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Objective: To analyze the allocation of human resources for chronic disease prevention and control of district/county-level centers for disease control and prevention(CDC) in China in 2020. Methods: Survey subjects were from National Chronic Noncommunicable Disease and Risk Factor Surveillance Sites and National Demonstration Areas for Chronic Noncommunicable Disease Prevention and Control (demonstration areas). A survey examining the allocation of human resources for chronic disease prevention and control at district/county-level CDC was conducted in December 2021 through the National Demonstration Areas Management Information System. The number and rate of allocation of human resources for chronic disease prevention and control in district/county-level CDC were analyzed and the Wilcoxon rank sum test was used to compare the difference between demonstration and non-demonstration areas and between urban and rural areas. The Kruskal-Wallis H test was used to compare the difference in east, central and west regions. The Gini coefficient and Theil index were used to evaluate the balance of human resource for chronic disease prevention and control. Results: A total of 678 districts/counties were investigated, and 664 districts/counties responded effectively, with an effective response rate of 97.9%. The establishment rate of district/county-level CDC was 98.34% (653/664), and the establishment rate of chronic disease prevention and control departments of district/county-level CDC was 96.02% (627/653). In 627 district/county-level CDC with departments for chronic disease prevention and control, the median number of full-time technical personnel for chronic disease prevention and control was 4, the median number of full-time technical personnel in demonstration areas (4 persons) was higher than in non-demonstration areas (3 persons), highest in the east region (5 persons) than in the middle region (4 persons) and the west region (4 persons), higher in urban areas (4 persons) than in rural areas (4 persons) (all P values<0.05). The allocation rate was 0.71 people/100 000, which was higher in demonstration areas (0.73 people/100 000) than in non-demonstration areas (0.67 people/100 000), highest in the west region (0.82 people/100 000) than in the middle region (0.71 people/100 000) and east region (0.67 people/100 000), higher in rural areas (0.77 people/100 000) than in urban areas (0.68 people/100 000) (all P values<0.05). The Gini coefficient for the allocation by population size was 0.352 9. The total Theil index for demonstration and non-demonstration areas, different regions, and urban-rural areas were 0.067 8, 0.076 3, and 0.000 2, with the intra-group contribution of 97.35%, 99.52%, and 98.80%, respectively. Conclusion: In 2020, the allocation of human resources for chronic disease prevention and control in district/county-level CDC is relatively balanced. The variation in the allocation of human resources for chronic disease prevention and control exist between demonstration and non-demonstration areas, urban and rural areas, and across regions.
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Humans , Noncommunicable Diseases/prevention & control , Workforce , China , Risk Factors , Chronic DiseaseABSTRACT
Objective: To evaluate the efficacy and safety of intravenous iron supplementation in patients with recurrent iron deficiency anemia (IDA) . Methods: This retrospective analysis of 90 patients with recurrent IDA from May 2012 to December 2021 was conducted, comparing the efficacy and safety of the intravenous iron therapy group and the oral iron therapy group. Results: Among the 90 patients with recurrent IDA, 20 were males and 70 were females, with a median age of 40 (range: 14-85) years. A total of 60 patients received intravenous iron supplementation and 30 received oral iron supplementation. The hematologic response rates in the intravenous iron group were significantly higher than those in the oral iron group at 4 and 8 weeks after treatment [80.0% (48/60) vs 3.3% (1/30) and 96.7% (58/60) vs 46.7% (14/30), all P<0.001, respectively]. The median increase in hemoglobin levels was also significantly higher in the intravenous iron group than in the oral iron group [38 (4, 66) g/L vs 7 (1, 22) g/L at week 4 and 44.5 (18, 80) g/L vs 19 (3, 53) g/L at week 8, all P<0.001]. The intravenous iron group had a significantly higher proportion of patients who achieved normal hemoglobin levels than the oral iron group (55.0% vs 0 and 90% vs 43.3%, all P<0.001, respectively). Iron metabolism indicators were tested before and after 8 weeks of treatment in 26 and 7 patients in the intravenous and oral iron groups, respectively. The median increase in serum ferritin (SF) levels in the intravenous iron group 8 weeks after treatment was 113.7 (49.7, 413.5) μg/L, and 54% (14/26) of these patients had SF levels of ≥100 μg/L, which was significantly higher than the median increase in SF levels in the oral iron group [14.0 (5.8, 84.2) μg/L, t=4.760, P<0.001] and the proportion of patients with SF levels of ≥100 μg/L (P=0.013). The incidence of adverse reactions was 3.3% (2/60) in the intravenous iron group, which was significantly lower than that in the oral iron group [20.0% (6/30), P=0.015]. Conclusion: Intravenous iron supplementation is more effective for hematologic response, faster hemoglobin increase, and higher iron storage replenishment rates compared with oral iron supplementation in patients with recurrent IDA, and it is well tolerated by patients.
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Male , Female , Humans , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Anemia, Iron-Deficiency/epidemiology , Sucrose/therapeutic use , Ferric Compounds/therapeutic use , Retrospective Studies , Iron/therapeutic use , Hemoglobins/therapeutic useABSTRACT
Objective:To evaluate the extent and progression of coronary artery calcification in maintenance hemodialysis (MHD) patients, and to explore the risk factors of rapid progression of coronary artery calcification in MHD patients.Methods:The patients who underwent MHD in the Huashan Hospital affiliated to Fudan University from January 1, 2013 to December 31, 2017 were enrolled. This study included cross-sectional study and prospective cohort study. Multi-slice spiral computed tomography was used to measure coronary artery calcification, and coronary artery calcium score (CACS) was calculated. In the cross-sectional study, 62 MHD patients were enrolled. According to baseline CACS, the patients were divided into low calcification group (CACS < 100) and high calcification group (CACS ≥ 100). The nutritional and bone mineral metabolism indexes were compared between the two groups. Multiple linear regression analysis was used to analyze the correlation between CACS and muscle mass and laboratory indicators. Since 6 patients were lost to follow-up, 56 MHD patients who were followed-up regularly were enrolled in the prospective cohort study. According to the progression of CACS, the patients were divided into slow progression group (ΔCACS/year < 100) and rapid progression group (ΔCACS/year ≥ 100). Logistic regression equation was used to analyze the risk factors of coronary calcification progression. Hosmer-Lemeshow goodness of fit test and receiver operating characteristic curve were used to evaluate the performance of multivariate logistic regression model.Results:In the cross-sectional study, the age of 62 patients was (62.34±10.82) years old, and the median dialysis age was 78 (39,139) months. Among the 33 male patients, compared with the low calcification group ( n=7), the high calcification group ( n=26) had older age ( t=-2.281, P=0.030) and higher blood triglyceride ( Z=-1.985, P=0.047), and there was no statistically significant difference in muscle mass between the two groups; among the 29 female patients, the muscle mass/height 2 ( t=-2.600, P=0.015) and serum calcium ( t=-2.641, P=0.014) in the high calcification group ( n=15) were both higher than those in the low calcification group ( n=14), and the hemoglobin level was lower ( t=2.531, P=0.018), and the difference in muscle mass between the two groups was not statistically significant. High sensitivity C-reactive protein ( β=0.425, P=0.022) was independently correlated with CACS in male patients, and muscle mass/extracellular water ( β=-0.580, P=0.001) was independently correlated with CACS in female patients. In the prospective cohort study, the age of 56 patients was (59.82±11.14) years old, and the median dialysis age was 82 (40, 146) months. There was no significant difference in all-cause mortality between slow progression group ( n=22) and rapid progression group ( n=34), but the proportion of cardiovascular events in rapid progression group was significantly higher than that in slow progression group ( P=0.017). Compared with the slow progression group, the rapid progression group had higher proportion of males ( χ2=4.791, P=0.029), older age ( Z=-2.131, P=0.038), lower baseline muscle mass/extracellular water ( Z=2.482, P=0.016) and high-density lipoprotein cholesterol ( t=2.133, P=0.042), and faster rate of muscle mass loss (Δmuscle mass·height -2·year -1) ( Z=-2.282, P=0.023). Multivariate logistic regression analysis results showed that muscle mass loss ( OR=0.089, 95% CI 0.010-0.792, P=0.030) and baseline CACS ( OR=1.003, 95% CI 1.000-1.005, P=0.021) were influencing factors for progression of coronary artery calcification in MHD patients. Conclusion:Increasing baseline CACS and rapid reduction in muscle mass are risk factors for the progression of coronary artery calcification in MHD patients.
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Objective:To investigate the effect of multi line therapy for lung adenocarcinoma transformed into small cell lung cancer (SCLC), and review and discuss the related literature.Methods:Combined with the clinical examples of lung adenocarcinoma transformed SCLC after treatment with anti epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs), the diagnostic process and multi line treatment plan of transformed SCLC were analyzed, and the therapeutic effect was evaluated by imaging. At the same time, it was reviewed and discussed in combination with relevant literature.Results:Serological tumor markers were significant for the diagnosis of transformed SCLC after EGFR-TKI treatment of lung adenocarcinoma, and pathology was still the gold standard for its diagnosis. The multiline therapy of SCLC has certain effect on transformed small cell lung cancer.Conclusion:The overall prognosis of lung adenocarcinoma transformed into SCLC after EGFR TKIs treatment is poor, so it is necessary to diagnose and treat it as early as possible, evaluate the effect of imaging in time, and make treatment adjustment quickly.
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Objective:To analyze the patterns of antibacterial agents in Chinese children surveyed by the China multi-center monitoring network for the application of antibacterial agents in children and neonates in 2019 by using World Health Organization (WHO) Access, Watch, Reserve and Not-recommended (AWaRe) and typical anatomical/therapeutic/chemical (ATC) in this study.Methods:The cross-sectional method was adopted.A multi-center cross-sectional survey was conducted on one day from September to December 2019.The information of all inpatients taking antibiotics was uploaded to the network-based data collection system (https: //garpec-31.mobilemd.cn/login.aspx? relogin=true). This study covered 13 hospitals from 10 provinces and cities in China.All hospitalized children in the Respiratory Department, Infectious Disease Department, General Surgery Department, Pediatric Intensive Care Units, Neonatal Intensive Care Units and Neonatology joined in this survey.The clinically used antibacterial agents were classified by AWaRe and ATC, and the AWaRe and ATC distributions of antibacterial agents prescribed for Chinese children and neonates were described.Results:Of the 2 644 antibiotic prescriptions included from 13 hospitals, 2 134 (80.71%) were for children and 510 (19.29%) were for neonates.Of all antibiotic prescriptions, there were 368 (13.92%) Access antibiotics prescriptions, 1 973 (74.62%) Watch prescriptions, 60 (2.27%) Reserve prescriptions and 243 (9.19%) Not-recommended prescriptions.The top-five antibiotics prescribed for children and neonates were third-generation cephalosporins (1 056, 39.94%), macrolides (492, 18.61%), carbapenems (275, 10.40%), beta lactam-beta lactamase inhibitors (246, 9.30%), and second-generation cephalosporins (136, 5.14%). The use ratios of Access, Watch, Reserve and Not-recommended antibiotics in each center ranged from 0 to 30.00%, 36.67% to 97.20%, 0 to 17.02% and 0 to 33.33%, respectively.In 1 360 antibiotic prescriptions for children and neonates with pneumonia, there were 152 (11.18%) Access antibiotics, 1 051 (77.28%) Watch antibiotics, 37 (2.72%) Reserve antibiotics, and 120 (8.82%) Not-recommended antibiotics.The top-five antibiotics prescribed for children with pneumonia were third-generation cephalosporins (522, 38.38%), macrolides (388, 28.53%), beta lactam-beta lactamase inhibitors (141, 10.37%), carbapenems (117, 8.6%) and penicillins (49, 3.60%).Conclusions:Watch antibiotics and broad spectrum antibiotics such as third-generation cephalosporins and macrolides prone to induce resistance are the main antibacterial agents used in Chinese children and neonates with pneumonia.Broad-spectrum antibiotics may be overused in Chinese children and neonates.
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AIM: To compare the effectiveness of unilateral lateral rectus recession-medial rectus resection(RR))and lateral rectus recession-medial rectus plication(RP)in the treatment of exotropia. METHODS: Evidence-based medicine research. A systematic database search was conducted Medline, Embase, Web of Science, the Cochrane Register of Controlled Trials and so on from August 2011 to August 2021. Related studies meeting the inclusion criteria were included in our study. The main outcome measures were as follows: success rate and postoperative deviation. Mean difference(MD)and odds ratio(OR)with 95% confidence interval(CI)were statistical analyzed as measurement data and continuous variables statistics. RESULTS: A total of two randomized controlled studies and five retrospective studies were included. The Meta-analysis results showed that the success rate of surgery was similar for RP group compared with RR group(OR=0.65, 95%CI:0.39-1.07, P=0.09). There was no difference in the incidence of poor postoperative prognosis of the two groups(the undercorrection and overcorrection rates)(OR=1.59; 95%CI: 0.92-2.74, P=0.10; OR=4.43; 95%CI: 0.69-28.18, P=0.12). There were no significant differences in postoperative deviation and the amount of external oblique drift(MD=0.75, 95%CI: -0.27-1.76, P=0.15; MD=-0.34, 95%CI: -1.30-0.63, P=0.50). CONCLUSION: The success rate of RP and RR surgery is close to the incidence of poor postoperative prognosis, moreover, there was no significant difference between the deviation and the amount of external oblique drift after the two surgeries, RP is an effective surgical procedure for the treatment of exotropia.
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Objective:To study the predictive value of total serum bilirubin (TSB) and the ratio of bilirubin to albumin (B/A) in neonatal acute bilirubin encephalopathy (ABE).Methods:Neonates with extremely severe hyperbilirubinemia (TSB≥425 μmol/L) treated in the Nanjing Maternal and Child Health Hospital, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Northwest Women and Children's Hospital, Yinchuan Maternal and Child Health Hospital and Liaocheng People's Hospital from March 2018 to August 2019 were selected as prospective subjects for this study. According to the score of brain injury induced by bilirubin, the subjects were divided into ABE group and non-ABE group, and the predictive value of TSB peak and B/A for neonatal ABE were analyzed.Results:A total of 194 infants with extremely severe hyperbilirubinemia were recruited in this study, including 20 in ABE group and 174 in non-ABE group. The peak value of bilirubin ranged from 427 to 979 μmol/L. The optimal critical values of TSB peak value and B/A for ABE prediction were 530 μmol/L and 9.48, respectively. The sensitivity and specificity of ABE prediction were 85.0% and 92.8% when combined with TSB peak and B/A values.Conclusions:TSB peak combined with B/A value can effectively identify neonatal ABE. When the TSB peak value was greater than 530 μmol/L and the B/A value was greater than 9.48, the neonates had a higher risk of neonatal ABE.
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OBJECTIVE@#To investigate the clinical characteristics and risk factor analysis of necrotizing pneumonia in children.@*METHODS@#A retrospective study was used to analyze the case data of 218 children with severe pneumonia hospitalized in the Department of Respiratory Medicine, Children's Hospital of Capital Institute of Pediatrics from January 2016 to January 2020, and they were divided into 96 cases in the necrotizing pneumonia group (NP group) and 122 cases in the non-necrotizing pneumonia group (NNP group) according to whether necrosis of the lung occurred. The differences in clinical characteristics (malnutrition, fever duration, hospitalization time, imaging performance, treatment and regression follow-up), laboratory tests [leukocytes, neutrophil ratio, platelet (PLT), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and lactate dehydrogenase (LDH)] and bronchoscopic performance between the two groups were compared, and Logistic regression analysis of clinical risk factors associated with necrotizing pneumonia was performed to further determine the maximum diagnostic value of each index by subject operating characteristic curve (ROC). The critical value of each index was further determined by the ROC.@*RESULTS@#The differences in age, gender, pathogenic classification, and bronchoscopic presentation between the two groups of children were not statistically significant (P>0.05); whereas the imaging uptake time of the children in the NP group was higher than that in the NNP group (P < 0.05). The differences in malnutrition, fever duration, length of stay, white blood cell count, neutrophil ratio, CRP, PCT, and D-dimer were statistically significant between the two groups (P < 0.05). The imaging uptake time was lower in children under 6 years of age than in those over 6 years of age, and the imaging uptake time for bronchoalveolar lavage within 10 d of disease duration was lower than that for those over 10 d; the imaging uptake time was significantly longer in the mixed infection group than that in the single pathogen infection group. Logistic regression analysis of the two groups revealed that the duration of fever, hospital stay, CRP, PCT, and D-dimer were risk factors for secondary pulmonary necrosis (P < 0.001, P < 0.001, P < 0.001, P=0.013, P=0.001, respectively). The ROC curves for fever duration, CRP, PCT, and D-dimer were plotted and found to have diagnostic value for predicting the occurrence of pulmonary necrosis when fever duration >11.5 d, CRP >48.35 mg/L, and D-dimer > 4.25 mg/L [area under ROC curve (AUC)=0.909, 0.836, and 0.747, all P < 0.001].@*CONCLUSION@#Children with necrotizing pneumonia have a longer heat course and hospital stay, and the imaging uptake time of mixed pathogenic infections is significantly longer than that of single pathogenic infections. Children with necrotizing pneumonia under 6 years of age have more advantageous efficacy of electronic bronchoscopic alveolar lavage within 10 d of disease duration compared with children in the group over 6 years of age and children in the group with disease duration >10 d. Inflammatory indexes CRP, PCT, and D-dimer are significantly higher. The heat course, CRP, PCT, and D-dimer are risk factors for secondary lung necrosis in severe pneumonia. Heat course >11.5 d, CRP >48.35 mg/L, and D-dimer >4.25 mg/L have high predictive value for the diagnosis of necrotizing pneumonia.
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Child , Child, Preschool , Humans , C-Reactive Protein/analysis , Malnutrition , Necrosis , Pneumonia/diagnosis , Pneumonia, Necrotizing , Prognosis , ROC Curve , Retrospective Studies , Risk FactorsABSTRACT
AIM:To evaluate the effects of intermittent exotropia(IXT)on the quality of life of children and their parents using the Chinese version of intermittent exotropia questionnaires(CIXTQ).METHODS: The scores of CIXTQ were collected from IXT children and the same number of age-matched control children in department of ophthalmology, Nanjing Children's Hospital from June 2020 to June 2021. They were the Chinese version of intermittent exotropia questionnaires scores(CIXTQ, for children to assess their health related quality of life), the parental proxy CIXTQ(pp-CIXTQ, for parents to assess children's life quality)scores and the parent CIXTQ(p-CIXTQ, for parents to assess their life quality)scores. To explore: 1)The differences in the CIXTQ, pp-CIXTQ and p-CIXTQ scores between IXT children and the normal children; 2)The relationship between the CIXTQ and pp-CIXTQ scores in IXT children; 3)The factors affecting the quality of life in children with IXT.RESULTS: A total of 156 patients with IXT and 156 age-matched normal children were included. CIXTQ scores in the children with IXT group was lower than that in the control group(t=-12.915, P<0.001). In IXT group, there was no difference observed in CIXTQ or pp-CIXTQ scores(t=-0.718, P=0.473). As suggested by item-level analysis, children in the IXT group were more concerned about how others think of them and their vision, whereas parents were more concerned about whether the child needs surgery, and whether the permanent damage of strabism caused to the eyes of their children and whether strabismus affects their social life.CONCLUSION: The CIXTQ performed better in distinguishing the children with IXT and those with normal condition, and it can accurately predict the impact of IXT on children, and benefit to make personalized treatment regimens.
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OBJECTIVE@#To compare the clinical efficacy, survival, and prognosis of autologous hematopoietic stem cell transplantation (ASCT) with new drug chemotherapy in the treatment of newly diagnosed multiple myeloma (NDMM) in the new drug era.@*METHODS@#The clinical data of 149 patients with NDMM treated with new drug induction regimen in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to December 2019 were retrospectively analyzed. Twenty-four patients who received ASCT were in ASCT group, and 125 patients who did not receive ASCT were in non-ASCT group. The median follow-up time was 43 (1-90) months. The propensity score matching (PSM) method was used to balance confounding factors, then depth of response, overall survival (OS), and progression-free survival (PFS) between the two groups were compared and subgroup analysis was performed.@*RESULTS@#After matching, the covariates were balanced between the two groups. Fifty-one patients (15 cases in ASCT group and 36 cases in non-ASCT group) were included. ASCT patients had a better complete response (CR) rate than non-ASCT patients receiving maintenance therapy (93.3% vs 42.3%, P=0.004), while there were no statistical differences in deep response rate and overall response rate (ORR) between the two groups (93.3% vs 65.4%, P=0.103; 93.3% vs 96.2%, P=1.000). Before matching, the 3 and 5-year PFS rate and median PFS (mPFS) in ASCT group and non-ASCT group were [89.6% vs 66.5%, P=0.024; 69.8% vs 42.7%; non-response (NR) vs 51.0 months], and the 3 and 5-year OS rate and median OS (mOS) were (100% vs 70.6%, P=0.002; 92.3% vs 49.6%; NR vs 54.0 months). After matching, the 3 and 5-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.6% vs 61.7%, P=0.182; 62.7% vs 45.7%; NR vs 51.0 months), the 3 and 5-year OS rate and mOS were (100% vs 65.6%, P=0.018; 88.9% vs 46.9%; NR vs 51.0 months). Subgroup analysis showed that patients with mSMART 3.0 high risk stratification, the 3-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.3% vs 41.5%, P=0.091; NR vs 34.0 months), and the 3-year OS rate and mOS were (100% vs 41.5%, P=0.034; NR vs 34.0 months). Patients with mSMART 3.0 standard risk stratification, the 3-year PFS rate and OS rate in ASCT group and non-ASCT group were (83.3% vs 76.8%, P=0.672; 100% vs 87.2%, P=0.155). The 3-year PFS and OS rate in MM patients who achieved deep response within 3 months after transplantation compared with non-ASCT patients who achieved deep response after receiving maintenance therapy were (83.1% vs 56.7%, P=0.323; 100% vs 60.5%, P=0.042), and the 3-year PFS and OS rate in patients who achieved overall response in both groups were (83.1% vs 62.5%, P=0.433; 100% vs 68.1%, P=0.082). After matching, Cox multivariate regression analysis showed that mSMART 3.0 risk stratification and ASCT were independent prognostic factors for OS.@*CONCLUSION@#In the new drug era, ASCT can increase CR rate and prolong OS of NDMM patients. ASCT patients who are mSMART 3.0 high risk stratification or achieved deep response within 3 months after transplantation have better OS than non-ASCT patients receiving new drug chemotherapy. ASCT and mSMART 3.0 risk stratification are independent prognostic factors for OS in NDMM patients.
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Humans , Antineoplastic Combined Chemotherapy Protocols , Disease-Free Survival , Hematopoietic Stem Cell Transplantation , Multiple Myeloma/drug therapy , Pharmaceutical Preparations , Propensity Score , Retrospective Studies , Stem Cell Transplantation , Transplantation, Autologous , Treatment OutcomeABSTRACT
Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.
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ObjectiveTo analyze allergen-specific IgE （sIgE） in the serum of patients with allergic diseases， and provide the basis for clinical diagnosis and treatment. MethodsThe serum sIgE of 29 902 patients with allergic diseases in Hangzhou City of Zhejiang Province was detected by ELISA， and the result was analyzed with gender， age， time distribution. ResultsThe positive rate of total IgE （tIgE） in 29 902 patients with allergic diseases was 77.34%. The most common inhaled allergens were dust mite （36.75%）， ragweed （11.23%） and tree pollen （9.06%）， and the most common food allergens were egg protein （9.90%）， milk （8.88%） and crab （4.62%）. The positive rate of sIgE in men was higher than that in women. The positive rate of sIgE in people less than 18 years old was higher than that in people more than 18 years old. The positive rates of tree pollen sIgE decreased year by year. Most patients were allergic to one allergen， accounting for 52.52% of the total sIgE positive patients. ConclusionDust mite， ragweed， tree pollens， egg protein and milk are important allergens in Hangzhou. The prevention and treatment of allergic diseases should focus on these allergens. We should understand that the distribution of allergens in different ages and genders is different， so the prevention and treatment should focus on different aspects.
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ObjectiveTo analyze allergen-specific IgE （sIgE） in the serum of patients with allergic diseases， and provide the basis for clinical diagnosis and treatment. MethodsThe serum sIgE of 29 902 patients with allergic diseases in Hangzhou City of Zhejiang Province was detected by ELISA， and the result was analyzed with gender， age， time distribution. ResultsThe positive rate of total IgE （tIgE） in 29 902 patients with allergic diseases was 77.34%. The most common inhaled allergens were dust mite （36.75%）， ragweed （11.23%） and tree pollen （9.06%）， and the most common food allergens were egg protein （9.90%）， milk （8.88%） and crab （4.62%）. The positive rate of sIgE in men was higher than that in women. The positive rate of sIgE in people less than 18 years old was higher than that in people more than 18 years old. The positive rates of tree pollen sIgE decreased year by year. Most patients were allergic to one allergen， accounting for 52.52% of the total sIgE positive patients. ConclusionDust mite， ragweed， tree pollens， egg protein and milk are important allergens in Hangzhou. The prevention and treatment of allergic diseases should focus on these allergens. We should understand that the distribution of allergens in different ages and genders is different， so the prevention and treatment should focus on different aspects.
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Jie-Geng-Tang (JGT), a traditional formula, is employed in the treatment of sore throat and cough and comprises Platycodonis Radix and Glycyrrhizae Radix et Rhizoma in the ratio 1 : 2. Our previous study demonstrated that JGT protected mice from S. aureus-induced acute lung injury (ALI). Five constituents of JGT showed antibacterial activities against S. aureus in vitro. However, the potential effective constituents of JGT in vivo were still unclear. In this study, the chemical constituents of JGT were identified by liquid chromatography with quadrupole time-of-flight spectrometry (LC-Q-TOF-MS). A total of 96 constituents were identified or assumed, including seven organic acids, 45 flavonoids, 36 triterpene saponins, and eight compounds of other types. The structures of 31 of the constituents were confirmed by comparing them with corresponding authentic standards. Moreover, 15 prototypes and 49 metabolites were deduced in the serums of mice, 24 prototypes and 47 metabolites were deduced in the lungs of mice after the oral administration of JGT. Three types of constituents, namely organic acids, flavonoids, and triterpene saponins, could be absorbed into the blood. Moreover, flavonoids and triterpene saponins were more likely distributed in the lung than in the blood. To the best of our knowledge, this is the first report on the systematic metabolites profile of JGT in vivo. The results reported were beneficial to the elucidation of the effective material basis of JGT.
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Objective:To investigate the risk factor of renal anemia in maintenance hemodialysis patients (MHD) and the association of N-terminal pro-brain natriuretic (NT-proBNP) level with renal anemia.Methods:Patients who received MHD for more than 3 months at Huashan Hospital affiliated to Fudan University from August 2018 to November 2018 were selected as the subjects. The patients were divided into anemia group and non-anemia group according to the hemoglobin level. The patients' general data, the laboratory examination and dialysis related data during the observation period were collected. Pearson correlation analysis was used to analyze the correlation between anemia indicators, dialysis-related indicators and blood NT-proBNP levels. Stepwise multiple linear regression analysis was used to analyze the risk factors for anemia in MHD patients.Results:A total of 160 patients with MHD were included in this study, aged (63.11±11.35) years. There were 79 males (49.4%) and 81 females (50.6%). The dialysis age was (118.01±82.32) months, hemoglobin was (110.09±13.48) g/L, and the median NT-proBNP was 3 985 ng/L. There were 73 cases (45.6%) in anemia group and 87 cases (54.4%) in non-anemic group, and NT-proBNP levels were significantly higher in anemia group than that in the non-anemia group ( t=-3.714, P<0.001). Hemoglobin levels were positively correlated with weekly dialysis time ( r=0.228) and albumin ( r=0.349), and negatively correlated with NT-proBNP levels ( r=-0.318). Hematocrit was positively correlated with weekly dialysis time ( r=0.283), serum calcium ( r=0.317), phosphorus ( r=0.264) and albumin ( r=0.513) with significance (all P<0.05). Univariate regression analysis showed that the level of ln (NT-proBNP) was negatively correlated with hemoglobin ( P<0.001). Stepwise multiple linear regression results showed that low albumin level and high NT-proBNP level were independent risk factors for renal anemia in MHD patients. Conclusions:The increase level of NT-proBNP in MHD patients is independently associated with the decrease level of hemoglobin. Low albumin level and high NT-proBNP level are risk factors for renal anemia, suggesting that the treatment of renal anemia needs to consider improving the factors such as malnutrition and high volume.
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OBJECTIVE: To study the characteristics and clinical application of radical laparoscopic myomectomy.METHODS: Retrospectively analyze the clinical data of 31 patients with uterine leiomyomas undergoing laparoscopic radical myomectomy at the Department of Obstetrics and Gynecology,the First Affiliated Hospital of Soochow University,from January 2016 to December 2018.The surgical indications,operation time,intraoperative blood loss,postoperative menstrual recovery,postoperative uterine fibroid recurrence rate and postoperative sexual and life quality change indicators were analyzed.RESULTS: All patients were with multiple uterine fibroids(averaged 42.6±3.5 years),and all of them received successful operation.There were no patients who underwent laparotomy or hysterectomy.The postoperative fibroids residual rate among the 31 patients was 3.23%(1 case).The recurrence rate of postoperative uterine fibroids half a year later was 9.68%(3 cases).Five patients has no significant change in postoperative menstruation volume while the other 25 patients had volume reduction(t=8.614,P0.05).Only one patient suffered from hot flashes,night sweating and other menopausal symptoms.WHOQOL-BREF scale was used for patients to assess preoperative and postoperative quality of life,and there were obviously improved psychological and physiological score in patients after operation(P<0.05).CONCLUSION: For women with multiple uterine fibroids who have surgical indications and a strong desire to retain the uterine but have no fertility requirements,radical laparoscopic myomectomy may be the most effective surgical therapy,which can achieve the purpose of surgical treatment,improving the resection rate,and maintaining low postoperative recurrence rate,preserving menstruation and the function of uterus and ovary,and increasing the sexual life quality.
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Objective To analyze the pathogenic characteristics of sepsis in patients with hepatic failure, and to explore the risk factors for sepsis in patients with liver failure. Methods The data of 221 patients with hepatic failure admitted to Tianjin Second People's Hospital from January 2014 to December 2018 were retrospectively collected. The patients were divided into two groups according to whether they suffered from sepsis or not. The pathogeny results of blood culture in patients with sepsis were observed. The levels of white blood cell (WBC), neutrophil (Neut), platelet (PLT), lactic acid (Lac), C-reactive protein (CRP) and procalcitonin (PCT) were compared between the two groups. The risk factors for sepsis in patients with hepatic failure were analyzed by multivariate Logistic regression analysis. Results Among 221 patients, 27 cases had incomplete data and were excluded. Finally, 194 cases were enrolled in the analysis, including 52 in sepsis group and 142 in non-sepsis group. From 2014 to 2018, there were 11, 12, 11, 11 and 8 positive cases of sepsis in patients with liver failure. The positive rate of Gram-positive (G+) bacteria increased year by year (2, 3, 4, 5 and 4 cases of G+ bacteria from 2014 to 2018). There was no significant difference in demographic and medical history data, such as gender, age and history of diabetes mellitus between the two groups. Compared with non-sepsis group, Neut, Lac, CRP and PCT in sepsis group were significantly increased [Neut:0.81±0.09 vs. 0.74±0.15, Lac (mmol/L): 3.04±0.61 vs. 2.00±0.43, CRP (mg/L): 44.09±8.37 vs. 40.54±8.37, PCT (μg/L): 0.34±0.12 vs. 0.31±0.11], with significant differences (all P < 0.05). But there was no statistical difference in WBC or PLT between the two groups. The multivariate Logistic regression model incorporated the indicators with statistical significance in univariate analysis. The results showed that Lac was an independent factor of sepsis in patients with hepatic failure [odds ratio (OR) = 58.286, 95% confidence interval (95%CI) = 16.633-204.247, P =0.000]. Conclusions For patients with hepatic failure infection, the ratio of G+ bacteria increased year by year. Elevated Lac is an independent risk factor for sepsis in patients with liver failure.
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Objective To summarize the clinical outcomes of surgical correction of velophary geal insufficiency (VPI) with two procedures of radical intravelar veloplsties,and to discuss the indication selection of surgical technique.Methods 58 cases of various cleft palate were speech evaluated and diagnosed as mild to moderate VPI,who aged from 3 to 28 years (mean age 7.5 years).Group Ⅰ (36 cases) were performed surgery in the way of modified Furlow double-opposing Z-plasty.Group Ⅱ (22 cases) were performed surgery in the way of Sommerald radical IVV.All cases were followed up for 6 months to 1 year after surgery,with speech evaluation and objective examination of nasopharygoscopy and fixed position lateral X ray.The X-ray images of lateral view of velum was read through PACS image system.The effective work length of soft palate and the pharyngeal gap of the velum at rest and function were measured directly through PACS system.The data of each case before and after surgery were compared.Results 34 of 36 cases (94.50％) in modified-Furlow group and 21 of 22 cases (95.5％) in Sommerlad group finally recovered complete velopharyngeal closure.Compared between before and post operation,the effective work length of soft palate in modified Furlow group increased by 9.50±2.35 mm,the length in Sommerlad group increased by 7.50±3.32 mm.The differences were statistically significant by paired T test (P＜0.001).None of all cases complained nasal airway obstruction.Conclusions Both types of radical IVVs are highly effective to be recommended for surgical correction of mild to moderate VPI.Strict selection of surgical indication and excellent surgical skill are necessary for good treatment outcomes.
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Objective To investigate the effect of cartilage acetabular ,glenoid labrum and acetabular tissue on closed reduction of developmental dysplasia of hip ( DDH ) by analyzing the outcomes of the ultrasound measurement on DDH before and after Pavik Harness treatment . Methods Graf method was used in ultrasound measurement before the treatment . Position of cartilaginous acetabulum and glenoid labrum and displacement direction of femoral head in 31 patients with hip dislocations ( type D ,type Ⅲ ,typeⅣ ,36 hips) were recorded . T he follow‐up testing with ultrasound measurement on the inside of the hip were performed after 1 －2 weeks of Pavik Harness treatment . M ediolateral dimension ,anteroposterior dimension and the area of maximum section of acetabular tissue were measured . Reduction effects were evaluated . Results T he success rate of reduction of dislocation hips with cartilaginous acetabulum on the head orientation was obviously higher than that on the foot orientation( P ＜0 .000 1) . T he success rate of reduction of dislocation hips with glenoid labrum on the head orientation was obviously higher than that on the foot orientation ( P ＝ 0 .001 6 ) . T here was a statistically significant difference in the success rate of different types of hip dislocation ( type D , type Ⅲ , type Ⅳ ) ( P＝ 0 .002 7 ) . T here were statistically significant differences in mediolateral dimension ,anteroposterior dimension and the area of maximum section of acetabular tissue between the reduction group and the group without dislocation ,the irreducible group and the group without dislocation ,the irreducible group and the reduction group ( P ＜ 0 .01) . Conclusions Ultrasonography is of great significance in the diagnosis and treatment of children with DDH . T he position of hip cartilaginous acetabulum and glenoid labrum ,types of hip dislocation and the volume of acetabular tissue have important effects on the success of the closed reduction .
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Objective To assess the trends and characteristics of CD 4 +T lymphocyte counts among patients with acquired immune deficiency syndrome ( AIDS) in Tianjin City.Methods The demographic and clinical characteristics of AIDS patients diagnosed in Tianjin Second People′s Hospital from 2005 to 2017 were analyzed.The CD4 +T lymphocyte count and the frequency of CD 4+T lymphocyte count ＜200 cells／μL were analyzed according to age , transmission route and education level.The chi-square test was used for counting data.The rank sum test was used for the data that did not conform to normal distribution .Results The 3 062 patients were aged (38.2 ±11.9) years.There were 2 867 males (93.6%) aged (37.8 ±11.8) years, and 195 female patients ( 6.4%) aged (43.3 ±12.6) years.The CD4+T lymphocyte counts of these patients presented an increasing trend from 2005 to 2017, with statistically significant differences among different years (Z＝18.871, P＜0.05).The frequency of CD4 +T lymphocytes ＜200 cells／μL showed a decreasing trend , with statistically significant difference in different years (χ2 ＝7.017,P＜0.05).The CD4+T lymphocyte counts in patients of all age groups showed an increasing trend from 2005 to 2017, with statistically significant differences (Z＝6.849, 9.532, 7.146, 6.874, 8.038, 11.249, and 10.059, respectively, all P＜0.05).The CD4+T lymphocyte counts in homosexual patients presented an increasing trend , with statistical significance in different years (Z＝8.038, P＜0.05).The CD4+T lymphocyte counts in patients who received education more than 13 years (include 13 years) presented an increasing trend , with statistical significance (Z＝4.573, P＜ 0.05).Conclusions The median CD4+T lymphocyte counts of AIDS patients receiving primary treatment in Tianjin city are increasing by years , while the proportion of severe immunosuppression is decreasing.Patients who are infected through homosexual transmission and those with high level of education seek medical care earlier.