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ObjectiveTo understand the situation about time interval between the onset and medical visit among tuberculosis patients in Huaibei City， Anhui Province from 2017 to 2021， and to determine the delayed medical visit and its risk factors， as to provide evidence for tuberculosis prevention and control. MethodsCase information of confirmed tuberculosis patients in Huaibei City in 2017‒2021 was collected from the tuberculosis management information system. Factors associated with time interval between the onset and medical visit were analyzed using rank sum test and multivariate linear regression. Furthermore， factors associated with the delayed medical visit were determined by Chi-square test， Chi-square Cocharan⁃Mantel⁃Haensze test and logistic regression. ResultsThe median time interval between the onset of tuberculosis and medical visit were 22 days among the tuberculosis patients in Huaibei City from 2017‒2021， and the proportion of delayed medical visit was 68.57%. There was an overall decreasing trend in the proportion of delayed medical visit over years （χtrend2=17.342， P=0.002）. Using the multivariate linear regression， positive for Mycobacterium Tuberculosis in the pathogenic diagnosis， and presence of comorbidities were determined to be the risk factors associated with increased time interval between the onset and medical visit. Furthermore， logistic regression analysis showed that patients aged ≤24 years （OR=0.596， 95%CI：0.503‒0.706， P<0.05）， 25‒ years （OR=0.667， 95%CI：0.559‒0.796， P<0.05）， 35‒ years （OR=0.762， 95%CI：0.613‒0.947， P<0.05）， and 45‒54 years （OR=0.838， 95%CI：0.711‒0.987， P<0.05） had significantly lower risk of delayed medical visit than those aged ≥ 55 years old group. Regarding the household registration status， non-local residents had lower risk of delayed medical visit than local residents （OR=0.838， 95%CI：0.732‒0.960， P<0.05）. ConclusionPositive for Mycobacterium tuberculosis in the pathogenic diagnosis， and presence of comorbidities were risk factors associated with increased time interval between the onset and medical visit. The proportion of delayed medical visit among tuberculosis patients in Huaibei City from 2017 to 2021 showed a decreasing trend over 5 years， and age ≥55 years old and local residents were risk factors associated with delayed medical visit.
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Objective To study the effects of morphine on serum concentrations of cortisol (COR), adrenaline (ADR), noradrenaline (NAD) and dopamine (DOP) in premature infants requiring mechanical ventilation (MV).Method From January to November, 2017, premature infants (gestational age: 28～36 weeks and body weight :1 000～2 499 g) admitted to neonatal department of our hospital and received mechanical ventilation were prospectively studied.The participants were randomly assigned into morphine group and control group.Modified neonatal pain assessment scale ( NIPS ) and Ramsay scores were calculated at the beginning of MV (before the administration of morphine ) and at different time points after MV (2 h, 12 h, 24 h and 48 h after the administration of morphine ).Serum concentrations of COR , ADR, NAD and DOP were also measured at the beginning of MV and 24 h after MV/morphine.The scores and concentrations were compared between the two groups.Result A total of 60 infants were included, with 30 infants in each group.The modified NIPS and Ramsay scores and serum concentrations at the beginning of MV were similar between the two groups ( P＞0.05).The modified NIPS and Ramsay scores at 2 h, 12 h, 24 h and 48 h after the initiation of MV were significantly lower in the morphine group comparing with the control group[2 h: (0.8 ±0.5) vs.(2.9 ±0.7), (0.9 ±0.6) vs.(2.3 ±0.6); 12 h: (1.1 ±0.6) vs.(2.8 ±0.8), (1.3 ±0.7) vs.(2.3 ±0.8); 24 h: (1.4 ±0.8) vs.(3.0 ±0.7), (1.6 ±0.6) vs. (2.4 ±0.8); 48 h: (1.3 ±0.7) vs.(2.7 ±0.9), (1.7 ±0.7) vs.(2.5 ±0.8)].Furthermore, serum concentrations of COR, ADR, NAD and DOP at 24 h after MV were also significantly lower in the morphine group [COR: (165.4 ±25.0) nmol/L vs.( 319.8 ±71.2) nmol/L, ADR: ( 30.3 ±4.5) ng/L vs. (45.4 ±4.3) ng/L,NAD: (138.0 ±16.5) ng/L vs.(230.5 ±26.1) ng/L, DOP: (43.6 ±7.2) ng/L vs.(86.3 ±10.0) ng/L, P＜0.05].Conclusion Morphine is associated with lower serum concentration of catecholamine and lower NIPS scores during MV in premature infants.