 patients with ureteral injury, 2 patients with bladder injury, and 1 patient with intestinal injury. Postoperative complications occurred in 130 patients (13.0%, 130/1 000), including 66 cases of lower limb venous thrombosis, 20 cases of lymphatic cyst, 8 cases of hydronephrosis, 9 cases of ileus, 16 cases with infection, 6 cases with genital fistula, 4 cases with trocar site herniation and 1 case with subcutaneous emphysema. The incidence of intraoperative complications was 3.1% (25/811) in malignant tumors and no case in benign diseases, the incidence rate in malignant tumors was significantly higher than that in benign diseases ( χ2=4.778, P=0.029). The incidence rate in cervical cancer (4.2%, 17/405) and EOC (3.6%, 4/112) were significantly higher than those in endometrial carcinoma (1.4%, 4/279) and vulvar cancer (0/15; P<0.05). The incidence of postoperative complications was 15.2% (123/811) in malignant tumors and 3.7% (7/189) in benign diseases. The incidence rate in malignant tumors was significantly higher than that in benign diseases ( χ2=17.807, P<0.01), but there were no significant difference among different malignant tumors ( χ2=4.318, P=0.229). (3) The correlative factors affecting the occurrence of surgical complications: patient′s age, BMI, previous pelvic or abdominal surgery history, the nature of disease (malignant or benign), operation time, and comorbidities had a significant impact on the incidence of postoperative complications ( P<0.05). Multivariate logistic regression analysis showed that the patient′s age ≥40 years old, BMI ≥25 kg/m 2, previous pelvic or abdominal surgery history, malignant tumors and comorbidities were independent influential factors of the postoperative complications ( P<0.05). Conclusions:Perioperative complications vary according to the type of the surgery. The age, BMI, previous pelvic or abdominal surgery history, malignant tumors, and comorbidities are influential factors of postoperative complications.
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Time-driven activity based costing is embraced in the healthcare sector for its correction of inherent defects of activity-based accounting. The authors constructed a two-level hierarchical cost accounting model for medical service items based on the time-driven ABC. The first-level hierarchical cost is calculated down to the department level in line with cost management regulations of the hospital financial system, while the second-level cost allocation is based on " time" as the basic sharing criterion, which is collected and assigned to specific medical service items with the activity content and process as carriers. The standard cost and actual cost of comparable medical service projects are calculated respectively by means of introducing the concept of socially necessary labor-time, which provides a scientific and feasible management method for evaluating the performance of medical service items.
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To explore the optimized dispatch of the rescue resources based on the mastered resources informa-tion. The objective function was set as the shortest rescue time, and 0-1 programming models were established and solved for the conditions that the number of medical rescue units was more or less than needed by the missions. In the two conditions, the model's calculated results were both optimal, and could be used to obtain the optimal dispatch solutions while the medical rescue time was the shortest. The 0-1 programming model can be effectively used to optimize dispatch strategy for medical rescue team.
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Objective To explore the clinicopathological characteristics in young women with breast cancer.Methods The clinicopathological data of 201 cases of breast cancer with age below 35 years from Apr.1997 to Apr.2010 in Anyang Tumor Hospital were retrospectively analyzed and compared with those of 251 cases of breast cancer patients selected randomly with age more than 60 years during the same period.All these cases had undergone surgical treatment and been confirmed by pathologist.Results In the young group,the percentage of patients with the course of disease less than six months was higher than that of the old-aged group [82.09 ％ (165/201),72.11％ (181/251)] (x2 =6.19,P ＜ 0.05).The incidence of the tumor size ≤ 2 cm in the young group was less than that of the old-aged group [19.90 ％ (40/201),30.28 ％ (76/ 251)] (x2 =6.302,P ＜ 0.05).The incidence rate of metastasis of lymph nodes in the young group was less than that of the old-aged group [63.68 ％ (128/201),54.19 ％ (136/251)] (x2 =4.145,P ＜ 0.05).The incidence rate of stage 0～ Ⅰ in the young group was more than that of the old-aged group [11.94 ％ (24/201),17.53 ％ (44/251)] (x2 =2.729,P ＞ 0.05).Conclusion The tumor size in the young group is larger than that in the old-aged group,pTNM classification in the young group is later than that in the latter group and the incidence rate of metastasis of lymph nodes in the young group is higher than that in the latter group.In young patients with breast cancer the percentage of tumors with advanced tumor stage and poor prognosis are more than that in elder breast cancer patients.In addition,these young patients have lower awareness to mammary adenocarcinoma.Young ladies should examine breast cancer by themselves and go to hospital for regular inspections in order to discovere,diagnose and treat cancer earlier.
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Astragalus polysaccharide (APS)was applied to treat rat model of type 2 diabetes mellitus.Blood glucose and insulin, the activity of PKB/Akt and translocation of GLUT4 in skeletal muscle of rats were examined. Results showed that AIMS decreased blood glucose, which may be related with increasing sensitivity of insulin, activity of PKB/Akt and transloeation of GLUT4 in the skeletal muscle tissue.
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Objective To investigate the effect of infiltrated mast cells on the biological characteristics of uterine carcinoma.Methods Twelve leiomyomas,ten uncertain malignant uterine leiomyomas,and seven uterine leiomyosarcomas were studied with light microscopy for the morphometry about their histological feature,mast cell particle and factor Ⅷ-related antigen(FⅧRAg);Cell apoptosis was measured by flow cytometry.The correlative analysis was carried out between the mast cell and others factors.Results Comparing with smooth muscle tumors of uncertain malignant potential(4209.9?273.0),the count of tumor cell was the highest in leiomyosarcoma(3557.6?346.3)(P
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Through making a summary of using the portable X-ray machine in the earthquake relief,the equipment of the advantages and disadvantages in the field are analyzed and introduces the problems and solutions in application,and gives some improved suggestions for tripod.
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Objective: The aim of this study is to compare the clinical data and result between transcatheter closure and surgical repair for the treatments of secundum ASD in patients above 50 years old, and explore the indications for these two methods. Methods: From January 1998 to December 2003, 53 patients with surgical repair and 42 patients with transcatheter closure were enlisted according to the diagnosis of ASD. The ages of all of cases were above 50 years old. The interventional approach was administrated with Amplatzer device. The surgical approach mended the defect directly or with autologous pericardium. These patients were followed up by echocardiography (Echo). The clinical data including the diameter of the right ventricle (RVD), the pulmonic flow velocity, the pulmonary pressure and the tricuspid valve regurgitation. Results: In surgery group, surgical mortality was 1 9% (1/53). Cerebral embolism occurred in 4 (7 5%) patients. Pericardial effusion and other complications occurred in 24.5%. All 42 patients with ASD were effectively closed with Amplatzer occlude. One occluder displaced and moved into pulmonary artery on the fourth day after the treatment. The short term effective rate was 97 6% in transcatheter closure group. The diameter of ASD showed by Echo was significantly less in patients treated with transcatheter closure than that in surgical repair group. The hospitalization time was significantly less in patients treated with transcatheter closure. The follow up data recorded decreased load of right ventricle, the decreased diameter of right ventricle as well as the relief of pulmonary artery hypertension. Conclusion: The data suggested that of surgical approach of ASD has a wider indication for patients in different stages of the disease, whereas surgical morbidity may increase in elderly patients due to their pre existed diseases. However, the transcatheter closure for ASD is feasible for patients with smaller defects.
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Objective: To summarize the experience of valve replacement for multiple valve insufficiency in patients with giant left ventricle and the operative indication. Methods: Multiple valvular operations were performed in 62 patients with giant left ventricle between 1991 and 2002. Combined mitral and aortic valve replacement was performed in 56, tricuspid valve annuloplasty in 43, left atrium placation surgery in 12, and mitral valve replacement in 5. Results: The early postoperative complication and mortality rate were 45.2% and 17.7%, respectively .The late mortality rate was 6.5%. The main factors influencing the early surgical results were preoperative severe left ventricular enlargement (ESD ≥6.0cmand EDD ≥8.0cm) and systolic dysfunction (EF ≤0 40 and FS ≤0 25), perioperative ventricular fibrillation, postoperative low cardiac output and multiple organal failure. The main factors affecting long term survival were postoperative severe ventricular arrhythmia and left ventricular enlargement with depressed systolic performance. Conclusion: The keys to improve the early and late results of multiple valve replacement in these patients with giant left ventricle are the choice of optimum surgical timing, the proper management of the high risk factors mentioned above during perioperative and follow up periods.
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Objective: To evaluate the mitral, aortic and tricuspid valve replacement for rheumatic heart disease. Methods: From June 1990 to June 2001, 941 patients underwent valve replacement. Among them, 24 patients underwent simultaneously mitral, aortic and tricuspid valve replacement. There were 17 females and 7 males, with mean age of 36 years (ranged from 18 to 59 years). Eight patients had previous closed mitral valvotomy. Eleven patients complicated with left atrium thrombus, 16 with hapotomeglia, and 8 with ascites. The X ray results showed that the C/T ratio was 0.66 to 0.91. The heart function (NYHA) was class III in 9, and class IV in 15. All patients had combined mitral, aortic valve lesions associated with severe tricuspid valve regurgitation. Results: One patient died postoperatively with an operative mortality of 4.2%. 23 patients followed up from 20 to 36 months (mean, 26.4 months). There was no thrombolism and anticoagulant related hemorrhage. The echocardiography demonstrated the diameter of left atrium right ventricle, and LVDd significantly decreased after operation. The heart function was also significantly improved. Conclusion: The combination of mitral, aortic and tricuspid valve replacement could achieve a satisfactory result with low mortality and better recovery of heart function.
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Objective To evaluate the outcomes of one-stage repair of aortic coarctation (CoA) and associated cardiac anomalies in infants through a midline sternotomy. Methods Between June 2002 and August 2005, 36 patients (27male, 9 female) underwent surgery for CoA. The age was from 18 days to 8 years[mean (14.3?9.5) months], 27 patients (75%) were younger than 1 year and 18 patients (50%) were younger than 3 months. The body weight was from 3.0 to 23 kg [mean(6.6?3.0)kg]. 27 patients were symptomatic infants and 8 patients were asymptomatic of adults. One patient had recoarctation after repair through a left thracotomy one year ago. The associated cardiac anomalies included ventricular septal defect, patent ductus arteriosus, secundum atrial septal defect, hypoplasia of the aortic arch, transposition of great arteries and subaortic stenosis. 36 cases underwent one-stage operation of extended end-to-end anastomosis through a midline sternotomy. Results One patient died postoperatively with a mortality of 2.8 %. The cause of death was heart and lung function failure. 35 cases were followed up from 4 months to 3 years .One late death occurred. 34 cases were in good condition and no recoarctation. Conclusion Outcomes of one-stage repair of CoA and associated cardiac anomalies in infants through a midline sternotomy is excellent. Technique of extended end -to-end anastomosis may potentially reduce the incidence of recoarctation.
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Objective To study the changes of nitric oxide synthase in placenta during fetal cardiac bypass. Methods Eight pregnant ewes (gestation 120～140 d)were divided equally into control group and bypass group. Bypass group underwent fetal cardiac bypass with centrifugal pump and placenta. Fetal hemodynamic date and blood gas value were recorded before and after bypass. Placenta vascular resistance was calculated. Fetal serum nitric oxide (NO), serum endothlin-1(ET-1) and nitric oxide synthase (NOS) of placenta tissue were assayed. Transcriptions of endothelial NOSmRNA in placental tissue were assayed with RT-PCR technique. Results Acidosis and pressure of oxygen decreased after bypass appeared in fetal lamb of bypass group. Placenta vascular resistance of bypass group elevated significantly (P
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Objective To analyze the causative of damaged bioprosthetic valves implanted in 41 patients (with total 47 valves) over one year. Methods From June 1993 to June 2004,re-replacement of valves was performed in 41 patients with dysfunctional bioprosthetic valves. The interval between the two operations was 1～16 years [mean (9.7?4.1) years]. The 47 dysfunctional bioprosthetic valves were carefully observed and pathologically examined. Results Of the 47 valves, no valve frame was damaged; tear or perforation existed in 42 valves (89.3%); calcification was found in 35 valves (74.5%), with fibrosis; excrescence and thrombus coexisted in 2. Heavily damaged ones were sent for pathological examination, and infiltration of abundant phagocytes and monocytes was found. Conclusion Early damages were mainly tear or rupture, while late damages were compound outcomes of multiple damaging factors such as calcification, rupture, and tear.
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Objective To evaluate the results of direct anastomosis between the main pulmonary artery and right ventricle in the repair of complex congenital heart disease. Methods Between March 2001 and June 2004, seventeen patients with complex congenital heart disease underwent direct anastomosis between the main pulmonary artery and right ventricle. Among them, eleven patients were under 3 years old. Six patients had pulmonary atresia and ventricular septal defect (VSD), 4 had transposition of the great arteries and VSD, 4 persistent truncus arteriosus and 3 TOF with coronary artery straddling RVOT. Twelve patients underwent one stage complete corrective repair and 5 patients received staged procedures. Results There was 1 operative death with hospital mortality of 5.9%. Three out of 5 staged patients succeeded in the second corrective repair. At follow-up ranging from 1 to 40 months, all patients were growing well and their heart function were in NYHA class 0 or I. Conclusion Direct anastomosis between the main pulmonary artery and right ventricle can provide good results in the repair of certain complex congenital heart disease, especially in infant patients without suitable homograft.
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Objective To evaluate the effects of controlling arterial oxygen partial pressure (PaO 2) at the beginning and during cardiopulmonary bypass (CPB) on cyanotic myocardial protection. Methods 40 Children suffering from tetralogy of Fallot(TOF) under 3 years of age with SpO 2
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Objective: The experiment was designed to evaluate the in vitro creation of tissue engineered heart valve leaflets. Methods: Aortic artery was harvested from 6 hybrid young pigs. The endothelial and myofibroblast cells were isolated and cultured to get enough cells for seeding. The myofibroblast and endothelial cells were seeded on the scaffolds sequentially. The cellular scaffolds were cultured 28 days and sent for scanning electron microscopy (SEM), histological and hydroxyproline examination. Results: SEM showed that a large amount of cells attached on the scaffolds. The cell had covered a large area of scaffold with a lot of matrix synthesized. The HE stain showed large amount of cells growing on the scaffolds and some cells were found in the central part of scaffolds. Gomori stain showed that there was elastin synthesized on the scaffolds. Hydroxyproline content is (10.93?2.89) ?g/g (scaffolds). Conclusion: With vascular cell, it is possible to seed them onto biodegradable scaffolds and create a viable tissue-engineered heart valve leaflets in vitro.
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Objective: To study the long-term effects of mitral valve replacement with bioprostheses in rheumatic heart valve disease. Methods: 166 patients with rheumatic heart valve disease underwent isolated mitral valve replacement from Jan.1978 to Dec.1985. 79 Patients were male and 87 female. Patients' age ranged from 11 to 53 years[mean (29.4?9.9) years]. The patients were classified into two groups: group 1(age
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Objective To summarize the experience of radical treatment of tetralogy of fallot in adults.Method Between Nov. 1985 and May 2005,115 patients over 18 years of age with tetralogy of fallot underwent total surgical correction.Longitudinal or oblique right ventriculotomy was used to ensure complete release right ventricular outflow obstruction and complete ventricular septal defect closure.Transannular patches were used in 74 patients,right ventricular outflow tract(RVOT) patches in 37 cases,primary closure of right ventricle in 5 cases,respectively.One patient had separate pulmonary main artery and RVOT enlargement.Results Seven patients had residual septal defect and 3 cases suffered from residual RVOT obstruction.Severe cardiac output syndrome occurred in 10 patients and 6 patients died early postoperatively with the mortality rate of 5.22%.Conclusion By careful surgical management,the treatment of total correction in adult patients may result in good effectiveness.
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Objective: To investigate the possible pathogenesis and report the postoperative results of the late tricuspid regurgitation (TR) after left cardiac valve replacement. Methods: 56 patients developed severe TR after left cardiac valve replacement, including 10 patients with normal prosthesis valve function (group A) and 46 patients with prosthesis valve dysfunction (group B). Four patients underwent mitral valve replacement (MVR) and 6 patients underwent mitral and aortic valve replacement (DVR) in group A. In group B, 36 patients received MVR, 4 aortic valve replacement (AVR) and 6 DVR. Ten patients underwent tricuspid De Vega annuloplasty and 46 patients' tricuspid valves were normal during the initial operation. The surgical treatment of tricuspid valve included tricuspid valve replacement (TVR) in 9 and tricuspid valve plasty (TVP) in 47 at the second operation. Results: Two patients died postoperatively with hospital mortality of 3.6%. The 54 survivors were followed up from 6 to 132 months, mean 79.4 months. The heart function improved significantly in 8 after TVR and 40 after TVP. However, echocardiography showed moderate TR in 5 and severe TR in 1 patient after TVP and medical treatment was needed. Conclusion: The sustained pulmonary hypertension, irreversible right heart impairment, resumption of left ventricular function and sustained atrial fibrillation may be responsible for the development of late TR after left cardiac valve replacement. TVR may achieve a reliable result for severe functional TR and rheumatic tricuspid valve lesion. In some patients with TVP during the follow up, the TR might become more serious.