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Objective:To investigate the risk factors for the occurrence and poor in-hospital prognosis in patients with peripartum cardiomyopathy (PPCM).Methods:The clinical data of 35 patients with PPCM and 35 healthy pregnant women in Xuanwu Hospital, Capital Medical University and Beijing Friendship Hospital Affiliated to Capital Medical University from January 2003 to January 2022 were retrospectively analyzed. The personal histories, laboratory examination, imaging examination, cardiac function outcome, etc were collected. According to the left ventricular ejection fraction (LVEF) at discharge, the patients with PPCM were divided into in-hospital recovery group (LVEF≥50%, 18 cases) and prolonged disease group (LVEF<50%, 17 cases). Multivariate Logistic regression analysis was used to analyze independent risk factors of poor in-hospital prognosis in patients with PPCM.Results:Among 35 patients with PPCM, the age was (29.81 ± 5.37) years old, 17 cases (48.57%) complicated with gestational hypertension, 6 cases (17.14%) complicated with gestational diabetes mellitus, 24 cases (68.57%) of New York Heart Association (NYHA) cardiac function classification was Ⅲ to Ⅳ class, and 4 cases died (11.43%). The gestational age in patients with PPCM was significantly shorter than that in healthy pregnant women: (36.26 ± 4.27) weeks vs. (38.54 ± 4.59) weeks, the rates of multiple pregnancy and gestational hypertension were significantly higher than those in healthy pregnant women: 17.14% (6/35) vs. 2.86% (1/35) and 48.57% (17/35) vs. 11.43% (4/35), and there were statistical differences ( P<0.05 or <0.01). Compared with hospital recovery group, the patients in protracted disease group had shorter gestational age, larger left ventricular end-diastolic diameter, higher serum creatinine, C-reactive protein and amino-terminal pro-brain natriuretic peptide (NT-proBNP), worse NYHA cardiac function classification, and there were statistical differences ( P<0.05 or <0.01); but there were no statistical difference in LVEF at the first diagnosis and troponin I between two groups ( P>0.05). Multivariate Logistic regression analysis result showed that elevated creatinine was an independent risk factor for poor in-hospital prognosis in patients with PPCM ( OR = 4.554, 95% CI 1.536 to 13.684, P = 0.018). Conclusions:The gestational hypertension may be a risk factor for PPCM. The gestational hypertension, earlier onset time, enlarged left ventricular end-diastolic diameter, high NT-proBNP, high C-reactive protein, high creatinine and high cardiac function NYHA classification may be risk factors for poor in-hospital prognosis in patients with PPCM; and elevated creatinine is an independent risk factor for poor in-hospital prognosis in patients with PPCM.
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ObjectiveTo know the epidemic incidence features of the nurseries and kindergartens in Jinshan District， and to supply the scientific supporting data for the work of preventing and controlling the epidemic diseases in nurseries and kindergartens. MethodsThe epidemic incidence rate， diseases sequence， and time distribution in Jinshan District from Jan 1， 2011 to Dec 30， 2020 were subjected to descriptive epidemic analysis， and the incidence rate in different years was analyzed by the Model of Joinpoint. ResultsBetween 2011 and 2020 in Jinshan nurseries and kindergartens， the epidemic incidence rate were 5 257 cases， with an annual average of 3.28%. It presented the peak every 2 or 3 years， and the yearly peak was distinctively from March to June and from September to December. The top three epidemic diseases were hand-foot-mouth diseases， herpangina and chicken pox. The trend analysis by Joinpoint showed that there is no obvious downtrend in the overall incidence of infectious diseases， but the incidence rate trend of herpangina， influenza， and infectious diarrhea apparently appeared rising. ConclusionThe nurseries and kindergartens should prevent and control the epidemic incidence peak more targeted and effective. It should add the herpangina to the list of “The Nursery and Kindergarten Monthly Epidemic Report”.
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Objective:To observe the clinical effect of Traditional Chinese Medicine (TCM) collapsibility combined with pressure therapy in the treatment of eczema.Methods:From January 2021 to August 2021, 60 patients with lower extremity venous ulcers who were treated in Wangjing Hospital, China Academy of Chinese Medical Sciences were selected and randomly divided into the control group (30 patients) and observation group (30 patients). The control group was treated by the routine pressure therapy, and the observation group was by the TCM nursing intervention on the basis of the control group. Both groups were treated for 2 weeks. The visual analogy scale (VAS),chronic Venous Insufficiency Questionnaire (CIVIQ), Self-rating Anxiety Acale (SAS), and Self-rating Depression Scale (SDS) were measured and evaluated at baseline and after treatment.Results:The total response rate was 100.0% (30/30) in the observation group and 86.7% (26/30) in the control group, and the difference was statistically significant ( χ2=4.29, P=0.038). The VAS (2.47±0.68 vs. 2.97±0.14, t=3.95), SAS (40.31±11.93 vs. 55.87±4.53, t=4.73), SDS (44.30±5.38 vs. 47.61±5.33, t=2.39) scores were significantly lower than those in the control group ( P<0.05), CIVIQ score (86.63±2.74 vs. 84.67±3.23, t=2.54) was significantly higher than that of the control group ( P<0.05). Conclusion:TCM combined with pressure therapy can promote the healing of ulcers in patients with eczema, relieve pain, and improve the quality of life of patients.
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Objective:To analyze the impact of the national tertiary public hospital performance assessment(hereinafter referred to as the national examination) on the functional orientation of the provincial public hospitals in Zhejiang province, for reference to improve the allocation of provincial medical resources and high-quality development of public hospitals.Methods:The data came from the hospital financial data of 17 provincial tertiary public hospitals in Zhejiang province from 2012 to 2021 and the DRG quality performance analysis report of the tertiary hospitals in Zhejiang province from 2020 to 2021. The information of the number of employees and actual number of beds at the end of the period, etc., were extracted to analyze the overall operation of the hospital. The ratio of outpatient times to discharged times and the proportion of discharged patients undergoing surgery, as well as the proportion of discharged patients′ day surgery and level-4 surgery in hospital and in province were took as evaluation indicators to analyze the functional positioning of tertiary public hospitals.Results:Compared with 2012 to 2018, the average number of employees at the end of the period and actual number of beds in 17 hospitals from 2019 to 2021 increased by 761 and 303 respectively, and the average number of hospitalization days decreased by 2.26 days. The average ratio of outpatient times to discharged times in the hospital decreased from 175.76 in 2012 to 67.51 in 2021. The average proportion of discharged patients undergoing surgery in general hospitals increased from 0.39 in 2012 to 0.46 in 2021, and that in non-general hospitals decreased from 0.67 to 0.43. The average proportion of discharged patients undergoing day surgery in hospital and in province increased from 0.20 and 0.03 in 2020 to 0.23 and 0.04 in 2021 respectively, and the average proportion of discharged patients undergoing level-4 surgery in province increased from 0.04 to 0.05.Conclusions:The national examination could be conducive to strengthening the functional orientation of public hospitals. After the national examination, the ratio of outpatient times to discharged times in the provincial tertiary public hospitals in Zhejiang province had declined as a whole, the proportion of discharged patients in general hospitals had increased, but the proportion of level-4 surgery in hospitals needs to be further improved. The author suggested that we should continue to strengthen the operation mechanism of functional positioning of provincial public hospitals, improve the service capacity of hospitals for difficult and critical diseases, and improve the performance evaluation system of tertiary public hospitals.
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Objective:To investigate the influencing factors for unfavorable outcome of low-grade aneurysmal subarachnoid hemorrhage (aSAH).Methods:A retrospective study was performed. The clinical data of 273 patients with aSAH of World Federation of Neurosurgery (WNFS) grading I and II, admitted to our hospital from April 2017 to March 2021, were collected. According to modified Rankin scale (mRS) scores 3 months after treatment, these patients were divided into favorable outcome group (mRS scores of 0-2) and unfavorable outcome group (mRS scores of 3-6). Statistical methods were used to analyze the clinical and imaging data differences between the two groups and identify the independent influencing factors for unfavorable outcome. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive values of different independent factors in unfavorable outcome.Results:Among the 273 patients with low-grade aSAH, 45 patients had unfavorable outcome and 228 patients had favorable outcome. Univariate analysis showed that there was significant difference between the 2 groups in age, Fisher grading distribution, proportions of patients complicated with shunt dependent hydrocephalus, with delayed cerebral ischemia, or with intracranial hemorrhage, and WNFS grading ( P<0.05). Multivariate Logistic regression analysis showed that concurrent shunt dependent hydrocephalus ( OR=5.075, 95%CI: 1.705-15.102, P=0.004), age ( OR=1.090, 95%CI: 1.036-1.147, P=0.004), delayed cerebral ischemia ( OR=8.282, 95%CI: 3.447-19.896, P=0.000), and postoperative intracranial hemorrhage ( OR=8.603, 95%CI: 2.332-31.745, P=0.001) were independent influencing factors for unfavorable outcome. ROC curve analysis showed that the optimal diagnostic threshold of age was 65 years, and the areas under ROC curve for delayed cerebral ischemia and age in predicting unfavorable outcome were 0.733 ( 95%CI: 0.653-0.813, P=0.000) and 0.709 ( 95%CI: 0.622-0.796, P=0.000). Conclusion:Low-grade aSAH patients with age≥65, postoperative shunt dependent hydrocephalus, delayed cerebral ischemia, and intracranial hemorrhage are more likely to have unfavorable outcome; age and complicated delayed cerebral ischemia have certain diagnostic value in low-grade aSAH patients.
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Objective@#To describe the distribution characteristics of uric acid and associated factors among overweight and obese children in Tangshan City, so as to provide reference for the prevention of childhood hyperuricemia and related diseases.@*Methods@#A total of 543 overweight and obese school-age children in Tangshan from 2018 to 2019 were selected, 503 children of normal weight were selected as the control group. Height, weight, waist circumference(WC), blood pressure(BP) were measured, then the Body mass index(BMI) and waist-to-height ratio(WHtR) were calculated. Uric acid(UA), fasting blood glucose(FPG), total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol(HDL-C) and low density lipoprotein cholesterol(LDL-C) were measured. The distribution characteristics of uric acid level were described by age groups, and the relationship between uric acid and related indicators were analyzed.@*Results@#The mean uric acid of normal weight group,overweight and obese group were(278.15±89.68, 322.72±89.50)μmol/L respectively, the difference was statistically significant(t=-8.04, P<0.01). The detection rates of hyperuricemia in normal weight group, overweight and obesity group were 11.33% and 23.94% respectively, with statistically significant difference(χ2=28.28, P<0.01). UA level was positively correlated with age, BMI, body weight, TC, LDL-C(r=0.12，0.17，0.28，0.14，0.23，P<0.01), and negatively correlated with HDL-C(r=-0.25，P<0.01). Age, BMI, WHtR, TC, LDL-C were the influencing factors of hyper-uricemia[OR(95%CI)=0.82(0.72-0.94), 1.13(1.08-1.18), 0.38(0.23-0.64), 6.79(2.15-21.44), 0.04(0.01-0.14).@*Conclusion@#The urea level and high uric acid detection rate of overweight and obese children in Tangshan were higher than those of normal weight children. Age, obesity and dyslipidemia were influencing factors of hyperuricemia in obese and overweight children.
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The salary reform in public hospital is not only related to the interests of medical staffs,but also to the health care reform.Based on data of 17 provincial public hospitals in Zhejiang province from 2012 to 2017,and having calculated such factors as drug markup rate,hospital scale and general/ specialized hospital characteristics,the authors analyzed the effectiveness of public hospitals salaries reform from the perspectives of public duties performance,service quantity,medical expenditure,cost containment,service efficiency,implementation of insurance policies,among others.The growth rate of performance salary in Zhejiang provincial hospitals was less than 15％,and the performance salary accounted for less than 70％ of the total compensation.Such factors as cost containment,improvement of efficiency,service quantity and public welfare duties performance impose,though having minimal impact,were found to be significantly positively correlated to such compensation.Given the minimum impact of reforms in health care expenditure and insurance policy on public hospital salaries,lower medical expenditure and insurance refusal rates are conducive to raising such salaries.The salary reform of provincial public hospitals has achieved initial success,yet their salary system calls for further improvement.
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The salary reform in public hospital is not only related to the interests of medical staffs, but also to the health care reform. Based on data of 17 provincial public hospitals in Zhejiang province from 2012 to 2017, and having calculated such factors as drug markup rate, hospital scale and general/specialized hospital characteristics, the authors analyzed the effectiveness of public hospitals salaries reform from the perspectives of public duties performance, service quantity, medical expenditure, cost containment, service efficiency, implementation of insurance policies, among others. The growth rate of performance salary in Zhejiang provincial hospitals was less than 15%, and the performance salary accounted for less than 70% of the total compensation. Such factors as cost containment, improvement of efficiency, service quantity and public welfare duties performance impose, though having minimal impact, were found to be significantly positively correlated to such compensation. Given the minimum impact of reforms in health care expenditure and insurance policy on public hospital salaries, lower medical expenditure and insurance refusal rates are conducive to raising such salaries. The salary reform of provincial public hospitals has achieved initial success, yet their salary system calls for further improvement.
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Large medical equipments feature complex technology,high investment and operational costs,bearing major impacts on medical expenses.Curbing overinvestment and excessive growth of such expenses at public hospitals hence becomes one of the government key goals in regulatory control for these equipments.Based on data of provincial hospitals in Zhejiang and core variants as regulatory measures for large medical equipments,the authors came to important findings.For example,when such influencing factors as the supplier and customer characteristics of provincial public hospitals,and the equipment investment and medical expenses of other public hospitals are under control,the administrative licensing control of such equipments can lower the investment of medical equipments and medical expenses by 32.2％ and 78.2％ respectively,in comparison with the approval mechanism.It is therefore important to strengthen the regulation on large medical equipments at provincial level,and encourage human capital investment of public hospitals with service quality as orientation.These efforts can lower excessive supply of medical technology of provincial hospitals,and help the government to improve its regulatory effects for large medical equipments.
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Objective To analyze the economical operation and technical efficiency of Zhejiang provincial hospitals, and give references for deepening public hospitals reform.Methods We compiled data from 17 provincial public hospitals from 2013 to 2017 in Zhejiang, then used descriptive analysis to study hospitals′operating performance, and used stochastic frontier analysis( SFA) to analyze hospitals′ technical efficiency.Results From 2013 to 2017, the 17 provincial hospitals′ annual growth rate of outpatients and discharges were 5.2% and 9.5% , the number of outpatients and discharges at the general hospitals were 1.8 times and 2.5 times of those in specialized hospitals respectively.In these hospitals, service efficiency had been improved, and the income structure had become more reasonable.However, internal and external factors of the hospitals lowered technical inefficiency in their economic operation. Conclusions The economic operation mechanism of provincial hospitals should be further strengthened, and their external environment be improved as well.Only in this way can the hospitals achieve their operational goal of " doing the right thing and in the right way".
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The paper reviewed the history of drug price addition system and its impact on hospital management. Based on such facts,authors stated that the significance of abolishing drug price addition helped hospital management not to run their hospitals as a business, helped medical practitioners to make their clinical decisions based on medical needs, and to make the health care service deserve the professionals′value and contributions. Following the abolishment, the hospitals need to reform their internal operating mechanisms before they can achieve better performance.
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Objective To detect serum level of long noncoding RNA ( lncRNA) BC200 in gastric cancer(GC) patients, and investigate its relationship with clinical features , and evaluate its diagnostic value for GC.Methods A case-control study was performed.From November 2014 to July 2015, serum levels of lncRNA BC200 were detected by real-time quantitative polymerase chain reaction in 124 patients with GC , 41 patients with atrophic gastritis and 59 normal controls who were hospitalized in Qilu Hospital of Shandong University.Meanwhile , serum carcinoembryonic antigen ( CEA ) and carbohydrate antigen 72-4 ( CA72-4 ) were detected by electrochemical luminescence immunoassay .Serum levels of lncRNA BC200, before and 3, 7, 10, 30, 100 days after radical operation in another 31 patients with GC were determined.The sensitivity and specificity of serum lncRNA BC200, CEA and CA72-4 were analyzed by using of the receiver operating characteristic ( ROC) curve.The comparison between two groups was performed with Mann-Whitney U test and the comparison among many groups was conducted with Kruskal-Wallis H test.Results Serum levels of lncRNA BC200 in GC patients with stage Ⅰ and Ⅱ[1.041(0.794,1.462)] and stage Ⅲ and Ⅳ[1.290 (0.978,1.794)]were significantly higher than those in patients with precancerous lesion [0.969(0.699, 1.219)]and normal controls[0.801(0.556,1.599)](H =54.68,P<0.000 1).Compared with pre-operation[1.120 (0.859,1.663)], the serum BC200 levels decreased significantly in 10 days [0.903 (0.724,1.182)](U=55.0,P<0.000 1), 30 days[0.759(0.671,1.037)](U=299.0,P=0.026 1), and 100 days[0.478(0.378,0.635)](U=41.0,P<0.000 1) after surgery.The area under the receiver operating characteristics curve ( AUC) of serum lncRNA BC200 was 0.865 for GC diagnosis, which was significantly higher than that of serum CA 72-4 ( AUC =0.699 ) or CEA ( AUC =0.807 ) .The AUC of combined detection of three tests was 0.934.Conclusion Serum lncRNA BC200 levels are significantly increased in GC patients , which may be used as a potential biomarker in GC diagnosis and monitoring .
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Objective To investigate the clinical distribution and change in antimicrobial resistance of Acinetobact-er baumannii (A.baumannii)from a hospital between 2011 and 2013,so as to provide guidance for clinical treat-ment.Methods Sources and antimicrobial susceptibility testing results of A.baumannii from a hospital were ana-lyzed statistically.Results A total of 14 705 bacterial isolates were isolated in 2011 —2013,13.59%(n=1 999)of which were A.baumannii isolates,the percentage of A.baumannii in isolated pathogens in 3 years was 12.74%, 13.05%,and 14.85% respectively,which showed a rising trend (χ2 =9.458,P =0.002).The main specimen was sputum (n = 1 541 ,77.09%),bacteria were mainly isolated from patients in respiratory disease department (21 .71 %),surgical intensive care unit (16.26%),and emergency intensive care unit (8.26%).Antimicrobial re-sistance rates of A.baumannii increased year by year(all P <0.05);multidrug-resistant and extensively drug-resist-ant A.baumannii also increased year by year (all P <0.001).Conclusion Isolation rate and antimicrobial resistance rate of A.baumannii strains increase year by year,multidrug-resistant and extensively drug-resistant A.baumannii strains are obvious,which should be paid more attention in clinical department.
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As a rational economic man and agent, in the primary care Physicians not only pursue target in-come, but also pursue the utility of the agent. Different health care payment has different effect on physician, due to imperfect physician agent of the primary health care, the health care payment is difficult to achieve economic neutral. Based on the theory of target income and physician-induced demand, the paper proves that in the primary health care with the third party payment, there should be a prospective component of payment and fees should be lower than mar-ginal cost, which can not only improve the role of agent, but also constraint the physician-induced demand, so as to achieve health care for physician’s behavior constraints.
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Objective To investigate the effect of α-keto acid combined with low protein diet on kidney function, calcium-phosphorus metabolism and adenosine deaminase activity in malnourished patients with long term peritoneal dialysis.Methods Forty-six cases malnourished patients with long term peritoneal dialysis were selected from May 2013 to August 2014 in the hospital and divided into two groups.The control group (n=23) were treated by conventional therapy, acceptable daily intake of protein 1.2 g/(kg? d).The experiment group (n=23) were treated by α-keto acid combined with low protein diet, acceptable daily intake of protein 0.8 g/(kg? d).Two groups were treated for three months.Serum calcium, phosphorus, nutritional status assessment, adenosine deaminase activity and renal function were observed and compared after treatment.ResuIts After twelve months ’ treatment, compared with control group, serum creatinine, blood urea nitrogen, serum uric acid of experiment group were lower ( P0.05).ConcIusion α-keto acid combined with low protein diet could effectively increase serum calcium level, reduce serum phosphorus level, ADA activity and WBC count, and improve nutritional status in long-term peritoneal dialysis patients, which has important significance.
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Objective To establish a direct reverse transcription real-time fluorescence quantitative polymerase chain reaction ( RT-qPCR-D ) method for detecting serum circulating B cell-specific moloney murine leukemia virus integration site-1 (Bmi-1) mRNA, and analyze the levels of serum circulating Bmi-1 mRNA in colorectal cancer patients by using of this method for exploring its diagnosis value in colorectal cancer.Methods Methodology establishment.RNA was extracted from colorectal cancer HT 29 cell line, and detection standard curves of Bmi-1, ubiquitin C ( UBC), glyceraldehyde-3-phosphate dehydrogenase ( GAPDH) mRNAs were established , then the amplification efficiencies were calculated.Bmi-1 mRNA level was directly detected in serum and preparation buffer mixture , then the specificity of assay was evaluated by melting curve, and detection limit was observed through diluted serum samples.The serum circulating Bmi-1 mRNA levels were detected by ELISA in 158 cases with colorectal cancer , of which there were 26 cases of tumor node metastasis ( TNM)Ⅰstage, 53 cases of TNMⅡ, 47 cases of TNMⅢ, 32 cases of TNMⅣand 53 cases of controls with normal colonoscopy collected from January 2008 to January 2009 in Qilu Hospital of Shandong University.Comparisons of groups were determined by applying Mann-Whitney U test or Kruskal-Wallis test, and receiver operating characteristic ( ROC) curves were established to illustrate the diagnostic performance.Results The log values of Bmi-1, UBC and GAPDH showed good linear correlations with quantification cycle (Cq) values(R2 =0.990, 0.990, 0.991, all P 0.05).ROC curve analysis showed area under the ROC curve ( AUC) for serum circulating Bmi-1 mRNA was 0.921(95%CI=0.876-0.953), which was significantly superior to the AUC of CEA (0.745, 95%CI=0.680-0.802, Z=4.697, P0.05).Conclusions The study establishes a higher sensitive, specific for detecting serum circulating Bmi-1 mRNA. Based on this method , serum circulating Bmi-1 mRNA is found to be increased in colorectal cancer , and is superior to traditional tumor marker CEA in diagnosis of colorectal cancer, which may become a potential detection index for early detection of colorectal cancer.
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Objective To discuss the mechanism of progesterone that soften brain water content in traumatic brain edema in rats. Methods The models of focal lobe contusion and laceration of brain were made on the male rats treated by the progesterone following injury. Immunohistochemical method was used to assess the expression of aquaporin-4 (AQP4). Evan's Blue method was used to detect the permeability of blood-brain barrier. Results Treated by the progesteron, the brain water content was significantly decreased, and the lower expression of AQP4 took place on astrocytes of the contusion and peri-contusion of the brain tissue after 24 h,72h ,and 120h . The content of EB was decreased at 6 h and 24 h post-injury. Conclusions Progesterone can soften the traumatic brain water content, which may be associated with the attenuation of AQP4 in frontal lobe contusion following traumatic brain injury ( TBI) and progesterone can protect the blood-brain barrier at early time after TBI.
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Anti-phospholipid antibody and lupus anticoagulant appear in the blood of patients with human immunodeficiency virus (HIV)infection,which result in the increased levels of von Willebrand factor and D-dimer,and decreased the levels of protein S,protein C,antithrombin and heparin cofactor,and thus rgsult in hypercoagulation status.In addition,the HIV infection itself and secondary opportunistic infections may also cause endothelial injury.Both hypercoag ulation status and endothelial injury may promote the occurrence of thrombotic diseases.
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The evaluation of undergraduate course teaching by the Ministry of Education is a challenge to all our teachers,but it is also a chance for us to improve the teaching quality of infectious disease class.In this article we summarized the experience of the infectious disease education reform of many years,and discussed the approach and means of improving the teaching quality of infectious disease class.
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Objective To observe the effect of acupuncture analgesia on delivery and observe the result of analgesia in mother and infant.Methods Totally 324 primiparae were randomized into four groups:Electro-acupuncture group,82 cases,transcutaneous electrical nerve stimulation(TENS)group,82 cases,control group,81 cases,and spinal-epidural analgesia group,79 cases.The VAS scores of pain,degree of satisfaction of analgesia,outcome of delivery and changes of endorphin concentration were observed during the delivery and after.Results Compared with the TENS group and control group,viewing from the VAS scores of 30~120 minutes after analgesia,the effect in the electro-acupuncture group was better,but not as good as that in the spinal-epidural analgesia group,the difference was significant(P