Health-seeking intention for urinary incontinence among adult women in Gansu Province / 预防医学

Objective@#To investigate the health-seeking intention for urinary incontinence among adult women in Gansu Province, so as to provide insights into the management of female urinary incontinence.@*Methods @#Women at ages of 20 years and older who lived in 8 communities and 8 villages of Gansu Province for at least one year were recruited using the multi-stage stratified cluster random sampling method. A face-to-face questionnaire survey was conducted from October 2019 to February 2020, and the demographic features, urinary incontinence status and health-seeking intention were collected and descriptively analyzed.@*Results@#A total of 3 580 questionnaires were allocated and 3 485 were recovered, with a recovery rate of 97.35%. The respondents had a mean age of ( 51.18±17.13 ) years, with 1 759 respondents ( 50.47% ) that lived in urban areas, and 1 726 ( 49.53% ) that lived in rural areas. There were 1 150 respondents with self-reported urinary incontinence ( 33.00% prevalence ), including 340 cases with stress urinary incontinence ( 29.57% ), 78 cases with urge urinary incontinence ( 6.78% ) and 732 cases with mixed urinary incontinence ( 63.65% ). The overall proportion of health-seeking intention for urinary incontinence was 41.57%, and the proportions of health-seeking intention were 51.76%, 39.74% and 37.02% for stress, urge and mixed urinary incontinence, respectively. The proportion of health-seeking intention for urinary incontinence appeared a tendency towards a decline with the increase in household monthly income per capita and frequency of urinary leakage, and appeared a tendency towards a rise with the increase in educational levels ( P<0.05 ). In addition, a higher proportion of health-seeking intention for urinary incontinence was seen in women living in urban areas than in rural areas (5 3.63% vs. 31.98%, P<0.05 ), and a higher proportion was found in women with mental labors than in those with physical labors ( 60.81% vs. 40.24%, P<0.05 ), while a higher proportion was found in married women than in divorced or widowed women ( 44.33% vs. 23.53%, P<0.05 ).@*Conclusions@#There is a low proportion of health-seeking intention for urinary incontinence among adult women in Gansu Province. Age, occupation, place of residence, educational level, income, marital status, and frequency of urine leakage may affect the intention to seek medical care for urinary incontinence among adult women.

A nested case-control study on zinc levels in maternal whole blood and fetal cord blood and risk of congenital heart disease in offspring / 环境与职业医学

Background Zinc is a trace element essential for normal fetal heart development, and excess zinc can be toxic. The relationship between maternal and fetal zinc levels and the development of congenital heart disease (CHD) in the offspring is unclear. Objective To study the effects of maternal and neonatal zinc exposure levels on the risk of developing CHD in the offspring. Methods The data and biological samples of the study subjects were derived from the birth cohort established by Gansu Provincial Maternity and Child Care Hospital in Lanzhou from 2010 to 2012. Questionnaire surveys were conducted at baseline in the first trimester and at follow-up visits in the second trimester, the third trimester, and 42 d after delivery. Maternal venous blood during the third trimester and neonatal umbilical venous blood at delivery were collected, and information on their birth outcomes was extracted from medical records. Ninety-seven children with CHD diagnosed by echocardiography at birth and confirmed at the follow-up after 42 d were selected as the case group, and 194 healthy full-term infants were selected as the control group, 1∶2 matched for maternal age and geographical location from the database. The zinc concentrations in whole blood of pregnant mothers and umbilical cord blood of fetuses in both groups were measured by inductively coupled plasma mass spectrometry. According to the quartiles P25 and P75 of zinc levels in the whole blood of pregnant mothers and neonatal cord blood in the control group, zinc exposure was divided into three groups: low, medium, and high. After adjusting for maternal vaginal bleeding in early pregnancy, pre-pregnancy folic acid and vitamin supplementation, birth weight, and umbilical cerclage confounders, a multiple conditional logistic regression model was applied to analyze the associations between maternal whole blood and fetal umbilical cord blood zinc levels and the risk of CHD in the offspring, and a further subgroup analysis was performed by disease classification. Results The medians (P25, P75) of maternal whole blood zinc levels in the case group and the control group were 5.034 (3.456, 6.644) and 4.693 (3.411, 5.646) mg·L−1, respectively, with significant differences between the two groups (P=0.029). The medians (P25, P75) of neonatal cord blood zinc level was 2.153 (1.479, 2.405) mg·L−1 in the case group and 1.636 (1.304, 1.979) mg·L−1 in the control group, with significant differences between the two groups (P<0.001). The zinc levels of maternal whole blood and neonatal cord blood in the simple CHD group were significantly higher than those in the control group (P<0.05). The multiple conditional logistic regression model showed that compared with the maternal medium zinc exposure level group (3.41-5.65 mg·L−1), the risk of offspring CHD was 2.225 times of the high exposure level group (>5.65 mg·L−1) (OR=2.225, 95%CI: 1.017-4.868). Compared with the neonatal medium zinc exposure level group (1.30-1.98 mg·L−1), the neonatal high exposure level group (>1.98 mg·L−1) also had an increased risk of CHD (OR=4.132, 95%CI: 1.801-9.480). The subgroup analysis results showed that compared with corresponding medium exposure level groups, the risk of simple CHD in the offspring of the maternal high zinc exposure level group was increased (OR=4.081, 95%CI: 1.427-11.669), and the risks of simple CHD (OR=7.122, 95%CI: 2.126-23.854) and complex CHD (OR=5.165, 95%CI: 1.859-14.346) of neonates of the neonatal high zinc exposure level group were increased. Conclusion Under the exposure levels of the study population, high concentrations of zinc exposure in pregnant mothers and neonates may be associated with the incidence of CHD.

An Exploration to Carry Out Ideological and Political Education of "Loving Experimental Animals and Reverencing for Life" for Medical Students / 中国医学伦理学

To implement the fundamental task of the Ministry of Education on carrying out curriculum ideological and political education and promoting colleges and universities to implement the morality education, this study tried to carry out ideological and political education for medical students in "medical functional science experimental course", and organically integrated the ideological and political elements of "loving experimental animals and reverencing for life" into the teaching of this course. This paper explored the implementation process and effect evaluation of ideological and political courses from the aspects of teaching objects, design, objectives, in-class and off-class practical activities, and analyzed the current problems and future directions. In order to provide beneficial ideas for the ideological and political construction of college curriculum and help cultivate excellent and innovative medical talents with warmth and feelings.

Epidemic characteristics of epidemic Japanese encephalitis and antibody levels in healthy people in Longnan City, Gansu Province from 2015 to 2020 / 中华地方病学杂志

Objective:To understand the epidemic characteristics of epidemic Japanese encephalitis and the antibody level of healthy people in Longnan City, Gansu Province, analyze and evaluate its epidemic risk, and provide scientific basis for future prevention and control of Japanese encephalitis.Methods:By retrospective analysis, the data of Japanese encephalitis cases in Longnan City from 2015 to 2020 were collected from the "Japanese Encephalitis Monitoring Information Report Management System" of the "China Disease Prevention and Control Information System", and the distributions of the cases(time, region and population distribution) were statistically described and analyzed. In 2018, the cluster stratified sampling method was adopted to select Li County and Xihe County with higher incidence rate of Japanese encephalitis in Longnan City, and Wudu District and Hui County with lower incidence rate as monitoring sites, and 3 administrative villages (communities) were selected from each monitoring site to collect blood samples from healthy people to detect the level of Japanese encephalitis IgG antibodies.Results:From 2015 to 2020, a total of 261 cases of Japanese encephalitis were reported in Longnan City, with an average annual incidence of 1.66 per 100 000; among them, the number of reported cases in 2017 and 2018 accounted for 82.38% (215/261) of the total number of cases. The incidence of Japanese encephalitis was mainly concentrated in August, accounting for 72.03% (188/261); 9 counties (districts) in Longnan City had reported cases of Japanese encephalitis, and the top 5 counties (districts) with the number of cases were Li County (68 cases), Xihe County (64 cases), Wudu District (40 cases), Kang County (33 cases) and Cheng County (18 cases), accounting for 85.44% (223/261) of the total number of cases. The age of onset of Japanese encephalitis cases was mainly concentrated in the 40 - < 60 years old, accounting for 40.23% (105/261); male to female ratio was 1.00 ∶ 1.14 (122 ∶ 139); the occupation was mainly farmers, accounting for 75.86% (198/261). A total of 887 sera samples from healthy people were tested, and the antibody positive rate was 91.09% (808/887); the difference in antibody positive rate of different age groups was statistically significant (χ 2 = 5.77, P < 0.05); the differences of positive rate of antibodies between different genders and regions were not statistically significant (χ 2 = 0.45, 2.06, P > 0.05). Conclusions:The incidence of Japanese encephalitis in Longnan City is mainly middle-aged farmers, with a high incidence in August each year. After the outbreak of Japanese encephalitis in Longnan City in 2017 and 2018, it has showed a low epidemic trend, and the positive rate of Japanese encephalitis antibody in healthy people is high. It is recommended to carry out regular monitoring of Japanese encephalitis immunization level of healthy people and strengthen the immunization of key populations in time.

Distribution of peripheral blood lymphocyte subpopulations in 654 children of preschool age / 国际儿科学杂志

Objective@#To investigate the distribution of peripheral blood lymphocyte subpopulations in 654 children aged 28 days to 7 years, and to provide a basis for establishing a normal reference range.@*Methods@#A total of 654 healthy Han children aged 28 days to 7 years were enrolled.The children were divided into infant group(28 days-12 months)(180 cases, 27.52%), toddler group(1-3 years)(184 cases, 28.13%), and preschooler group(3-7 years)(290 cases, 44.34%). Peripheral blood samples were collected, and the percentages of lymphocyte subpopulation were detected by flow cytometry.@*Results@#There were statistically significant differences between boys and girls in CD3+ CD4+ T cells, CD3+ CD8+ T cells percentages and the CD4+ /CD8+ ratio in infant group(Z=-2.595, 3.317, -3.492, all P<0.05); in CD3+ CD4+ T cells percentage in toddler group(Z=2.312, P<0.05); in CD3+ T cells, CD3+ CD4+ T cells, CD3-CD19+ B cells, CD3-CD16+ CD56+ NK cells percentages and the CD4+ /CD8+ ratio in preschool age group(Z=4.088, 4.991, 3.129, -6.949, 2.141, all P<0.05). The comparison in all age groups showed significant differences in CD3+ T cells, CD3+ CD4+ T cells, CD3-CD19+ B cells, CD3-CD16+ CD56+ NK cells percentages and the CD4+ /CD8+ ratio in boys(χ2=6.925, 51.543, 39.563, 87.751, 30.334, all P<0.05), in CD3+ CD4+ T cells, CD3+ CD8+ T cells, CD3-CD16+ CD56+ NK cells percentages and the CD4+ /CD8+ ratio in girls(χ2=27.646, 44.046, 26.066, 54.238, all P<0.05). The CD3+ CD4+ T cells and CD3-CD19+ B cells percentages declined with age(χ2=82.345, 40.214, all P<0.05); The CD3+ CD8+ T cells and CD3-CD16+ CD56+ NK cells percentages increased with age(χ2=38.43, 108.302, all P<0.05).@*Conclusion@#The peripheral blood lymphocyte subpopulation values differ by gender and age.It is necessary to establish the reference range of lymphocyte subpopulations for children in Lanzhou according to gender and age.

Distribution of peripheral blood lymphocyte subpopulations in 654 children of preschool age / 国际儿科学杂志

Objective To investigate the distribution of peripheral blood lymphocyte subpopulations in 654 children aged 28 days to 7 years,and to provide a basis for establishing a normal reference range.Methods A total of 654 healthy Han children aged 28 days to 7 years were enrolled.The children were divided into infant group (28 days-12 months) (180 cases,27.52％),toddler group (1-3 years) (184 cases,28.13 ％),and preschooler group (3-7 years) (290 cases,44.34％).Peripheral blood samples were collected,and the percentages of lymphocyte subpopulation were detected by flow cytometry.Results There were statistically significant differences between boys and girls in CD3+ CD4 + T cells,CD3 + CD8 + T cells percentages and the CD4 +/CD8 + ratio in infant group (Z =-2.595,3.317,-3.492,all P ＜ 0.05);in CD3 +CD4 + T cells percentage in toddler group (Z =2.312,P ＜ 0.05);in CD3 + T cells,CD3 + CD4 + T cells,CD3-CD19 + B cells,CD3-CD16 + CD56 + NK cells percentages and the CD4 +/CD8 + ratio in preschool age group (Z =4.088,4.991,3.129,-6.949,2.141,all P ＜ 0.05).The comparison in all age groups showed significant differences in CD3 + T cells,CD3 + CD4 + T cells,CD3-CD19 + B cells,CD3-CD16 +CD56 + NK cells percentages and the CD4 +/CD8 + ratio in boys (x2 =6.925,51.543,39.563,87.751,30.334,all P ＜ 0.05),in CD3 + CD4 + T cells,CD3 + CD8 + T cells,CD3-CD16 + CD56 + NK cells percentages and the CD4 +/CD8 + ratio in girls (x2 =27.646,44.046,26.066,54.238,all P ＜ 0.05).The CD3 +CD4+ T cells and CD3-CD19+ B cells percentages declined with age (x2 =82.345,40.214,all P ＜0.05);The CD3+ CD8+ T cells and CD3-CD16+ CD56+ NK cells percentages increased with age (x2 =38.43,108.302,all P ＜0.05).Conclusion The peripheral blood lymphocyte subpopulation values differ by gender and age.It is necessary to establish the reference range of lymphocyte subpopulations for children in Lanzhou according to gender and age.

A phase Ⅲ clinical trial study on the safety and immunogenicity of ACYW135 group meningococcal conjugate vaccine inoculated in 3 month old infants / 中华预防医学杂志

The aim of this study was to evaluate the safety and immunogenicity of the first domestic ACYW135 meningococcal conjugate vaccine and a control vaccine named AC group meningococcal conjugate vaccine for 3 months (90-119 days) infants. From February 2017 to June 2018, a randomized, blinded, and similar vaccine-controlled clinical trial design was adopted at the Henan Vaccine Clinical Research Base. The subjects were 3 months old healthy infants, a total of 720, based on a 1∶1 ratio. The random allocation table for entry was randomly assigned to the experimental group and the control group. According to the 3, 4, and 5 month-old vaccination procedures, the subjects were vaccinated with test vaccine (ACYW135 group meningococcal conjugate vaccine) and control vaccine (group A group C meningococcal polysaccharide conjugate vaccine), of which 720 were given the first dose, 696 were given the second dose (test group: 346; control group: 350), and 692 were given the third dose (test group: 344; Control group: 348). The overall adverse reaction rate of the test vaccine was 21.90% (230 cases), which was lower than the 32.04% (339 cases) of the control vaccine (0.05). Group Y and W135 was 88.17% (298 cases), 99.41% (336 cases), respectively. The GMT results showed that the test vaccine group A was 56.24, the control vaccine was 57.43 (>0.05); the group C test vaccine (43.53) was higher than the control group (27.28) (<0.001). The group Y and W135 are 89.22 and 140.66, respectively. Among them, the proportion of the group C GMT antibody ≥ 1∶128 for test vaccine (31.07%, 105 cases) was higher than the control vaccine (16.22%, 55 cases) (<0.001). ACYW135 group meningococcal conjugate vaccine has more safety and immunogenicity after application to 3 month old infants.

ReLationship between maternaL body composition in first trimester and gestationaL diabetes meLLitus / 中华围产医学杂志

Objective To investigate the relationship between maternal body composition in first trimester and gestational diabetes mellitus (GDM). Methods In this nested case-control study based on a prospective cohort study, we enrolled gravidas between 8 and 14 weeks of gestation, who received prenatal care and voluntary nutrition evaluation in Gansu Provincial Maternity and Children Health Care Hospital, from July 2016 to January 2017. Body mass index (BMI) of each gravida was recorded and the maternal body composition including body fat, body fat percentage and fat-free mass was measured by bioelectrical impedance analysis. Pregnancy outcomes were followed up. A total of 70 patients diagnosed with GDM were allocated to the GDM group and 140 healthy gravidas matching for age and pre-pregnancy BMI were selected as the control group. Differences in body composition between two groups and their relationships with GDM were analyzed by Chi-square test and multivariate logistic regression. ResuLts Maternal BMI ≥ 30 kg/m2 (OR=1.973, 95%CI:1.095-7.664, P=0.024) and body fat percentage≥30%,≥35% and≥40% in first trimester (OR=1.261, 95%CI:1.021-2.982, P=0.010; OR=4.020, 95%CI: 1.341-7.950, P<0.001; OR=8.311, 95%CI: 5.018-42.771, P<0.001) were the risk factors of GDM. ConcLusions BMI ≥ 30 kg/m2 and body fat percentage ≥ 30% in first trimester are risk factors for GDM and excessive adipose tissue may play an important role in the development of GDM.

Factor anaIysis and ROC curve construction of sensory integration screening for chiIdren aged 4-6 years / 中华实用儿科临床杂志

Objective To rkskarch,dkvklop and vkrife of a simplk scrkkning path for 4-6 ekar old childrkn＇s sknsore intkgration. Methods Nink hundrkd and thirte-six childrkn agkd 4-6 ekars wkrk invkstigatkd be stratifikd clustkr random sampling from Octobkr to Novkmbkr of 2017,of whom 476 wkrk boes and 460 wkrk girls. L sknsore intk-gration rating scalk(Childrkn＇s Edition)was uskd to asskss thk sknsore intkgration abilite,and thk main kntre construc-tion profilk scrkkning scalk was kxtractkd according to thk factor analesis,and thk critical valuk was dktkrminkd in com-bination with thk arka undkr thk subjkct opkrating charactkristic curvk( AOC),thk rkliabilite,validite,sknsitivite and spkcificite wkrk kvaluatkd. ResuIts Thk sknsore intkgration disordkr ratk of 4-6 ekar old childrkn was 47. 76﹪,and thk 14 main factors wkrk kxtractkd be factor analesis,and thk cumulativk contribution ratk was 75. 052﹪. Lftkr thk max-imal orthogonal rotation of varianck,thk itkms with factor load matrix cokfficiknt ≥0. 75 wkrk sklkctkd to construct thk simplk sknsore intkgration scrkkning scalk,which wkrk simplifikd to 2 classification options from 13 itkms in thk original tablk. Thk sknsitivite of thk simplk scrkkning scalk was 82. 77﹪,and thk spkcificite was 80. 16﹪,and thk arka undkr thk AOC curvk was 0. 815. Thk corrklation cokfficiknts of vkstibular balanck,propriockption,tactilk sknsation,visual smoothnkss and auditore rkcognition with thk summare tablk wkrk 0. 793,0. 372,0. 699,0. 604,0. 482,rkspkctivkle( all P﹦0. 000). Thk Kappa of thk summare tablks and gknkrad tablk was 0. 628(P﹦0. 000). Thk Cronbach＇s Llpha of thk summare tablk was 0. 767. ConcIusions Thk simplk scrkkning scalk simplifiks thk sknsore intkgration rating scalk into skvkral main itkms,which is simplk to opkratk and can bk uskd as a primare scrkkning mkthod for sknsore intkgration disordkr.

Construction of evaluation system on integrated experiment course / 中华医学教育探索杂志

Integrated experiment course is beneficial to optimizing the whole structure of medical courses and plays an important role in improving medical students' comprehensive quality and innovation capability. After several years of reform and exploration, Shanghai Jiao Tong University School of Medicine has developed the medical functional integrated experiment course with concept of "strengthen quality, reinforce foundation, encourage innovation and provide professional service", established a diversified evaluation system, and developed a corresponding assessment scale for reviewing students' comprehensive ability and the quality of experiment teaching. This paper investigated and prospected how to construct and optimize this evaluation system from the aspects of the relationship between evaluation method and course structure, and their effects, so as to provide strategic guidance for the further development of integrated experiment course.

Construction of evaluation system on integrated experiment course / 中华医学教育探索杂志

Integrated experiment course is beneficial to optimizing the whole structure of medical courses and plays an important role in improving medical students' comprehensive quality and innovation capability. After several years of reform and exploration, Shanghai Jiao Tong University School of Medicine has developed the medical functional integrated experiment course with concept of "strengthen quality, reinforce foundation , encourage innovation and provide professional service", established a diversified evaluation system, and developed a corresponding assessment scale for reviewing students' comprehensive ability and the quality of experiment teaching. This paper investigated and prospected how to construct and optimize this evaluation system from the aspects of the relationship between evaluation method and course structure, and their effects, so as to provide strategic guidance for the further development of integrated experiment course.

Blood lipid level of elderly population in high fluoride areas in Xiaotangshan, Changping District, Beijing / 中华地方病学杂志

Objective To investigate the distribution of blood lipid of elderly population in high fluorideareas,and compare blood lipid levels in the same age in China.Methods The study used 541 elderly people over 70 years of age who lived in Xiaotangshan for more than 10 years up to 2017.Fasting blood (3 ml) samples were taken,and their cholesterol (TC),triglyceride (TG),high density lipoprotein (HDL) and low density lipoprotein (LDL)were detected,respectively.The results were analyzed and compared with the blood lipid levels of adults over 70 years old in 2010.Results In this study,a total of 541 elderly people over 70 years old,with age of (74.98 ± 4.67)years,were surveyed.There were 246 males,with age of (75.13 ± 4.69) years and 295 females,with age of (74.86 ±4.66) years.The blood TC,TG,HDL and LDL were (4.87 ± 1.07),(1.53 ± 0.93),(1.33 ± 0.31) and (2.60 ± 0.73)mmol/L for the aged people over 70 years old,respectively.The 4 indexes of women over 70 years old were (4.99 ±1.09),(1.67± 1.00),(1.36 ± 0.31) and (2.67 ± 0.75) mmol/L,respectively.Four indicators of women over the age of 70 were higher than those of men [(4.71 ± 1.01),(1.36 ± 0.81),(1.30 ± 0.31),(2.53 ± 0.70) mmol/L,t =3.18,3.95,2.21,2.23,P ＜ 0.05].The levels of blood TC,TG,HDL and LDL were (4.30 ± 1.06),(1.33 ± 1.03),(1.15 ± 0.33)and (2.42 ± 0.78) mmol/L,respectively,in the aged people over 70 years old in the rural areas of China in 2010,and their blood lipid levels were lower than those of people lived in Xiaotangshan area.The differences were statistically significant (t =12.34,5.04,13.80,5.96,P ＜ 0.05).Conclusion We should take health education activities because of the high serum lipid level in high fluoride areas of Xiaotangshan area.

Analysis of the risk factors of neonatal asphyxia in southern Gansu province high-altitude area / 中国新生儿科杂志

Objective To study the prevalence and the main risk factors of neonatal asphyxia in southern Gansu province high-altitude area.Method From October 2016 to December 2016,clinical data of neonates born in eight hospitals of the region were analyzed.A uniform questionnaire was used to survey the maternal condition and family background.Univariate and multivariate Logistic regression analysis were used to determine the risk factors of neonatal asphyxia.Result A total of 183 newborns were born with asphyxia (mild 157 cases,severe 26 cases),and the incidence of neonatal asphyxia was 15.3％ (183/1 197).The multivariate Logistic regression analysis indicated that the risk factors included altitude less than 3 000 meters (OR =2.693,95％ CI 1.275 ～5.689),maternal fever (OR =2.986,95％ CI 1.163 ～7.666),prolonged labor (OR =2.925,95％ CI 1.112 ～ 7.691),fetal distress (OR =7.000,95％ CI 3.254 ～ 15.056),uterine inertia (OR =2.737,95％ CI 1.484 ～ 5.047),umbilical cord abnormality (OR =3.094,95％ CI 2.051 ～4.668),amniotic fluid abnormality (OR =2.033,95％ CI 1.230 ～3.361)and placental abnormality (OR =2.753,95％ CI 1.016 ～ 7.464).Annual household income more than 30 000 yuan (OR =0.452,95％ CI 0.297 ～0.687) was protective factor of neonatal asphyxia.Conclusion The incidence of neonatal asphyxia was high in the region,which was related to intrauterine and intrapartum factors.Antepartum monitoring and timely treatment should be strengthened to reduce the incidence of newborn asphyxia.

Effect of occupational stress on recurrent spontaneous abortion in women of childbearing age / 中华劳动卫生职业病杂志

Objective@#To investigate the influence of occupational stress on recurrent spontaneous abortion (RSA) in women of childbearing age.@*Methods@#From January to December, 2017, 75 working women of childbearing age (25-35 years) who were admitted to a provisional hospital in Lanzhou, China and diagnosed with RSA were assigned into patient group. At a 1∶4 ratio, 300 age-matched working women who had normal first pregnancy were randomly selected as controls. A case-control study was conducted by a self-made questionnaire and the effort-reward imbalance scale. The impact of occupational stress on RSA in women of childbearing age was analyzed by evaluation of occupational harmful factors, regularity, effort-reward ratio, and sleep quality.@*Results@#There were significant differences in the distribution of sleep, daily exercise, night shift, extrinsic-effort/low-reward score, and effort/low-reward score between the patient group and the control group (χ2=7.867, P<0.05; χ2=7.377, P<0.05; χ2=3.714, P<0.05; χ2=6.651, P<0.05; χ2=8.556, P<0.05) . With controlled factors such as general conditions and living habits, logistic regression analysis showed that poor sleep quality and high-effort/low-reward were risk factors for RSA (odds ratio[OR]=1.462, 95% confidence interval[CI]: 1.032~2.073; OR=3.253, 95%CI: 1.169~9.053) . A regular work was a protective factor against RSA (OR=0.644, 95%CI: 0.438-0.946) .@*Conclusion@#In occupational stress, irregular working hours, lack of sleep, and high-effort/low-reward are risk factors for RSA. Working women of childbearing age should ensure adequate sleep, pay attention to effort-reward balance, and make a regular work schedule.

Construction and development of medical functional experiment integrated curriculum / 中华医学教育探索杂志

To cultivate high-quality medical talents,Shanghai Jiao Tong University School of Medicine established a multidisciplinary and comprehensive basic medical practical integration curriculum Medical Functional Experiment.Over several years' exploration and renovation,insisting on student-centered,this course has established a modular experiment teaching system with emphasis on foundation,combina-tion with clinical and focusing on innovation.Integration curriculum adopts four-stage teaching pattern which is suitable for medical students,and implements diversified teaching method and evaluation system.And meanwhile,the paper explores the ideas and approaches to further deepen the construction of teaching staff,expand experimental teaching techniques,strengthen the construction of curriculum materials,and strengthen the cultivation of teachers' innovative ability.

Effect of PASMC apoptosis on reversal of hypoxic pulmonary arterial remodeling during reoxygenation and its related molecular mechanism / 中国病理生理杂志

AIM: To explore the effect of pulmonary arterial smooth muscle cell (PASMC) apoptosis on the reversal of hypoxic pulmonary arterial remodeling during reoxygenation and its possible mechanism.METHODS: Male SD rats (n=24) were randomly divided into normoxia for 4 weeks group, hypoxia for 4 weeks group, reoxygenation for 1 week after hypoxia for 4 weeks group and reoxygenation for 6 weeks after hypoxia for 4 weeks group.Right ventricular systolic pressure (RVSP), right ventricular hypertrophy index, pulmonary arterial medial thickness (MT) and medial area (MA) as well as autophagy and apoptosis in the pulmonary arterial medial layer were examined during hypoxia-reoxygenation.The rat primary PASMCs were divided into normoxia for 48 h group, hypoxia for 48 h group, reoxygenation for 24 h after hypoxia for 48 h group and normoxia for 72 h group to explore the changes of PASMC autophagy and apoptosis following hypoxia-reoxygenation.Finally, primary PASMCs were divided into normoxia for 72 h group, reoxygenation for 24 h after hypoxia for 48 h group and reoxygenation for 24 h after hypoxia for 48 h + chloroquine (inhibitor of autophagy) group to investigate the effect of PASMC autophagy during hypoxia on the apoptosis during reoxygenation.RESULTS: After hypoxia for 4 weeks, the RVSP, during right ventricular hypertrophy index, MT and MA increased significantly compared with normoxia group (P<0.05), and gradually decreased during reoxygenation.The expression of LC3 in the pulmonary arterial medial layer increased evidently after hypoxia and gradually reversed during reoxygenation.Moreover, the P62 and cleaved caspase-3 expression decreased after hypoxia compared with normoxia group, and increased markedly following reoxyge-nation.The expression of cleaved caspase-3/PARP in rat primary PASMCs decreased significantly under hypoxia (P<0.05), and increased evidently during reoxygenation.The expression of P62 and LC3-II decreased markedly under hypoxia (P<0.05).After inhibition of PASMC autophagy under hypoxia, the expression of cleaved caspase-3/PARP decreased remarkably during reoxygenation (P<0.05).CONCLUSION: The PASMC apoptosis participates in the reversal of hypoxic pulmonary arterial remodeling, and the PASMC autophagy under hypoxia might facilitate its apoptosis during reoxygenation.

Improvement of comprehensive ability of eight-yearprogram undergraduates by complex scene PBL teaching method / 基础医学与临床

Objective Evaluation the effect to improve the eight-year program medical students` comprehensive ability between standard of PBL mode and complex scenarios PBL mode.Methods To comparative improved teaching quality between complex scenarios PBL teaching mode and standard of the PBL teaching mode by final exam scores and DREEM scale.Results The complex scenarios PBL teaching mode improve the ability of problem solving score significantly higher than the standard scores of PBL teaching mode at the start of analyzing questions and help students to stimulate interest, increase self-confidence, (P<0.05).Comparative analysis shows the comprehensive thinking ability of medical students has improved significantly.ConclusionsComplex scenarios PBL teaching mode can improve the ability of handling the students` study enthusiasm, comprehensive ability and strain capacity more effectively than that of standard PBL teaching mode.The obvious effect is worth promoting.

Clinical effect of dipeptide base Ⅳ peptide enzyme inhibitors combined with insulin in the treatment of type 2 diabetes / 中国基层医药

Objective To study the clinical curative effect of dipeptide base peptidase Ⅳ inhibitors (DPP-4) combined with insulin in the treatment of type 2 diabetes.Methods 100 patients with type 2 diabetes were selected as the research subjects,and they were randomly divided into two groups by single blind randomization method,50 cases in each group.The control group adopted the premixed insulin therapy for a month,the observation group received the DPP-4 inhibitors combined with premixed insulin therapy for a month.The blood sugar success rate,weight,incidence of hypoglycemia of the two groups were compared.Results After treatment,the fasting blood glucose value,2 h postprandial blood glucose of the two groups were significantly decreased(t=5.155,P=0.000;t=6.591,P=0.000;t=7.488,P=0.000;t=7.574,P=0.000).But there were no statistical differences between the two groups after treatment (all P>0.05).The incidence rate of hypoglycemic events of the observation group was obviously lower than that of the control group (x2=5.982,P=5.982).Before treatment,the ALT,AST,serum creatinine,urea nitrogen between the two groups had no significant differences(all P>0.05).The body weight,body mass index of the observation group were significantly lower than those of the control group (t=6.931,P=0.000;t=16.010,P=0.000).Conclusion The DPP-4 inhibitor combined premixed insulin therapy for type 2 diabetes has significant hypoglycemic effect,can effectively reduce hypoglycemic events,effectively control the weight,and its effect on liver and kidney function is relatively mild,safe and reliable.

Clinical stages and outcomes of severe cases on hand, foot and mouth disease / 中华流行病学杂志

Objective To understand the characteristics and relation of clinical stage and outcome of severe cases on hand,foot and mouth disease (HFMD) and to establish the evaluation method for understanding severity of this disease.Methods According to factors as geographical location,economic and epidemic levels,five provinces (Henan,Shandong,Yunnan,Zhejiang and Sichuan provinces) were selected.Reported severe cases of HFMD from the National Notifiable Diseases Reporting System were selected randomly in the five provinces.Basic epidemiological information,clinical data,and pathogen testing results in the involved hospitals were collected.Clinical stages on all the patients were decided in accordance with "the clinical expert consensus on diagnosis and treatment for severe case of enterovirus type 71 (EV71) infections (2011 edition)".Data were analyzed using SPSS software 18.0 and other epidemiological methods.Results A total of 657 severe HFMD cases were investigated,with 326 cases positive of EV71,accounting for 91.3％ (326/357) among all the laboratory-confirmed cases.Of the 657 cases,542 cases (82.5％,95％CI:79.4％-85.3％) were diagnosed as in stage 2 (with nervous system involvement),99 cases (15.1％,95％CI:12.4％-18.0％) in stage 3 (early phase of function failure on heart and lung),and 16 cases (2.4％,95％CI:1.4％-3.9％) were in stage 4 (function failure of heart and lung).11 cases (1.7％,95％CI:0.9％-3.0％) were with squeal when discharged from hospital with 8 cases (1.2％,95％CI:0.6％-2.3％) died.When comparing the proportions among stage 2,stage 3 and stage 4,significant differences were found between age groups (x2=22.632,P=0.012).The younger the patient was the lower the proportions of stage 2 and the more proportion of stage 3 appeared.When comparing the proportions of clinical stages among the five provinces,significant differences (x2=41.481,P =0.000) were noticed.Proportions of different clinical stages in gender,ethnicity,occupation,place of residence types and the type of pathogen appeared no significant differences,respectively.However,the proportions of squeal and death in stage 2,stage 3 and stage 4 showed significant differences (sequela:x2=12.960,P=0.001;Death:x 2=16.850,P=0.001),respectively.Conclusions The pcrccntage of clinical stages of severe HFMD patients related to the rate of squeal and death.Clinical staging can be used for assessing the clinical severity of complications and the effectiveness of treatment,of HFMD.

Clinical stages and outcomes of severe cases on hand, foot and mouth disease / 中华流行病学杂志

Objective To understand the characteristics and relation of clinical stage and outcome of severe cases on hand,foot and mouth disease (HFMD) and to establish the evaluation method for understanding severity of this disease.Methods According to factors as geographical location,economic and epidemic levels,five provinces (Henan,Shandong,Yunnan,Zhejiang and Sichuan provinces) were selected.Reported severe cases of HFMD from the National Notifiable Diseases Reporting System were selected randomly in the five provinces.Basic epidemiological information,clinical data,and pathogen testing results in the involved hospitals were collected.Clinical stages on all the patients were decided in accordance with "the clinical expert consensus on diagnosis and treatment for severe case of enterovirus type 71 (EV71) infections (2011 edition)".Data were analyzed using SPSS software 18.0 and other epidemiological methods.Results A total of 657 severe HFMD cases were investigated,with 326 cases positive of EV71,accounting for 91.3％ (326/357) among all the laboratory-confirmed cases.Of the 657 cases,542 cases (82.5％,95％CI:79.4％-85.3％) were diagnosed as in stage 2 (with nervous system involvement),99 cases (15.1％,95％CI:12.4％-18.0％) in stage 3 (early phase of function failure on heart and lung),and 16 cases (2.4％,95％CI:1.4％-3.9％) were in stage 4 (function failure of heart and lung).11 cases (1.7％,95％CI:0.9％-3.0％) were with squeal when discharged from hospital with 8 cases (1.2％,95％CI:0.6％-2.3％) died.When comparing the proportions among stage 2,stage 3 and stage 4,significant differences were found between age groups (x2=22.632,P=0.012).The younger the patient was the lower the proportions of stage 2 and the more proportion of stage 3 appeared.When comparing the proportions of clinical stages among the five provinces,significant differences (x2=41.481,P =0.000) were noticed.Proportions of different clinical stages in gender,ethnicity,occupation,place of residence types and the type of pathogen appeared no significant differences,respectively.However,the proportions of squeal and death in stage 2,stage 3 and stage 4 showed significant differences (sequela:x2=12.960,P=0.001;Death:x 2=16.850,P=0.001),respectively.Conclusions The pcrccntage of clinical stages of severe HFMD patients related to the rate of squeal and death.Clinical staging can be used for assessing the clinical severity of complications and the effectiveness of treatment,of HFMD.