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Objective:To analyze the status quo and influencing factors of non-alcoholic fatty liver disease in community-dwelling elderly women.Methods:A total of 9 754 female residents aged 60-79 years who attended health check-up in Anting Town Community Health Service Center from June 2019 to December 2021 were enrolled in the study. According to the ultrasound diagnosis, there were 5 220 cases of non-alcoholic fatty liver disease (NAFLD group) and 4 534 cases without NAFLD (non-NAFLD group). The general information, physiological and biochemical indicators were compared between two groups with Mann-Whitney U test and Chi-square test; the influence factors of NAFLD were analyzed with logistic regression. Results:The overall prevalence of NAFLD was 53.52%(5 220/9 754), prevalence in the 65-69 age group was the highest and that in the 75-79 age group was the lowest. Body mass index ( Z=47.667), waist circumference ( Z=45.949), waist-to-hip ratio ( Z=30.805), systolic blood pressure ( Z=7.543), diastolic blood pressure ( Z=7.621), fasting blood glucose ( Z=20.298), glycated hemoglobin ( Z=23.588), alanine aminotransferase ( Z=29.624), aspartate aminotransferase ( Z=7.824), total bilirubin ( Z=4.441), triglyceride ( Z=34.597), low-density lipoprotein cholesterol ( Z=2.476) and blood uric acid ( Z=29.934) levels of NAFLD group were significantly higher than those in non-NAFLD group (all P<0.05); the mean age ( Z=-3.885) and high density lipoprotein cholesterol ( Z=-23.553) in NAFLD group were significantly lower than those in non-NAFLD group (all P<0.001); there were no significant differences in the levels of total cholesterol ( Z=1.762)and creatinine ( Z=1.453) between the two groups (all P>0.05). The proportion of patients had type 2 diabetes mellitus ( χ2=368.395), hypertension ( χ2=208.503), hypertriglyceridemia ( χ2=883.831), hyperuricemia ( χ2=228.562), central obesity ( χ2=1 506.580), high risk of stroke ( χ2=605.322) and high risk of ASCVD ( χ 2=309.434) in NAFLD group were significantly higher than that of non-NAFLD group (all P<0.001). Logistic regression analysis showed that age ( OR=0.937, 95% CI: 0.928-0.946), body mass index ( OR=1.224, 95% CI:1.194-1.255), waist circumference ( OR=1.072, 95% CI: 1.062-1.082), glycosylated hemoglobin ( OR=1.348, 95% CI: 1.275-1.426), alanine aminotransferase ( OR=1.032, 95% CI: 1.026-1.037), triglyceride ( OR=1.757, 95% CI: 1.646-1.875) and serum uric acid ( OR=1.004, 95% CI: 1.004-1.005) levels were the influencing factors for NAFLD in elderly women (all P<0.001). Conclusion:The prevalence rate of non-alcoholic fatty liver disease in the community-dwelling elderly women is high, which are associated with multiple influencing factors.
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From November 2020 to November 2021, the TEST(Task-Experience- Supervise-Thinking) teaching model was adopted for general practice residency training in teaching clinic of Changfeng Health Service Center of Shanghai Putuo district. The satisfaction of mentors, residents and patients was surveyed with self-assessment questionnaire. The satisfaction scores of mentors, residents and patients were (79.89±0.40), (79.96±0.19) and (49.92±0.40). The adaption of model TEST in teaching clinic is more effective in training of clinical competency, communication ability, management ability and narrative ability for general practice residents. It is also beneficial for mentors to upgrade their teaching ability, as well as for patients to improve their experience and satisfaction for seeking medical service. It is worth popularizing in the community practice base of general resident training.
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Objective To investigate the expression of Pin1 protein in HepG2 cells under endoplasmic reticulum stress (ERS) and its effect on cell proliferation and apoptosis. Methods The THLE3 cells were treated with tunicamycin (TM) (TM group) or DMSO (DMSO group) for 48h. The HepG2 cells were treated with TM (TM group), ATRA(ATRA group), TM+ATRA (TM+ATRA group) or DMSO (DMSO group) for 48h. The protein levels of Bip and Pin1 were detected by Western blot, cell proliferation was detected by CCK-8 assay, and cell apoptosis was detected by flow cytometry. Results The expression of Bip both increased in THLE3 and HepG2 cells treated with TM, indicated that TM effectively induced ERS in cells. Compared with the DMSO group, the protein level of Pin1 in THLE3 cells in TM group was decreased with the increasing of TM concentration (P < 0.001). In TM+ATRA group, with the increasing of TM concentration, the expression of Pin1 was decreased in HepG2 cells (P < 0.01). The inhibitory rates was (29.33±4.73)% in HepG2 cells in TM group, significantly lower than (60.33±2.08)% in THLE3 cells in TM group (P < 0.001). In TM+ATRA group, the growth inhibition rates was increased to (60.33±6.03)% in HepG2 cells. The apoptosis rate of THLE3 cells in TM group was (22.25±0.78)%, significantly higher than (3.57±0.31)% in DMSO group (P < 0.01). The apoptosis rates of HepG2 cells in ATRA group and TM+ATRA group were significantly higher than that in the DMSO group ((10.03±0.49)% vs. (5.10±1.00)%, P < 0.05 and (23.70±0.75)% vs. (5.10±1.00)%, P < 0.01). Conclusions HepG2 cells resist ERS-induced apoptosis by maintaining Pin1 protein level. Reducing the protein level of Pin1 can significantly inhibit the cell proliferation and induce apoptosis.
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Objective:To explore the effect of family doctor-specialist dual-contract service model on the management of type 2 diabetic patients in the community.Methods:Two hundred patients with type 2 diabetes mellitus (T2DM)who were treated in Changfeng Community Health Service Center between February 2019 and January 2021 were selected as the study objects by cluster sampling method. Patients were randomly divided into study group and control group with 100 cases in each group. The control group was managed with the conventional family doctor contract service, and the study group was managed with the family doctor-specialist double contract service. After one year of management, the fasting blood glucose, 2 h-postprandial blood glucose, glycosylated hemoglobin, diet control, blood glucose monitoring, medication compliance, exercise and other health behaviors, quality of life and satisfaction of patients were compared between two groups.Results:After intervention, fasting blood glucose, 2 h-postprandial blood glucose and glycosylated hemoglobin in the study group were significantly lower than those in the control group ( t=10.29, 8.49, 7.99, all P<0.05); the health related behaviors such as diet control, exercise behavior, blood glucose monitoring, and medication compliance in the study group were significantly better than those in the control group ( t=9.78, 6.72, 39.81, 7.88, all P<0.05); the quality of life in patients of study group was higher than that of the control group ( P<0.05); the satisfaction rate in study group was higher than that of control group (90.0% vs. 69.0%, χ 2=6.39, P=0.031). Conclusion:Compared with conventional family contract service model, the double contract service improves patient self-management, helps to reduce the blood glucose level and gains high patients′ satisfaction, which is worth promoting and applying in the management of type 2 diabetic patients in the community.
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Objective:To analyze the risk factors of non-alcoholic fatty liver disease (NAFLD) among elderly residents in the community.Methods:A total of 1 894 patients aged 60-75 years with NAFLD visiting general practice clinic from March 2016 to March 2018 were enrolled in the study; 1 894 age and sex-matched subjects without NAFLD served as the control group. The data of gender, age, smoking status,body mass index (BMI), waist circumference, blood pressure, blood biochemistry,past medical history and other clinical and laboratory testing were collected in the two groups. Multivariate logistic regression analysis was performed to explore the related risk factors of NAFLD.Results:The BMI [(27±3) kg/m 2vs.(24±3) kg/m 2, t=-26.139], waist circumference [(89±8) cm vs.(82±8) cm, t=-24.398], heart rate [(75±11) bpm vs. (74±11) bpm, t=-2.370], and diastolic blood pressure [(87±10) mmHg vs. (85±10) mmHg(1 mmHg=0.133 kPa), t=7.898] in the NAFLD group were significantly higher than those in the control group(all P<0.05). The levels of fasting blood glucose (FBG) [(5.9±2.0)mmol/L vs. (5.3±1.5) mmol/L, t=10.438], glycated hemoglobin (HbA1c) [(6.2±1.2)% vs. (5.9±0.9)%, t=11.654], alanine aminotransferase (ALT)[(24±16) mmol/L vs. (18±15) mmol/L, t=11.915], aspartate aminotransferase (AST) [(23±11) mmol/L vs.(22±13) mmol/L, t=4.300], blood uric acid (UA) [(342±84) mmol/L vs. (307±80) mmol/L, t=13.189], total cholesterol (TC) [(5.3±1.1) mmol/L vs. (5.1±1.0) mmol/L, t=6.073], triglycerides (TG)[1.71(1.29,2.35) mmol/L vs. 1.17 (0.91,1.57) mmol/L, Z=37.261], and low-density lipoprotein cholesterol (LDL-C)[(3.4±0.9) mmol/L vs. (3.2±0.9) mmol/L, t=6.984] in NAFLD group were significantly higher than those in the control group (all P<0.01); and the levels of blood creatinine (Cr) [(70±17) mmol/L vs. (71±18) mmol/L, t=-2.712] and high-density lipoprotein cholesterol (HDL-C) [(1.3±0.3) mmol/L vs. (1.5±0.4) mmol/L, t==-16.726] in NAFLD group were significantly lower than those in the control group (all P<0.01). The proportion of people with hypertension [53.8% (1 019/1 894) vs. 43.4% (822/1 894)], type 2 diabetes [16.7%(317/1 894) vs. 11.3%(214/1 894)], metabolic syndrome [48.3% (915/1 894) vs. 18.0% (341/1 894)] in NAFLD group was significantly higher than that in the control group (χ 2=41.013, 23.237, 392.446, P<0.01). Logistic regression analyses revealed 13 independent risk factors of NAFLD, including 60-75 years-old female ( OR=2.348, 95 %CI: 1.917-2.876, P<0.01), high BMI ( OR=1.143, 95 %CI: 1.099-1.189, P<0.01), elevated TG ( OR=1.894, 95 %CI: 1.716-2.090, P<0.01), LDL-C ( OR=3.066, 95 %CI: 2.359-3.983, P<0.01) and HbA1c ( OR=1.276, 95 %CI: 1.175-1.386, P<0.01). Conclusion:The factors associated with NAFLD are complicated; and corresponding measures targeting the risk factors should be taken to reduce the occurrence and development of NAFLD among elderly people in the community.
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Objective To evaluate the effect of intensive hypertension management model for patients with uncontrolled blood pressure in community.Methods Three hundred and seven hypertensive patients,whose blood pressure was not controlled with administration of two or more kinds of antihypertensive drugs,entered in the intensive management program from May 2015 to December 2017.Using calcium channel blockers,angiotensin converting enzyme inhibitors or angiotensin receptor blockers and diuretic as the primary scheme,the medication was adjusted by general practitioners under the guidance of specialists in tertiary hospitals.The "seamless" two-way referral between community and tertiary hospitals was implemented,and the blood pressure control,medication and adverse effects were analyzed.Results Among 307 patients,157 were males (51.1％) and the mean age was (65.0±8.6) years.There were 246 (80.0％)patients with moderate and severe hypertension 44 (14.3％) patients complicated with diabetes,and 63(20.5％) patients having comorbidities,and the patients with high risk or extremely high-risk accounted for 85.0％ (261/307).Through (3.97± 1.21) months (1-6 months) intensive management,systolic blood pressure decreased from (167.56±16.73)mmHg(1 mmHg=0.133 kPa) in the baseline to (132.79±11.24)mmHg (t=33.34,P＜0.01),and diastolic blood pressure from (95.34± 12.59) mmHg to(79.11 ±7.85) mmHg (t=23.67,P＜0.01),blood pressure control rate was 75.6％(232/307).No serious adverse reactions occurred.During the period 42 patients were referral to hospital through green channel with a referral rate of 13.7％,and six patients were diagnosed as secondary hypertension.Angiotensin receptor antagonists and calcium antagonists were the main antihypertensive drugs.After intensive management patients taking three or more antihypertensive drugs increased by 158 and those taking diuretics increased by 116.Conclusions The intensive management model is effective in patients with uncontrolled blood pressure in community.Early use of C+A,A+D,and A+C+D treatment schemes for uncontrolled patients in the community can improve the rate of reaching the target and is safe.
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Objective To evaluate the effects of the non-supine position and the supine position during the second stage of labor on delivery outcomes.Methods In total,642 singleton term primiparas in the Fourth Hospital of Hebei Medical University between January 2013 and March 2014 were divided into the non-supine position group (n=320),which included the lateral (n=204) and hands-and-knees position (n=116),and the supine position group (n=322) according to primipara's choice.Delivery outcomes in the two groups were compared using the Student's t test,Mann-Whitney rank sum test and the x2 test.Results The incidence of caesarean section was similar in the non-supine position and supine position groups [0.9％(3/320) vs 1.9％ (6/322),x2=0.438,P=0.508].Compared with the supine position group,women in the non-supine position group had a higher incidence of perineal lacerations grede Ⅰ [85.2％ (270/317) vs 65.2％ (206/316),x2=33.884],longer duration of the second stage of labor [48.0 min (31.0-78.0 min) vs 41.0 min (25.0 67.3 min),Z=-3.066] and greater blood loss after 2 hours of labor [240.0 ml (200.0-287.5 ml) vs 210.0 ml (160.0-260.0 ml),Z=-3.736],but a significant reduction in posterolateral episiotomies [5.3％(17/317) vs 23.4％ (74/316),x2=41.908],perinealedema [13.6％ (43/317) vs 21.2％ (67/316),x2=6.430] and meconiumstained liquor [20.8％ (66/317) vs 33.2％ (105/316),x2=12.356] (all P＜0.05).In the non supine position group,fetal heart rate showed fewer early decelerations,variable decelerations and late decelerations than in the supine position group [10.1％ (32/317) vs 17.1％ (54/316),x2=6.593; 2.8％ (9/317) vs 6.6％ (21/316),x2=5.079; 3.2％ (10/317) vs 7.6％ (24/316),x2 6.139; all P＜0.05,respectively].Conclusions The non supine position during the second stage of labor may improve delivery outcomes.
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Objective To investigate the level of self-perceived burden(SPB) and analyze the influencing factors in continuous ambulatory peritoneal dialysis(CAPD) patients.Methods One hundred and ten CAPD patients were investigated by a self-designed demographic questionnaire and Self-Perceived Burden Scale (SPBS).Results The total score of SPBS was (30.27±7.88) points,being in a middle level,and 85.45％ of the patients showed different levels of burden.Single factor analysis showed the influencing factors of self-perceived burden were marital status,family per capita income,the main caregivers and selfcare ability.Conclusions Most CAPD patients have obvious self-perceived burden,nursing staff should use the relevant nursing measures to reduce the SPB with CAPD patients and improve their quality of life.
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ObjectiveTo evaluate the expression of heat shock protein in child asthma patient and investigate the risk factors of child's asthma. MethodPatients with clinical data of pediatric asthma history from outpatients department in Wuhan fifth hospital and follow up data were selected. The analysis of interrelated element was used with conditional logistic regression. ResultThe result of logistic analysis demonstrated that asthma was related with these risk factors, including history of upper respiratory infection, changes of weather, individual history of sensitive disease, family history of sensitive disease and heat shock protein. Fierce sports, factors of diet, passive smoking, and etc. Were not related to the degree of danger of asthma in this study. ConclusionHistory of upper respiratory infection, changeable weather, individual history of sensitive disease, family history of sensitive disease and heat shock protein were related with the degree of asthma. It should be helpful to treat asthma with continued propagation and education to advocate standardized treatment.
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Objective To study the effect of CO2 pneumoperitoneum on the anti-apoptotic capability of gallbladder carcinoma cell line (GBC-SD).Methods The CO2 pneumoperitoneum was established in vitro.After GBC-SD cells were exposed to CO2 pneumoperitoneum at 12 mmHg for 1,2,3,4 h,the expressions of survivin mRNA was examined by RT-PCR.The untreated GBC-SD cells served as control.Results Under a pressure of 12 mmHg,the expressions of survivn had an increasing tendency with the exposure time.Conclusions Under certain pressure and within certain exposure time,CO2 pneumoperitoneum could improve anti-apoptotic capability of GBC-SD cells,which may be one of the mechanisms of the promoting effect of carbon dioxide pneumoperitoneum on malignant cell growth.