Coefficient of variation of heart rate and blood pressure in rapid identification of children with suspected orthostatic intolerance / 中华儿科杂志

Objective: To investigate the clinical value of coefficient of variation of heart rate and blood pressure in rapid identification of children with suspected orthostatic intolerance(OI). Methods: This was a retrospective study. The medical records of 379 children with OI were collected, who were admitted to the Department of Pediatrics of Qilu Hospital of Shandong University from January 2015 to January 2020. Another 20 out-patient children without syncope or syncope aura were selected as control. According to the results of standing test and head-up tilt test (HUTT), all the patients with OI were divided into the following 4 groups: vasovagal syncope (VVS) group, postural tachycardia syndrome (POTS) group, POTS combined with VVS (POTS+VVS) group and HUTT negative group. Then, coefficient of variation of systolic pressure (SBPCV), coefficient of variation of diastolic pressure (DBPCV) and coefficient of variation of heart rate (HRCV) in standing test and HUTT were calculated. Kruskal-Wallis test was used for comparison among the five groups, and Dunnett's T3 method for comparison between two groups. Paired t test was used to compare the coefficient of variation between supine and erect position and tilt position in each group. The predictive values of HRCV,SBPCV and DBPCV for negative HUTT were evaluated by receiver operating characteristic (ROC) curve. Results: Among the 379 children, there were 79 in HUTT negative group, 208 in VVS group, 52 in POTS group, and 40 in POTS+VVS group. The SBPCV of supine-erect position of the control group, HUTT negative group, VVS group, POTS group, POTS+VVS group were (3.8±1.0)%, (5.3±2.2)%, (6.6±3.4)%, (5.9±3.6)%, (6.9±2.8)%, respectively. Similarly, the SBPCV of supine, erect and head-up tilt position were (4.5±0.8)%, (6.0±1.9)%, (7.1±2.6)%, (6.0±2.1)%, (7.3±2.5)%; the DBPCV of supine-erect position were (7.3±1.2)%, (9.1±3.7)%, (9.1±4.9)%, (9.1±4.8)%, (11.6±4.6)%; the DBPCV of supine, erect and tilt position were (7.4±1.1)%, (9.4±2.9)%, (10.1±3.8)%, (9.2±3.3)%, (11.0±4.7)%; the HRCV of supine-erect position were (7.6±2.6)%, (12.9±3.7)%, (16.2±4.3)%, (21.2±5.9)%, (24.9±5.3)%; and the HRCV of supine, erect and tilt position were (8.1±1.6)%, (10.1±2.7)%, (14.1±4.3)%, (15.6±3.7)%, (18.9±4.0)%, respectively. All the indexes showed significant differences among the five groups (χ2=21.91, 25.47, 19.82, 14.65, 104.52, 92.51, all P<0.05). ROC curve analysis showed that when the SBPCV and HRCV of supine-erect position reached 4.4% and 10.5%, the area under the curve of ROC were 0.713 and 0.877, the sensitivity of predicting negative HUTT were 58.2% and 78.5%, and the specificity were 80.0% and 95.0%, respectively. Conclusions: Coefficient of variation of heart rate and blood pressure may serve as potential diagnostic indexes in evaluating autonomic function of OI patients. SBPCV ≥ 4.4% or HRCV ≥ 10.5% of supine-erect position could be an indication of HUTT.

China′s strategy and experience in preventing and controlling the local spreading and epidemic of COVID-19 / 上海预防医学

After implementing a series of prevention and control strategies of Corona Virus Disease 19(COVID-19), China′s local epidemic situation has been basically blocked.While China has achieved a periodic success, global pandemic situation is still serious.Together with the timeline of China′s epidemic prevention and control this study reviewed the main strategies and measures in response to COVID-19 epidemic from Dec.2019 to Mar.23, 2020, and summarized China′s prevention and control plans and experiences.We hope all countries could fully understand the importance of non-pharmaceutical public health interventions, make positive and effective adjustments to the measures and strategies of prevention and control based on their own national conditions.

Strategy of acetabular anteversion in total hip arthroplasty with lumbar degenerative kyphosis / 中国骨伤

OBJECTIVE@#To investigate how to place the anteversion of acetabular prosthesis more reasonably in patients with lumbar degenerative kyphosis.@*METHODS@#A total of 122 patients with degenerative kyphosis of lumbar spine who underwent total hip arthroplasty from December 2017 to October 2019 were included and divided into experimental group and control group, 61 cases in each group. In experimental group, there were 25 males and 36 females, with a median age of 67.0 years;the median course of disease was 46.0 months;the functional pelvic plane with acetabular anteversion was set according to different types of pelvic anterior plane bracket. In control group, there were 27 males and 34 females, with a median age of 67.0 years;the median course was 42.0 months;in control group, the anteversion was set by the traditional method. The patients were followed up for 3 months. The operation time and blood loss were recorded. The incidence of infection and dislocation within 3 months was counted. Harris score before and 3 months after operation was recorded. Functional anteversion angle of standing position was measured 3 months after operation.@*RESULTS@#Compared with control group, there was no difference in operation time and blood loss between the two groups (P=0.918, 0.381);there was no infection between two groups within 3 months after operation;there was 1 case of hip joint dislocation in the control group and no dislocation in experimental group. There was no significant difference in Harris score before and after operation. Three months later, reexamination of pelvic standing radiographs showed that the number of patients with functional anteversion of acetabular prosthesis outside the safe area was less in experimental group thanin control group (@*CONCLUSION@#According to the preoperative evaluation and classification of patients, better functional anteversion of acetabular prosthesis can be obtained with the help of pelvic anterior plane reference bracket in hip arthroplasty with lumbar degenerative kyphosis.

Short and medium term follow-up study on the changes of spine pelvic parameters in patients with hip-spine syndrome after total hip arthroplasty / 中国骨伤

OBJECTIVE@#To investigate the influence of total hip arthroplasty on the changes of spine pelvic parameters in patients with hip spine syndrome.@*METHODS@#From January 2013 to October 2014, 22 patients (26 hips) with hip spine syndrome accompanied by necrosis of femoral head, hip osteoarthritis and congenital dysplasia of hip were treated with total hip arthroplasty. There were 12 males and 10 females with an average age of 58.4 years (range, 45 to 76 years). The course of disease was 1.5 to 25 years with an average of 12.8 years. Before and after the operation, the anteroposterior, full length radiographs of both lower limbs, thoracolumbar spine and pelvis in standing position were routinely taken. The balance parameters of spine pelvis coronal plane and sagittal plane before and after the replacement were measured. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Harris score were performed before and after the operation.@*RESULTS@#All cases were followed up for 21 to 52 (32±8) months. No infection, prosthesis subsidence, loosening, prosthesis dislocation were found in the last follow up. After total hip arthroplasty, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic tilt (PT) were significantly reduced(@*CONCLUSION@#After total hip arthroplasty, the coronal and historical balance parameters of spine and pelvis are significantly improved, and the short term and medium-term effects are satisfactory.

Quality Requirements for Reference Intervals and Decision Limits in Clinical Laboratory / 现代检验医学杂志

Reference intervals and decision limits are critical parts of the clinical laboratory report.The evaluation ot their correct use represents a tool to verify the post analytical quality.Four elements are identified as indicators:① The use of decision limits for lipids and glycated hemoglobin.② The use of common reference values.③The presence of gender-related reference intervals for at least the following common serum measurands (besides obviously the fertility relate hormones):alkaline phosphatase (ALP),alanine aminotransferase (ALT),creatine kinase (CK),creatinine,gamma-glutamyl transferase (GGT),IgM,ferritin,iron,transferrin,urate,red blood cells (RBC),hemoglobin (Hb) and hematocrit (HCT).④) The presence of age-related reference intervals.The problem of specific reference intervals for elderly people is discussed,but their use is not recommended.On the contrary it is necessary the presence of pediatric age-related reference intervals at least for the following common serum measurands:ALP,amylase,creatinine,inorganic phosphate,lactate dehydrogenase,aspartate aminotransferase,urate,insulin like growth factor 1,white blood cells,RBC,Hb,HCT,alfafetoprotein and fertility related hormones.The lack of such reference intervals may imply significant risks for the patients.

Interpretation of External Quality Assessment Results in Clinical Laboratories and Suggested Approach on Investigating Unacceptable Results / 现代检验医学杂志

Important objectives of external quality assessment (EQA) is to detect analytical errors and urge laboratories to take corresponding corrective actions.The paper described knowledge required to interpret EQA results and present a structured approach on how to handle unacceptable EQA results.The interpretation of EQA results depends on five key points:the control material,the target value,the number of replicates,the acceptance limits and between lot variations in reagents.When there are unacceptable EQA results,these factors may be the sources of errors.The ideal EQA sample has two important properties:having no matrix effects;having a target value established with a reference method.If either of these two criteria is not entirely fulfilled,results not related to the performance of the laboratory may arise.To help and guide the laboratories in handling an unacceptable EQA result,National Center for Clinical Laboratories has developed a preliminary investigation on the sources of errors and corrective actions for nonconforming EQA results in fifteen EQA schemes.Then a flow chart with additional comments was developed based on the investigation and the document of QMS24 to help laboratories improve quality by use of EQA results.

Investigation on reasons of unacceptable external quality assessment results for blood gas and acid-base analysis in China / 临床检验杂志

Objective To investigate the reasons of unacceptable results and corrective measures adopted in external quality assessment (EQA)for blood gas and acid-base analysis.Methods The reasons of unacceptable results and corrective measures for three EQA testing events of blood gas and acid-base analysis in 2016 were reported through EQA system based on web which was developed by National Central for Clinical Laboratories.The responses were divided into seven major groups,including EQA samples,errors in reporting results,methodology,equipments,techniques,EQA evaluations and unexplainable results after survey.Results The disqualified rates of EQA survey on blood gas and acid-base analysis were ranged from 0.5％ to 13.1％ and reporting rates of disqualification causes were ranged from 45.8％ to 69.0％ (except for the groups less than 20 laboratories).In the reasons for unacceptable results technological defects (35.9％ to 37.0％)were mainly associated with inappropriate specimen handling and/or storing,reagents and calibration problems.The defects of equipments (24.4％ to 27.9％) included mainly the malfunction and failure to adhere to scheduled instrument maintenance procedures.The errors in reporting results (12.2％ to 19.7％) were mostly transcription errors and reporting wrong codes.The unexplainable results after survey account for 8.7％ to 9.6％.The methodological defects (8.1％ to 11.8％) were largely attributed to inadequate training and quality control method.The defects of EQA evaluations (0.8％ to 3.3％)were all due to inappropriate grouping.The categorizations of the problems in the three EQA testing events were similar.The most corrective measures were appropriate,in which re-education and training for staff and improvement in instruments,reagents,internal quality control,calibration and process of reporting results were included.Conclusion The analysis and classification for reasons of unacceptable EQA results should be helpful for laboratories in identifying opportunities for improvement and adopting corrective measures in time.

Arthroscopic treatment with canulated screw fixation through very high-posteromedial portal approach versus double bundle suture fixation for avulsion fracture of tibial attachment of posterior cruciate ligament / 中国组织工程研究

BACKGROUND: This team modified the arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach to perform direct compression. Thus, the pressure of the fracture block is evenly distributed on the healing line, and the operation is convenient and fixed firmly, but its clinical effect remains to be further confirmed. OBJECTIVE: To compare the clinical outcome of arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach and double bundle suture fixation for avulsion fracture of the tibial attachment of posterior cruciate ligament. METHODS: From January 2011 to May 2017, 60 cases of the avulsion fracture of posterior cruciate ligament (transverse diameter of fracture block > 10 mm) were treated operatively at the Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, China. According to different modes of operation in different periods, patients were assigned to two groups. In the canulated screw group (n=31), patients were treated with canulated screw through very high-posteromedial portal approach. In the suture group (n=29), patients were treated with double bundle suture fixation through posteromedial portal approach. General conditions were compared between the two groups. Knee function was assessed with the Intemational Knee Documentation Committee and Lysholm scores. Knee stability was evaluated with KT-2000 and posterior drawer test. RESULTS AND CONCLUSION: (1) All the patients were followed up (range 6-12 months). (2) The average operation time was (63.49±3.97) minutes in the canulated screw group and (87.28±3.46) minutes in the suture group (P < 0.05). At 3 months after surgery, all the patients were healed. (3) At the final follow-up, in the canulated screw group, the negative rate of posterior drawer test was 90%. Lysholm scores were 94.89±4.75. IKDC scores were 94.01±3.25. In the suture group, the negative rate of posterior drawer test was 90%. Lysholm scores were 95.56±3.63. IKDC scores were 95.52±4.72. No significant difference was determined between the two groups (P > 0.05). (4) KT-2000 measurement results revealed that there were no significant differences between the surgical knee and the normal knee in both groups (canulated screw group:(2.53±1.02)mm versus(2.12±0.83)mm;suture group:(2.65±0.82)mm versus(2.19±0.63)mm (P > 0.05). Moreover, no significant difference was detected in the affected knee of KT-2000 results between the two groups. (5) Both arthroscopic reduction with canulated screw through very high-posteromedial portal approach and double bundle suture fixation can achieve satisfactory clinical outcomes, but arthroscopic reduction with canulated screw through very high-posteromedial portal approach in patients with fracture block diameter > 10 mm can result in shorter operation time, more reliable fixation, and thus permit an early postoperative functional exercise.

Pragmatic Approach of Verification of Examination Procedures in Clinical Laboratory for Imprecision,Trueness and Diagnostic Accuracy / 现代检验医学杂志

Objective To propose a practice model for implementing procedures employed for the verification of validated ex-amination procedures already used for at least 2 years in their laboratory,in agreement with the ISO 15189 requirement at the Section 5.5.1.2.Methods In order to identify the operative procedure to be used,approved documents were identified, together with the definition of performance characteristics to be evaluated for the different methods;the examination proce-dures used in laboratory were analyzed and checked for performance specifications reported by manufacturers.Then,opera-tive flow charts were identified to compare the laboratory performance characteristics with those declared by manufacturers. Results The choice of performance characteristics for verification was based on approved documents used as guidance,and the specific purpose tests undertaken,a consideration being made of:imprecision and trueness for quantitative methods;diag-nostic accuracy for qualitative methods;imprecision together with diagnostic accuracy for semi-quantitative methods.Conclu-sion The described approach,balancing technological possibilities,risks and costs and assuring the compliance of the funda-mental component of result accuracy,appears promising as an easily applicable and flexible procedure helping laboratories to comply with the ISO 15189 requirements.

Analysis of Reference Intervals of 18 Routine Biochemistry in 56 Mutual Recognition Laboratories in Beijing-Tianjing-Hebei Region / 现代检验医学杂志

Objective To evaluate reference intervals consistency of 18 routine biochemistry among mutual recognition labora-tories by analyzing the information of reference intervals of these laboratories in Beijing-Tianjing-Hebei region.Methods Laboratories submitted the data of reference intervals via interval quality assessment(EQA)software which was based on WEB,then the background of the software save the data as Microsoft Excel 2007 document.Finally,the mutual recognition routine biochemical projects,including Kalium(K),Sodium(Na),Chlorinum(Cl),Calcium(Ca),Phosphorus(P),Total protein(TP),Albumin(ALB),Total cholesterol(TC),Triglyceride(TG),Creatinine(CRE),Urea(URE),Uric acid (UA),Glucose(GLU),Alanine amino transaminase(ALT),Aspartate aminotransferase(AST),γ-glutamyltranspeptidase (GGT),Lactate dehydrogenase(LDH)and Creatine kinase(CK)of 56 mutual recognition laboratories were chosen,and perform analysis on upper and lower limits of reference intervals and their sources.Results The sources of reference inter-vals differ among different laboratories.As for projects owning hygiene professional standards(including K,Na,Cl,Ca,P, TP,ALB,CRE,URE,ALT,AST,GGT,LDH,CK),the primary sources were hygiene professional standards(23.1%~48.1%),manufacturer instructions of reagents/instrument(17.3%~41.8%)and National Clinical Laboratory Procedures (18.9% ~37.0%),as for projects which didn't have professional standards(including TC,TG,UA and GLU),the main sources were manufacturer instructions of reagents/instrument(>41.1%)and National Clinical Laboratory Procedures(>45.3%).Moreover,more than half of laboratories(50.9%~58.9%)had verified the reference intervals.There were little difference among laboratories in the upper and lower limits of Cl,Ca,P,K and GLU,but bigger difference for other projects. Conclusion The upper and lower limits of reference intervals werenot consistent among laboratories.In order to ensure the comparability of the test results in beijing-tianjin-hebei region,laboratories should use reference intervals based on the popu-lation of beijing-tianjin-hebei region or China.

Genotyping of hepatitis C virus by PCR-fluorescent probe in Qingyang area / 中国免疫学杂志

Objective:To detect the genotyping of hepatitis C virus by PCR-fluorescent probe in Qingyang area,and to evaluate the performance of PCR-fluorescent probe. Methods:The clinical data and peripheral venous blood of patients with HCV were collected (n=289). PCR-fluorescent probe was used to detect the genotype and HCV RNA of hepatitis C virus,and compare with PCR reverse dot blot,RT nested-PCR. Results:Among 289 samples detected by PCR-fluorescent probe,the rate of genotyping of hepatitis C virus was 99. 3%(287/289),and 139 for 1b(48. 1%),136 for 2a(47. 1%),7 for 3a(2. 4%),5 for 3b(1. 7%),2 for unknow(0. 7%). The specificity and efficiency was 100%,better repeatability,consistent with PCR reverse dot blot and RT nested-PCR(98. 2%,P>0. 05). The ALT,AST,PLT and HCVRNA(lg)for 1b patients was higher than 2a(P<0. 05). Conclusion:Multi-genotype distribution of HCV was revealed in the hepatitis C patients of Qingyang,1b and 2a were the main genotypes,and the ratio was equal,2a was increased,1b was declined. The sensibility and specificity was higher for PCR-fluorescent probe,and could be used in clinic.

Therapeutic Observation of Electronic Mild Moxibustion Equipment in Treating Knee Osteoarthritis / 上海针灸杂志

Objective To evaluate the clinical efficacy of electronic mild moxibustion equipment in treating knee osteoarthritis (KOA) by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Method Sixty-six eligible patients were randomized into a mild moxibustion equipment group of 33 cases and a moxibustion group of 33 cases. The mild moxibustion equipment group was intervened by electronic mild moxibustion equipment, and the moxibustion group was treated with moxibustion. In the two groups, same acupoints were selected, including Neixiyan (EX-LE4), Dubi (ST35), Xuehai (SP10) and Liangqiu (ST34), and the treatment lasted for 4 weeks. The WOMAC scores of the two groups were observed before and after the treatment.Result The WOMAC scores dropped significantly in both groups after the intervention (P<0.001), and the score of the mild moxibustion equipment group was significantly lower than that of the moxibustion group (P<0.05).Conclusion Electronic mild moxibustion equipment and moxibustion both can effectively mitigate joint pain and improve knee joint function, but the moxibustion equipment can produce a more significant effect in improving the joint function than moxibustion.

Genotyping of hepatitis C virus by PCR-fluorescent probe in Qingyang area / 中国免疫学杂志

Objective:To detect the genotyping of hepatitis C virus by PCR-fluorescent probe in Qingyang area,and to evaluate the performance of PCR-fluorescent probe. Methods:The clinical data and peripheral venous blood of patients with HCV were collected (n=289). PCR-fluorescent probe was used to detect the genotype and HCV RNA of hepatitis C virus,and compare with PCR reverse dot blot,RT nested-PCR. Results:Among 289 samples detected by PCR-fluorescent probe,the rate of genotyping of hepatitis C virus was 99. 3%(287/289),and 139 for 1b(48. 1%),136 for 2a(47. 1%),7 for 3a(2. 4%),5 for 3b(1. 7%),2 for unknow(0. 7%). The specificity and efficiency was 100%,better repeatability,consistent with PCR reverse dot blot and RT nested-PCR(98. 2%,P>0. 05). The ALT,AST,PLT and HCVRNA(lg)for 1b patients was higher than 2a(P<0. 05). Conclusion:Multi-genotype distribution of HCV was revealed in the hepatitis C patients of Qingyang,1b and 2a were the main genotypes,and the ratio was equal,2a was increased,1b was declined. The sensibility and specificity was higher for PCR-fluorescent probe,and could be used in clinic.

Therapeutic Observation of Electronic Mild Moxibustion Equipment in Treating Knee Osteoarthritis / 上海针灸杂志

Objective To evaluate the clinical efficacy of electronic mild moxibustion equipment in treating knee osteoarthritis (KOA) by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Method Sixty-six eligible patients were randomized into a mild moxibustion equipment group of 33 cases and a moxibustion group of 33 cases. The mild moxibustion equipment group was intervened by electronic mild moxibustion equipment, and the moxibustion group was treated with moxibustion. In the two groups, same acupoints were selected, including Neixiyan (EX-LE4), Dubi (ST35), Xuehai (SP10) and Liangqiu (ST34), and the treatment lasted for 4 weeks. The WOMAC scores of the two groups were observed before and after the treatment.Result The WOMAC scores dropped significantly in both groups after the intervention (P<0.001), and the score of the mild moxibustion equipment group was significantly lower than that of the moxibustion group (P<0.05).Conclusion Electronic mild moxibustion equipment and moxibustion both can effectively mitigate joint pain and improve knee joint function, but the moxibustion equipment can produce a more significant effect in improving the joint function than moxibustion.

Analysis of magnetic susceptibility of normal brain of young adults by quantitative susceptibility mapping / 中国医学影像技术

Objective To explore the changes of susceptibility of different sides and gender in healthy young adults with quantitative susceptibility mapping (QSM).Methods Totally 41 healthy young right-handed adults underwent conventional brain MRI and QSM scan,and the susceptibility maps were obtained by the image post-processing software.Then the ROI of the bilateral frontal grey matter (FGM),frontal white matter (FWM),caudate (CA),globus pallidus (GP),putamen (PU),thalamus (TH),substantia nigra (SN),red nucleus (RN),dentate nucleus (DN),pons (PO),corpus callosum (CC) were manually drawn to obtain magnetic susceptibility on the susceptibility map.The magnetic susceptibility of each ROI was compare between both sides,as well as gender by Mann-Whitney test.Results The magnetic susceptibility of the bilateral ROI of GP was the highest,and SN was followed,FWM was minimum.The susceptibility of bilateral FGM,FWM,CA,GP,PU,TH,SN,RN,DN,PO,CC had no statistically significant differences (all P＞0.05).The magnetic susceptibility in CA of different gender had statistically significant difference (P＜0.05).Conclusion The brain magnetic susceptibility.can be measured by QSM,and it can assess brain iron content quantitatively.

Relationship between two blood stasis syndromes and inflammatory factors in patients with acute coronary syndrome / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between inflammatory factors and two Chinese medicine (CM) syndrome types of qi stagnation and blood stasis (QSBS) and qi deficiency and blood stasis (QDBS) in patients with acute coronary syndrome (ACS).</p><p><b>METHODS</b>Sixty subjects with ACS, whose pathogenesis changes belongs to qi disturbance blood stasis syndrome, were divided into 2 groups: 30 in the QSBS group and 30 in the QDBS group. The comparative analysis on them was carried out through comparing general information, coronary angiography and inflammatory factors including intracellular adhesion molecule-1 (ICAM-1), chitinase-3-like protein 1 (YKL-40) and lipoprotein-associated phospholipase A2 (Lp-PLA2).</p><p><b>RESULTS</b>Compared with the QSBS group, Lp-PLA2 and YKL-40 levels in the QDBS group showed no-significant difference (P>0.05); ICAM-1 was significantly higher in the QDBS group than in the QSBS group in the pathological processes of qi disturbance and blood stasis syndrome of ACS (P<0.05).</p><p><b>CONCLUSIONS</b>Inflammatory factor ICAM-1 may be an objective basis for syndrome typing of QSBS and QDBS, which provides a research direction for standardization research of CM syndrome types.</p>

A Bayesian Stepwise Discriminant Model for Predicting Risk Factors of Preterm Premature Rupture of Membranes: A Case-control Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Preterm premature rupture of membrane (PPROM) can lead to serious consequences such as intrauterine infection, prolapse of the umbilical cord, and neonatal respiratory distress syndrome. Genital infection is a very important risk which closely related with PPROM. The preliminary study only made qualitative research on genital infection, but there was no deep and clear judgment about the effects of pathogenic bacteria. This study was to analyze the association of infections with PPROM in pregnant women in Shaanxi, China, and to establish Bayesian stepwise discriminant analysis to predict the incidence of PPROM.</p><p><b>METHODS</b>In training group, the 112 pregnant women with PPROM were enrolled in the case subgroup, and 108 normal pregnant women in the control subgroup using an unmatched case-control method. The sociodemographic characteristics of these participants were collected by face-to-face interviews. Vaginal excretions from each participant were sampled at 28-36+6 weeks of pregnancy using a sterile swab. DNA corresponding to Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Candida albicans, group B streptococci (GBS), herpes simplex virus-1 (HSV-1), and HSV-2 were detected in each participant by real-time polymerase chain reaction. A model of Bayesian discriminant analysis was established and then verified by a multicenter validation group that included 500 participants in the case subgroup and 500 participants in the control subgroup from five different hospitals in the Shaanxi province, respectively.</p><p><b>RESULTS</b>The sociological characteristics were not significantly different between the case and control subgroups in both training and validation groups (all P > 0.05). In training group, the infection rates of UU (11.6% vs. 3.7%), CT (17.0% vs. 5.6%), and GBS (22.3% vs. 6.5%) showed statistically different between the case and control subgroups (all P < 0.05), log-transformed quantification of UU, CT, GBS, and HSV-2 showed statistically different between the case and control subgroups (P < 0.05). All etiological agents were introduced into the Bayesian stepwise discriminant model showed that UU, CT, and GBS infections were the main contributors to PPROM, with coefficients of 0.441, 3.347, and 4.126, respectively. The accuracy rates of the Bayesian stepwise discriminant analysis between the case and control subgroup were 84.1% and 86.8% in the training and validation groups, respectively.</p><p><b>CONCLUSIONS</b>This study established a Bayesian stepwise discriminant model to predict the incidence of PPROM. The UU, CT, and GBS infections were discriminant factors for PPROM according to a Bayesian stepwise discriminant analysis. This model could provide a new method for the early predicting of PPROM in pregnant women.</p>

Magnetic resonance imaging characteristics of unilateral versus bilateral intraplaque hemorrhage in patients with carotid atherosclerotic plaques / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the difference in the vulnerability of carotid atherosclerotic plaques in patients with unilateral and bilateral intraplaque hemorrhage (IPH).</p><p><b>METHODS</b>A retrospective analysis was conducted among 44 patients with unilateral IPH (30 cases) or bilateral IPH (14 cases) in the carotid plaques detected by magnetic resonance imaging (MRI) in our hospital between December, 2009 and December, 2012. The age, maximum wall thickness and incidence of fibrous cap rupture were compared between the two groups.</p><p><b>RESULTS</b>Compared with those with unilateral IPH, the patients with bilateral IPHs had a significantly younger age (66.6∓9.4 years vs 73.7∓9.0 years, P=0.027), a significantly greater maximum plaque thickness (6.3∓1.9 mm vs 5.0∓1.3 mm, P=0.035) and a higher incidence of ulcers (50% vs 13.3%, P=0.025). Logistic regression analysis revealed a significant association between bilateral IPHs and the occurrence of ulcer with an odd ratio (OR) of 6.5 (95% confidence interval [CI]: 1.5-28.7, P=0.014). After adjustment for gender in Model 1, bilateral IPHs were still significantly associated with presence of ulcer (OR=5.7, 95%CI: 1.1-29.2, P=0.036). But after adjustment for age (P=0.131) or maximum plaque thickness (P=0.139) in model 2, no significant correlation was found between bilateral IPHs and the presence of ulcer.</p><p><b>CONCLUSION</b>Compared with patients with unilateral IPH, those with bilateral IPHs are at a younger age and have a greater plaque burden and a higher incidence of fibrous cap rupture, suggesting a greater vulnerability of the carotid plaques in patients with bilateral IPHs.</p>

Application on NT-proBNP in Patients with Essential Hypertension / 现代检验医学杂志

Objective To study the N terminal pro brain natriuretic peptide (NT-proBNP)in serum of hypertension patients. Methods 152 patients with hypertension were included in this study.According to the different degree and development of hypertension,152 patients were divided into three different grade group of hypertension:first grade of hypertension group (30 patients),second grade of hypertension group (36 patients)and third grade of hypertension group (86 patients).And the 86 patients were divided into hypertension group (40 patients)and hypertension with diabetes group (46 patients)re-spectively,comparaed with the level of NT-proBNP in serum of different hypertension grade groups.Results The levels of the NT-proBNP in serum were 68±44,122±31 and 834±309 pg/ml of first grade of hypertension group,second grade of hypertension group and third grade of hypertension group,respectively.The level of the NT-proBNP was gradually increased with grade of hypertension (t=2.455,3.561,P<0.01).The level of the NT-proBNP (1 178±864 pg/ml)of hypertension with diabetes group was significantly higher than hypertension group (599±411 pg/ml)(t=3.785,P<0.01).Conclusion The level of NT-proBNP can obj ectively reflect the grade of the disease in patients with hypertension.it is a certain signifi-cance guiding for monitoring the clinical treatment of the disease.

Patient Trust in Physicians: Empirical Evidence from Shanghai, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patient trust in physicians, which can be considered a collective good, is necessary for an effective health care system. However, there is a widespread concern that patient trust in physicians is declining under various threats to the physician-patient relationship worldwide. This article aimed to assess patient trust in physicians through a quantitative study in Shanghai, China, and to provide appropriate suggestions for improving the trust in China.</p><p><b>METHODS</b>The data from a survey conducted in Zhongshan Hospital and Shanghai Tenth People's Hospital, which are two tertiary public hospitals in Shanghai, were used in this study. Patient trust in physicians was the dependent variable. Furthermore, a 10-item scale was used to precisely describe the dependent variable. The demographic characteristics were independent variables of trust in physicians. Binomial logistic regression was employed to analyze the factors associated with the dependent variable, which was divided into two categories on the basis of the responses (1: Strongly agree or agree and 0: Strongly disagree, disagree, or neutral).</p><p><b>RESULTS</b>This study found that 67% of patients trusted or strongly trusted physicians. The mean score of patient trust in physicians was 35.4 from a total score of 50. Furthermore, patient trust in physicians was significantly correlated with the age, education level, annual income, and health insurance coverage of the patients.</p><p><b>CONCLUSIONS</b>Patient trust in physicians in Shanghai, China is higher than previously reported. Furthermore, the most crucial reason for patient distrust in physicians is the information asymmetry between patients and physicians, which is a natural property of the physician-patient relationship, rather than the so-called for-profit characteristic of physicians or patients' excessive expectations.</p>