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Objective:The aim of the present study was to re-evaluate the diagnostic value and optimal cutoff point of captopril challenge test (CCT) in diagnosis of primary aldosteronism (PA).Methods:This is a retrospective study. All patients with a high risk for PA underwent screening test, and then proceeded to CCT and fludrocortisone suppression test (FST) on different days. The FST was used as a reference standard for PA. The plasma renin concentration (PRC) and plasma aldosterone concentration (PAC) were measured with an automated chemiluminescence immunoassay. Random number method was performed in the patients with unilateral primary aldosteronism (UPA), in order to make the proportion of the analyzed UPA in PA was 35%. Receiver operating characteristic (ROC) analyses were performed to compare diagnostic accuracy.Results:A total of 543 patients with 400 PA patients and 143 essential hypertension (EH) patients were enrolled. The diagnostic value of post-CCT PAC was significantly higher than that of the post-CCT plasma aldosterone-renin ratio (ARR), and that of the PAC suppression percentage, respectively. The area under the ROC curve (AUC ROC) was 0.86 (0.83, 0.89) for PAC, 0.78 (0.74, 0.82) for ARR, and 0.62 (0.56, 0.67) for the PAC suppression percentage (all P<0.01), respectively. The optimal cutoff point of post-CCT PAC for PA was 110 ng/L, in which the sensitivity and specificity were 73.25% and 79.02%, respectively. The diagnostic efficiency of post-CCT PAC was not improved either in combination with PAC suppression percentage or in combination with post-CCT ARR. Conclusions:CCT is a useful test for the confirmation of PA. PAC level of 110 ng/L at 2 h after 50 mg of captopril is recommended as an optimal cutoff point for the diagnosis of PA.
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Objective:To explore the role of hierarchical teaching based on the "competency-based" concept in the standardized training of respiratory nursing interns.Methods:A total of 70 nursing interns who came to the Department of Respiratory Medicine in Beijing Jishuitan Hospital for standardized training from September 2019 to August 2020 were selected as the study subjects. They were randomly divided into the study group and the control group by coin tossing method, 35 in each group. The study group used hierarchical teaching based on the "competency-based" concept, while the control group adopted conventional hierarchical teaching. The nursing ability and teaching quality of the two groups of nurses were compared. SPSS 23.0 was used for t-test and Chi-square test. Results:The theoretical knowledge scores of the nurses in the two groups after the standardized training [(95.29±3.13), (86.29±5.13)] were higher than those before the training [(78.22±4.48), (77.29±5.13)]. The scores of theoretical knowledges, operation skills, medical record reporting, and the comprehensive quality scores of the study group after the standardized training were higher than those of the control group, and the differences were statistically significant ( P<0.05). The satisfaction of teaching quality in study group was higher than that in control group, and the difference was statistically significant ( P<0.05). Conclusion:The hierarchical teaching based on the "competency-based" concept can significantly improve the teaching quality in the standardized training and the comprehensive quality of respiratory nursing interns, which is worthy of application.
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Objective:To explore the proportion of obstructive sleep apnea (OSA) in primary aldosteronism (PA) in Chinese population and compare the clinical characteristics between PA patients with OSA and those without.Methods:A total of 96 patients diagnosed with PA from September 2015 to November 2018 were recruited in this study. OSA was screened by cardio-respiratory polygraphy. According to the apnea hypopnea index (AHI), the patients were divided into PA with OSA group (AHI ≥5 times) and PA without OSA group (AHI<5 times).Results:Among all patients (96), 69 (71.9%) were with OSA, among them 22 patients (22.9%) were with mild OSA, 17 patients (17.7%) were with moderate OSA and 30 patients (31.3%) were with severe OSA. Compared with the patients without OSA, the patients with OSA were elder, and had higher levels of body mass index (BMI), waist circumference (WC), hip circumference (HC), creatinine (CR) and glycosylated haemoglobin (HbA1c) ( P<0.05), but lower concentrations of plasma aldosterone (PAC), supine aldosterone renin concentration ratio(ARR) and the PAC after the diagnosis test ( P<0.05). Spearman correlation analyses showed that BMI, WC, HC, CR and HbA1c were positively correlated with AHI ( P<0.05), while high-density lipoproteincholesterol (HDL-C), supine-PAC and saline infusion test(SIT)-post PAC were negatively correlated with AHI ( P<0.05). Conclusions:The proportion of OSA in PA patients is relatively high (71.9%). Metabolic abnormalities are more common in PA patients with OSA, indicating that screening for OSA should be carried out routinely in PA patients.
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OBJECTIVE：To investigate the effects of parecoxib sodium ，flurbiprofen axetil and lornoxicam combined with patient controlled intravenous analgesia （PICA） on postoperative analgesia in patients undergoing gynecological laparoscopic surgery and its effect on serum related factors. METHODS ：A total of 280 patients who underwent gynecologic laparoscopic surgery in the Second Affiliated Hospital of Hainan Medical University from Mar. 2017 to Mar. 2019 were randomly divided into control group （group C ），parecoxib sodium group （group P ），and flurbiprofen axetil group （group F ）and lornoxicam group （group L ）acording to random number table ，with 70 patients in each group. Four groups of patients received Sodium chloride injection 5 mL，Parecoxib sodium for injection 40 mg，Flurbiprofen axetil injection 50 mg and Lornoxicam for injection 8 mg （added 8 mg when the effect was not good ）intravenously at 30 min before the end of surgery. At the end of surgery ，they were given PICA of Sufentanil citrate injection and Dizosin injection for analgesia. The situation of pain and nausea symptom were evaluated at 6，12，24 and 48 h after surgery by using numerical rating scale （NRS）. The levels of serum CRP ，IL-6，SP and PGE 2 were detected by chemiluminescence method and ELISA. The times of pressing PICA pump and the dosage of analgesic were recorded in 4 groups within 24 h after surgery. The ADRs of patients within 48 h after surgery were recorded ，such as bloating ， dizziness，itchy skin ，respiratory depression and urinary retention. RESULTS ：At different time points ，the NRS scores of pain of group P ，F and L were significantly lower than those of group C ；and 48 h after surgery ，NRS score of pain of group L was significantly lower than those of group P and F （P＜0.05）. There was no statistical significance in the level of CRP ，IL-6，SP and PGE2 of 4 groups before surger （P＞0.05）. The CRP ，IL-6，SP and PGE 2 levels at each time point after surgery of group P ，F and L were significantly lower than those of group C ；compared with group P ，serum level of SP at 48 h after surgery as well as serum levels of PGE 2 at 12，24 and 48 h after surgery were significantly decreased in group F ，and serum level of IL- 6 at 48 h after surgery，serum levels of SP at 24 and 48 h after surgery ，serum levels of PGE 2 at 12，24，48 h after surgery were decreased significantly in group L ；compared with group F ，serum level of SP at 48 h after surgery as well as serum levels of PGE 2 at 12， 24，48 h after surgery were all decreased significantly in group L （P＜0.05）. There was no statistical significance in the incidence of anausea and vomiting among 4 groups（P＞0.05）. CONCLUSIONS ：Parecoxib sodium ，flurbiprofen axetil and lornoxicam combined with PICA can effectively relieve the pain of patients after gynecological laparoscopic surgery and reduce the levels of serum related factor ，and lornoxicam has the most obvious effect.
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Objective@#To compare the detection efficiency of the ratio of plasma aldosterone concentration to renin concentration (ARR) measured by imported and domestic chemiluminescent immunoassay kits for screening primary aldosteronism (PA) .@*Methods@#A total of 164 patients with essential hypertension and 64 patients with PA were recruited in this study. Plasma aldosterone concentration (PAC) and renin concentration (PRC) were measured concurrently by imported chemiluminescent immunoassay kit (Diasorin, Italy) and domestic kit (Mindray, Shenzhen, China) , and then ARR were calculated. A ROC curve analysis was performed to compare the screening efficacy of the two kits and the optimal ARR cut-offs for PA screening were recommended according to Youden’s index.@*Results@#The areas under the ROC curves (AUCROC) of ARR were 0.937 (95% CI 0.897-0.965, P<0.0001) detected by imported kit and 0.942 (95% CI 0.903-0.968, P<0.0001) detected by domestic kit. The difference of AUCROC of ARR detected by two kits was 0.00457 (95% CI -0.0210-0.0302, P<0.7263) .The highest Youden’s indexes of ARR were 0.749 (detected by imported kit) with the cut-off value of 12.8 (pg/ml) / (μIU/ml) (sensitivity 96.87%, specificity 78.05%) and 0.756 (detected by domestic kit) with the cut-off value of 12.5 (pg/ml) / (μIU/ml) (sensitivity 89.06%, specificity 86.59%) .@*Conclusions@#There was no significant difference between domestic and imported chemiluminescent immunoassays in the screening efficiency of ARR for PA.
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Objective To compare the detection efficiency of the ratio of plasma aldosterone concentra-tion to renin concentration (ARR) measured by imported and domestic chemiluminescent immunoassay kits for screening primary aldosteronism (PA). Methods A total of 164 patients with essential hypertension and 64 pa-tients with PA were recruited in this study. Plasma aldosterone concentration (PAC) and renin concentration (PRC) were measured concurrently by imported chemiluminescent immunoassay kit(Diasorin, Italy) and domestic kit (Mindray, Shenzhen, China), and then ARR were calculated. A ROC curve analysis was performed to compare the screening efficacy of the two kits and the optimal ARR cut-offs for PA screening were recommended according to Youden's index. Results The areas under the ROC curves (AUCROC) of ARR were 0.937 (95％ CI 0.897-0.965, P<0.0001) detected by imported kit and 0.942 (95％ CI 0.903-0.968, P<0.0001) detected by domestic kit. The difference of AUCROC of ARR detected by two kits was 0.00457 (95％ CI -0.0210-0.0302, P<0.7263).The highest Youden's indexes of ARR were 0.749 (detected by imported kit) with the cut-off value of 12.8(pg/ml)/(μIU/ml)(sensitivity 96.87％, specificity 78.05％) and 0.756 (detected by domestic kit) with the cut-off value of 12.5 (pg/ml)/(μIU/ml)(sensitivity 89.06％, specificity 86.59％). Conclusions There was no significant difference between domestic and imported chemiluminescent immunoassays in the screening efficiency of ARR for PA.
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Objective To evaluate the intervention effects of peer support education mode for type 2 diabetes control in rural residents.Methods A random cluster sampling method has been used,including 300 rural residents aged above 18 years old from three villages (184 in control group,116 in intervention group),in order to proceed the physical check-up and health education programs.Unchanged rate,transfer rate of patients,rate of impaired glucose tolerance,turn normal rate and other biochemical indicators of patients and people with impaired glucose tolerance from control group and intervention group were analyzed,to evaluate the intervention effects of peer support education mode.Results The glycemic control rate of intervention group for patients and people with impaired glucose tolerance (72.2％ and 71.4％) were higher than control group (43.6％ and 26.7％),but the unchanged rate of intervention group (13.9％ and 0.0％) were lower than control group (42.3％ and 73.3％).Patients with diabetes or glucose intolerance in the education group improved significantly in waist-to-hip ratio,uric acid,total cholesterol and HDL-C.Glycemic hemoglobin level also improved significantly in diabetes patients of the education group.Conclusion Peer support for education intervention seemed beneficial for diabetic control.The combination of education and effect evaluation was important in the evaluation of diabetes prevention and control.Peer support education also benefited the blood glucose control in general population.
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Objective To evaluate the intervention effects of peer support education mode for type 2 diabetes control in rural residents.Methods A random cluster sampling method has been used,including 300 rural residents aged above 18 years old from three villages (184 in control group,116 in intervention group),in order to proceed the physical check-up and health education programs.Unchanged rate,transfer rate of patients,rate of impaired glucose tolerance,turn normal rate and other biochemical indicators of patients and people with impaired glucose tolerance from control group and intervention group were analyzed,to evaluate the intervention effects of peer support education mode.Results The glycemic control rate of intervention group for patients and people with impaired glucose tolerance (72.2％ and 71.4％) were higher than control group (43.6％ and 26.7％),but the unchanged rate of intervention group (13.9％ and 0.0％) were lower than control group (42.3％ and 73.3％).Patients with diabetes or glucose intolerance in the education group improved significantly in waist-to-hip ratio,uric acid,total cholesterol and HDL-C.Glycemic hemoglobin level also improved significantly in diabetes patients of the education group.Conclusion Peer support for education intervention seemed beneficial for diabetic control.The combination of education and effect evaluation was important in the evaluation of diabetes prevention and control.Peer support education also benefited the blood glucose control in general population.
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Objective To analyze the effect of intrathecal injection of dexmedetomidine on the behavioral activity, pain degree and expression of protein kinase C in spinal dorsal horn of rat models of chronic neuropathic pain, and to investigate the analgesic mechanism of dexmedetomidine.Methods 75 healthy male rats were randomly divided into observation group, model group and control group, 25 rats in each group.Chronic sciatic nerve injury model was established in the observation group and model group.After modeling, intrathecal dexmedetomidine intervention was used in the observation group.The model group was treated with saline injection and there was no intervention in the control group.Before the modeling (BM)and at 3(D3), 5(D5), 7(D7), and 14 (D14)days after medicine administration, the behavioral capacity was evaluated by cumulative evaluation method and movement function evaluation, and the assessment of pain degree (mechanical withdrawal method and thermal withdrawal latency pain threshold detection method), PKC staining score (immunohistochemical SABC method), PKC mRNA assay (RT-PCR method) and PKC protein expression (Western blot) were conducted and the data were statistically analyzed.Results ① Before modeling, the behavior, the cumulative scores of motor function, MWT, and TWL showed no significant differences between the different groups (P>0.05).After modeling, the model group and observation group showed that the cumulative scores and motor function scores were increased significantly, MWT and TWL decreased significantly, and the changes in the observation group were significantly lower than those in the model group (P<0.05).After modeling, the cumulative scores, motor function scores, MWT, and TWL were significantly different between the groups (P<0.05).② The expression of PKC was negative in the control group and positive in the model group.In the observation group, after the initial establishment of model, the PKC was strongly positive, and along with the prolonged treatment, the PKC expression intensity was decreased, and only weakly positively expressed at 14 d.③ After modeling, the observation group and model group showed that the PKC mRNA and PKC protein expression levels were significantly higher than that of the control group (P<0.05).With the continuous drug administration, the PKC mRNA and PKC in the observation group were decreasing, and reached a level close to that of the control group at 14 d of drug administration.From the third day after modeling, at the same time points, the amount of PKC expression in the observation group was significantly lower than that in the model group (P<0.05).Conclusions Intrathecal injection of dexmedetomidine can improve the behavior of rat models with chronic neuropathic pain, and reduce the degree of pain.It may be related to the inhibition of protein kinase C expression in the spinal dorsal horn.
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Objective To evaluate efficacy of propofol compared with sevoflurane on inflammatory factor and liver function after hepatectomy. Methods 40 cases with hepatectomy were divided into propofol group ( P group) and sevoflurane group ( S group) , 20 cases in each group.The P group and S group respectively were given propofol or sevoflurane maintained anesthesia.The alanine aminotransferase( ALT) , total bilirubin( TBil) , aspartate amino transferase(AST), albumin(ALB), plasma tumor necrosis factor(TNF-α), interleukin-6(IL-6), interleukin-10(IL-10)and complication rate were compared between two groups.Results Postoperation 1d, 3d and 7d, the AST, ALT, and TBiL levels of S group were significantly lower than those of P group (P0.05].Conclusion Sevoflurane inhalation could effectively inhibit the plasma inflammatory cytokines secretion after hepatectomy, and promote liver function recovery, its effect is better than that of propofol.
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Objective To compare the accuracy of BIS and skin conductance (SC) for assessment of the depth of sedation induced by target-controlled infusion (TCI) of propofol. Methods Thirty ASA Ⅰ orⅡpatients aged 21-56 yr weighing 52-85 kg undergoing orthopedic operation on the lower limb under epidural anesthesia were enrolled in this study.After the onset of epidural anesthesia, TCI of propofol was started at an initial target plasma concentration (Cp) of 0.8 μg/ml. Th Cp was increased by 0.5-0.8 μg/ml every 3 min until OAA/S score=1. OAA/S score, BIS and SC values were recorded, SC change value (△SC) was calculated. Spearman rank-order correlation, receiver operating characteristic curve (area under curve AUC was calculated) and logistic regression were used to analyze the relationship of OAA/S score to BIS and △SC.Results BIS and △SC were significantly correlated with OAA/S scores (r were 0.920 and-0.859 respectively). The AUC of △SC (0.919, 0.946) was significantly better correlated with OAA/S score (5→4, 4→3) than that of BIS (0.761, 0.507), while BIS was better correlated (0.781, 0.959) with OAA/S score (3→2, 2→1) than ASC (0.577, 0.630). Logistic regression correctly predicted loss of consciousness. The accuracy of prediction was 93% for BIS and 82% for △SC. Conclusion The accuracy of SC for assessment of the depth of sedation induced by propofol TCI ishigher than that of BIS before loss of consciousness,while lower than that of BIS after loss of consciousness. BIS is more accurate in monitoring the loss of consciousness.
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Objective Health education was provided among driving coaches with overweight or obesity to improve their self-healthcare awareness.Methods Of 116 driving coaches from Changping District who underwent physical examinations and biochemical tests, 79 were confirmed to have overweight or obesity and received body weight management.Results Following 3 years of health management, 79 overweight or obese participants showed significant improvement in waist circumference ((93.5±8.4) vs (92.0±9.5) cm), systolic blood pressure ((130.8±12.4) vs (127.8±11.6) mm Hg, 1 mm Hg=0.133 kPa), diastolic blood pressure ((87.0±9.7) vs (85.6±9.3) mm Hg), high-density lipoprotein cholesterol ((1.1±0.4) vs (1.2±0.3) mmol/L), and glucose ((5.6±1.5) vs (5.4±1.6) mmol/L) (all P0.05).Conclusion Overweight and obesity in middle-aged adults is of concern and needs long-term effective interventions.
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Objective To investigate the effect of rocuronium on spectral entropy during induction of general anesthesia in patients of Uygur nstionality. Methods Forty ASA Ⅰ or Ⅱ patients (Uygur nationality) of both sexes, aged 20-50 yr, weighing 45-70 kg, undergoing elective surgery under general anesthesia, were divided into 2 groups ( n = 20 each): normal saline (NS) group and rocuronium group (group R). Anesthesia was induced with target-controlled infusion of propofol. The initial target plasma concentration wan net at 2 μg/ml. The concentration wan then increased by 0.5 μg/ml every 4 min until response entropy (RE) was decreased to 45 and maintained for 4 min. When the plasma concentration was equal to the effect-site concentration, iv rocuronium 0.6 mg/kg was injected in group R, while group NS received the equal volume of NS instead. Fentanyl 3 μg/kg was injected intravenously at 3 min after recuronium administration. The patients were tracheal intubated and mechanically ventilated. State entropy (SE) and RE were recorded immediately before induction (baseline, To), before rocuronium administration (T1), 2 main after rocuronium administration (T2) and at 0, 1, 2 and 3 min after intubation (T3-6). The difference between RE and SE wan calculated. Results The RE value at T3 and T4 and the difference between RE and SE at T2.5 were significantly lower in group R than in group NS ( P ＜ 0.05). Conclusion Rocuronium can decrease the RE value and degree of increase in the difference between RE and SE during induction of general anesthesia in patients of Uygur nationality, which may affect the accuracy of spectral entropy in monitoring the depth of anesthesia.
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Objective To explore the relationship of hypertension prevalence and body weight in children and teenagers in Changping district of Beijing. Methods With stratified cluster sampling, 4 247 students (2 090 female and 2 157 male) aged 7~18 yrs from primary and middle schools in Changping district were investigated in May to October, 2007, and examined on their body height, weight, systolic pressure, diastolic pressure, fasting blood glucose, etc. Data was analyzed with SPSS11.5. Result The rate of overweight and obesity was 13.47% 572 / 4 247); Hypertension 30.02% (1 275 / 4 247); The prevalence rates of hypertension in children-teenagers with overweight & obesity and with normal weight were 53.15% and 27.40%, respectively,(?2=153.74, P
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Objective To determine the specific recognition of Echinococcus granulosus (E.g.) cyst fluid crude antigen (EgCF) and antigen B (EgB) by serum specific IgG and IgE using Western blotting during anaphylactic shock induced by E. g. in sheep, and to investigate the importance of defined characteristics and molecular weight of the specific antigens. Methods EgCF was obtained through local slaughterhouses in Urumqi from the cysts of infected sheep liver. Western blotting was used to analyze total specific IgG and IgE antibodies in serum from sheep infected with E.g. using either crude antigen of E. g. and EgB, and to understand specific recognition of hydatid cyst antigens by serum total IgG and specific IgE. Results SDS-PAGE and Western blotting showed that there were differences between EgB and EgCF in electrophoresis pattern. EgB was recognized by IgG from sera of infected sheep in a series of bands with molecular weight ranging from 31, 43 to 66.2 kDa. No binding of IgG against EgCF was observed in any serum from the infected sheep during anaphylactic shock. In contrast, specific IgE antibodies in E. g. infected sheep obviously recognized the single 43 kDa subunit of EgCF, but no binding of specific IgE against EgB was observed in sera of the infected sheep. Conclusion EgCF is consisted of antigenic components in which there is a specific antigen against IgE with a molecular weight of over 43 kDa. This component may lead to an anaphylactic shock induced by E. g. . EgB is a specific antigen against the total IgG but not to the specific IgE.
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Objective To investigate the change of specific antibodies IgG, IgG1 subclass and IgE in sheep infected with Echinococcus granulosus(E.g) during anaphylactic shock, and to observe antigen B reactivity against IgG antibody in E.g\|infected sheep. \ Methods\ Antigen B and crude antigen were prepared with E.g cyst fluid (EgCF) from infected sheep. The enzyme\|linked immunosorbent assay(ELISA) was used for detecting the level of specific IgG, IgG1 and IgE during anaphylactic shock in sheep induced by E.g. \ Results \ The level of specific IgG, IgG1 and IgE was significantly higher in the infected sheep after 6 months than that of the uninfected control group (P