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Objective:To analyze the influenza vaccination status of chronic disease management patients in Qingpu district of Shanghai and the vaccination characteristics of different characteristic populations, so as to provide scientific basis for improving the influenza vaccination rate of chronic disease patients in the community.Methods:By comparing the data of Shanghai chronic disease management information system, immunization planning information system and medical association platform, 89 453 subjects who met the inclusion and exclusion criteria in Qingpu district were selected as the research objects. The vaccination coverage rate of the study subjects was calculated according to gender, age group, urban and rural distribution, occupation, chronic disease type and quantity, and the vaccination coverage rate of different subgroups was compared to analyze the influencing factors of vaccination coverage rate.Results:Most of the 89 453 patients with chronic diseases were 60 years old and above (71.93%). Patients with hypertension, diabetes, chronic obstructive pulmoriary disease (COPD) and three chronic diseases accounted for 87.12%, 28.67%, 8.71% and 1.83%, respectively. Influenza vaccination coverage in the 2016/2017 flu season was low, at 0.32%. Influenza vaccination coverage rate of women (0.37%) was higher than that of men (0.27%), which was 1.41 times respectively(95% CI: 1.16, 1.72) that of men patients. The coverage rate of influenza vaccination for the 70-79 year-old group was the highest (0.74%), which was 1.74 times respectively(95% CI: 1.39, 2.19) that of 60-69 year-old patients. The vaccination coverage rate of government departments and institutions was the highest (1.14%), which was 12.58 times respectively(95% CI: 4.52, 34.99) that of retirees. The vaccination rate of COPD patients (3.68%) was 2.50 times (95% CI: 1.66, 3.77) higher than that of patients without COPD.Conclusions:Influenza vaccination rate for chronic disease management patients in Qingpu district of Shanghai is low. Gender, occupation, age and types of chronic diseases are the influencing factors. Patients with chronic disease management should be included in the priority vaccination targets for influenza vaccines, and vaccination intervention for occupational chronic diseases such as non-retired agriculture and forestry patients, especially male patients, should be strengthened to improve influenza vaccination coverage rate.
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Objective:To explore the value of peripheral blood ionized calcium on the prognosis of elderly patients with sepsis.Methods:The clinical data of 73 elderly patients with sepsis from January 2018 to June 2019 in Shanghai Minhang Hospital, Fudan University, were retrospectively analyzed. Among them, 19 patients died within 28 days (death group), and 54 patients survived (survival group). The peripheral blood ionized calcium, procalcitonin (PCT), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and arterial lactic acid were compared between 2 groups. The risk factors affecting prognosis in elderly patients with sepsis was analyzed by multivariate Logistic regression. The receiver operating characteristic (ROC) curve was used to analyze the ability of each indicator in evaluating the prognosis.Results:The peripheral blood ionized calcium in death group was significantly lower than that in survival group: (0.93 ± 0.07) mmol/L vs. (1.05 ± 0.16) mmol/L, the PCT and APACHE Ⅱ were significantly higher than those in survival group: 2.43 (1.89, 3.76) μg/L vs. 1.34 (1.05, 2.72) μg/L and (20.20 ± 2.86) scores vs. (17.40 ± 3.95) scores, and there were statistical differences ( P<0.01); there was no statistical difference in arterial lactic acid between 2 groups ( P>0.05). Multivariate Logistic regression analysis result showed that the peripheral blood ionized calcium and PCT were independent risk factors affecting the prognosis in elderly patients with sepsis ( OR = 1.634 and 1.876, P<0.05). The ROC curve analysis result showed that the area under curve (AUC) of peripheral blood ionized calcium for the prognosis in elderly patients with sepsis was 0.844 (95% CI 0.740 to 0.918), the optimal cut -off value was 0.89 mmol/L, with a sensitivity of 83.3% and a specificity of 79.0%; the AUC of PCT for the prognosis in elderly patients with sepsis was 0.880 (95% CI 0.783 to 0.944), the optimal cut -off value was 2.79 μg/L, with a sensitivity of 81.4% and a specificity of 89.5%. Conclusions:The level of peripheral blood ionized calcium can predict the clinical outcome of elderly patients with sepsis.
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Objective To evaluate the effect of donor-derived infection on the clinical prognosis of the recipients undergoing liver transplantation. Methods Clinical data of 75 donors and recipients undergoing liver transplantation were retrospectively analyzed. According to the culture results of donor organ lavage fluid, all recipients were divided into the positive group (n=26) and negative group (n=49). Clinical parameters of the recipients during perioperative period were observed in the positive and negative groups. The sputum and peritoneal drainage fluid of the recipients undergoing liver transplantation were cultured. The incidence of postoperative infection of the recipients was observed. The 1.5-year survival curve of the recipients was analyzed by Kaplan-Meier method. Results In the positive group, the incidence of portal vein stenosis and thrombosis was significantly higher than that in the negative group (P < 0.05). Among 75 recipients undergoing liver transplantation, 33 cases (44%) developed postoperative infection mainly in the lung and abdominal cavity. The infection rate significantly differed between the positive group (77%) and negative group (27%, P < 0.05). In the positive group, sputum culture was positive in 10 recipients and peritoneal drainage culture was positive in 11 recipients. The sputum culture outcomes of 4 recipients were consistent with those of the organ lavage fluid culture of their donors. The peritoneal drainage culture results of 6 recipients were consistent with those of the organ lavage fluid culture of their donors. After anti-infection treatment, 2 recipients in the positive group died at postoperative 5 and 12 d, and the culture results of the remaining recipients were negative. In the negative group, 7 recipients were positive for sputum culture and 6 recipients were positive for peritoneal drainage culture. The culture results of all recipients were negative following anti-infection therapy. Two recipients died from graft failure at postoperative 1 month and 1 year. The 1.5-year survival rate did not significantly differ between the positive and negative groups (P > 0.05). Conclusions The effect of donor-derived infection on the early prognosis of liver transplant recipients cannot be neglected, whereas it exerts mild impact on the intermediate- and long-term clinical prognosis of the recipients.
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Objective To retrospectively explore the clinical symptoms ,diagnosis ,treatment and prognosis of posttransplant lymphoproliferative disorder (PTLD) after pediatric liver transplantation .Methods The diagnosis and treatment of PTLD were reviewed for 3 children recipient with living donor liver transplantation .Their primary diseases were biliary atresia ,glycogen storage disease type III and ornithine-transcarbamylase deficiency . All of them received FK506 for immunosuppression therapy . They were diagnosed as PTLD at 7 ,8 ,6 months post-operation respectively .Their major clinical manifestations were non-specific ,including fever ,diarrhea and anemia .Positron emission tomography/computed tomography (PET/CT) and ultrasound revealed enlarged mesenteric lymph nodes with neck lymphoadenopathy (n=2) . Pathological examinations of resected enlarged lymph nodes indicated post-transplantation lymphoproliferative disorder .One case was diffuse large B cell lymphoma and two of them belonged to preliminary EBER + . Results After a definite diagnosis ,there was one cycle of R-CHOP regimen (rituximab ,cyclophosphamide , pirarubicin ,vincristine ,dexamethasone) or 2 cycles of rituximab along with a .reduction of anti-rejection drug and they stayed in remission .Three were followed up for 37 ,39 and 20 months respectively from May 31 , 2019 . Currently transplanted liver function was stable and EBV viral load remained negative persistently .Conclusions This case highlights the complexity of clinical presentations and co-morbidities of PTLD . Reducing immunosuppressive agents and using rituximab plus chemotherapy can achieve a satisfactory efficacy for Epstein-Barr virus-related PTLD patients after pediatric liver transplantation .
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Objective To investigate the associations of obesity and physical activity with cognition in the elderly.Methods A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai.The subjects' body weight,body height,waist circumference and hip circumference were measured to calculate body mass index (BMI) and waist-hip ratio (WHR),and the data on self-reported physical activity level were collected through questionnaire survey.A comprehensive battery of cognitive tests was conducted to assess subjects' cognitive functions,including verbal recall,forward digit span (FDS),backward digit span (BDS),and verbal fluency (VF).General linear model was used to examine the associations of BMI,WHR and physical activity with cognition.Results A total of 7 913 participants were included,with a median age of 60 years.Age,sex,education level,income level,BMI,WHR and physical activity level were significantly associated with cognitive scores in univariate analysis.After adjusted for age,sex,education level and income level,BMI was no longer significantly associated with cognitive scores in all cognitive functions (all P＞0.01).WHR was significantly associated with VF score (P＜0.01).Abdominally obese participants had lower VF score than non-abdominally obese participants (P＜0.01).Physical activity level was significantly associated with all cognitive functions (P＜0.01).Compared with participants with moderate physical activity level,participants with low physical activity level had lower scores in all cognitive functions (P＜0.01).Conclusion Abdominal obesity and low physical activity level were negatively associated with cognition level in the elderly,suggesting that waist circumference control and physical activity might help maintain cognition in the elderly.
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Objective To investigate the associations of obesity and physical activity with cognition in the elderly.Methods A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai.The subjects' body weight,body height,waist circumference and hip circumference were measured to calculate body mass index (BMI) and waist-hip ratio (WHR),and the data on self-reported physical activity level were collected through questionnaire survey.A comprehensive battery of cognitive tests was conducted to assess subjects' cognitive functions,including verbal recall,forward digit span (FDS),backward digit span (BDS),and verbal fluency (VF).General linear model was used to examine the associations of BMI,WHR and physical activity with cognition.Results A total of 7 913 participants were included,with a median age of 60 years.Age,sex,education level,income level,BMI,WHR and physical activity level were significantly associated with cognitive scores in univariate analysis.After adjusted for age,sex,education level and income level,BMI was no longer significantly associated with cognitive scores in all cognitive functions (all P＞0.01).WHR was significantly associated with VF score (P＜0.01).Abdominally obese participants had lower VF score than non-abdominally obese participants (P＜0.01).Physical activity level was significantly associated with all cognitive functions (P＜0.01).Compared with participants with moderate physical activity level,participants with low physical activity level had lower scores in all cognitive functions (P＜0.01).Conclusion Abdominal obesity and low physical activity level were negatively associated with cognition level in the elderly,suggesting that waist circumference control and physical activity might help maintain cognition in the elderly.
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Objective To research the acute adverse effects of air pollution on the risk of stroke in the air pollution exposed people.Methods Daily counts of strokes occurrence (2004-2007) were obtained from the population-based stroke registry in one district of Shanghai.Air pollution data was obtained from the Shanghai Environmental Monitoring Center.A semi-parametric generalized additive model was used to study the acute effects of air pollution on stroke occurrence after controlling for long-term and seasonal trends,weather variables,and day of the week.Results The relative risks of stroke occurrence for per 10 ?g/m3 increase of PM10,SO2 and NO2 were 1.02 (95%CI:1.01-1.03),1.05 (95%CI:1.04-1.06) and 1.09 (95%CI:1.08-1.10),respectively.Conclusion The study has provided a new evidence for the association between air pollution and risk of stroke occurrence.