Association between interpregnancy interval and pregnancy complications in multiparas / 中华围产医学杂志

Objective:To explore the influence of interpregnancy interval (IPI) on pregnancy complications in multiparas.Methods:This was a retrospective cohort study involving 7 669 singleton parturients who delivered at ≥28 gestational weeks in the Affiliated Hospital of Southwest Medical University between December 2015 and December 2020 and had given birth in the third trimester before. Clinical data were collected, including the baseline characteristics, pregnancy complications, gestational weeks at delivery, and neonatal birth weight. According to the IPI, these women were divided into five groups: <12 months ( n=350), 12-<24 months ( n=945), 24-<60 months ( n=2 544), 60-<120 months ( n=2 478), and ≥120 months ( n=1 352). Based on the recommendation of the World Health Organization, pregnant women with an IPI of 24-<60 months were the control group. A multivariate logistic model was used to adjust for confounders and calculate the risks of pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). The influences of maternal age and previous delivery mode on the associations between IPI and maternal complications were analyzed. Analysis of variance (ANOVA), Chi-square test, and Cochran-Mantel-Haenszel Chi-square test were used for statistical analysis. Results:Compared with the control group, the incidence of GDM and HDP increased in the 60-<120 months group ( OR=1.23, 95% CI: 1.01-1.48 and OR=1.47, 95% CI: 1.13-1.92) and ≥120 months group ( OR=1.37, 95% CI:1.07-1.78 and OR=1.92, 95% CI: 1.39-2.64); the risks of uterine rupture/postpartum hemorrhage and placental abruption increased in the <12 months group ( OR=1.54, 95% CI: 1.01-2.34) and 12-<24 months group ( OR=2.38 95% CI: 1.13-5.02), respectively. In the 60-<120 months group, the risk of GDM increased only in non-elderly women (adjusted OR=1.71, 95% CI: 1.36-2.14), so did the risks of GDM and HDP in the ≥120 months group (adjusted OR=3.11, 95% CI: 2.10-4.62 and adjusted OR=1.81, 95% CI: 1.12-2.91). Among women who had undergone a previous cesarean section, the risk of GDM increased in the ≥120 months group (adjusted OR=1.35, 95% CI: 1.00-1.81). In the 60-<120 months group and ≥120 months group, the risk of HDP increased in postpartum women (adjusted OR=1.79, 95% CI: 1.08-2.95 and adjusted OR=3.32, 95% CI: 1.91-5.77). Conclusion:IPI≥60 months is a risk factor for GDM and HDP, and the associations between IPI and maternal complications are influenced by maternal age.

Effect of graphene oxide on the function of erythrocytes / 生物工程学报

The biocompatibility of nanomaterials has attracted much attention. Graphene oxide (GO) is a nanomaterial widely used in biomedicine, but its toxicity can not be ignored. In this study, the effect of GO on the blood system (the hemolysis rate, the fragility of erythrocyte, and acetylcholinesterase activity) was systematically investigated. The results showed that the hemolysis rate of erythrocytes was lower than 8% when the GO concentration was below 100 μg/mL (P5 μm (LGO) increased the activity of acetylcholinesterase by 42.67% (P<0.05). Then molecular dynamics simulation was used to study how GO interacted with acetylcholinesterase and increased its activity. The results showed that GO was attached to the cell membrane, thus may provide an electronegative environment that helps the hydrolysate to detach from the active sites more quickly so as to enhance the activity of acetylcholinesterase.

Research progress of anticoagulant management service for atrial fibrillation / 中华全科医师杂志

The morbidity and mortality caused by ischemic stroke resulted from atrial fibrillation are increasing year by year. Anticoagulation is the core strategy for the prevention and treatment of atrial fibrillation-related stroke. At present, the prominent problems in anticoagulation of atrial fibrillation in China include low rate of anticoagulation therapy, low rate of INR compliance, non-standard drug treatment, poor compliance with medication and follow-up, and so on. It has been reported that anticoagulation management service can significantly improve the effect and compliance of anticoagulation therapy, and reduce the hospitalization rate and emergency consultation rate of adverse events related to anticoagulation therapy. In this paper, the research progress of anticoagulant management service of atrial fibrillation at home and abroad is reviewed, providing reference for the establishment of anticoagulant management system under the hierarchical medical system in China.

Effect of preoperative simulation training on surgical indicators and postoperative infection in patients undergoing intestinal obstruction surgery / 中国基层医药

Objective To explore the effect of preoperative simulation training on surgical indicators and postoperative infection in patients with intestinal obstruction. Methods From November 2015 to November 2016, 66 patients with intestinal obstruction who received routine nursing in the Second People's Hospital of Wuxi were selected as control group. From December 2016 to December 2017,66 patients with intestinal obstruction surgery who received preoperative simulation training in our hospital were selected. as observation group. The surgical indicators and postoperative infections were compared between the two groups. Results The incision pain time,first exhaust time,land time and the hospitalization time in the observation group were (2. 19 ± 1. 08) d,(1. 53 ± 0. 72) d, (5. 21 ± 0. 98)d,(9. 75 ± 1. 49)d,respectively,which were shorter than those in the control group (all P < 0. 05). The CRP levels at postoperative 1 d,3 d and 6 d in the observation group were (6. 36 ± 1. 57) mg/ L,(7. 36 ± 1. 21)mg/ L,(6. 38 ± 1. 19)mg/ L,respectively,the PCT levels were (0. 46 ± 0. 14)ng/ mL,(0. 60 ± 0. 11)ng/ mL, (0. 38 ± 0. 06) ng/ mL, respectively, which were all lower than those in the control group, the differences were statistically significant ( all P < 0. 05). Conclusion Preoperative simulation training for patients with intestinal obstruction surgery can effectively optimize the surgical indicators and improve postoperative infection,and it is worthy of popularizing and applying.

Online questionnaire survey on knowledge of systemic lupus erythematosus among general practitioners in Beijing Dongcheng district / 中华全科医师杂志

Objective@#To survey knowledge of systemic lupus erythematosus (SLE) among general practitioners in Beijing Dongcheng district.@*Methods@#In November 2017, an online questionnaire survey on knowledge of SLE was conducted among 226 general practitioners from 7 community health service centers and 44 community health service stations in Beijing Dongcheng district. The questionnaire included three parts: the basic information of participants, SLE-related knowledge and the demand of continuing education for SLE.@*Results@#Total 225 valid questionnaires were received with a retrieval rate of 99.6%. The overall accuracy rate was 47.0%(1 269/2 700). And the rates of correct answer for SLE diagnosis, treatment and management were 28.3% (191/675), 58.4%(526/900) and 49.0%(551/1 125), respectively. Educational background, professional titles and working years had a certain impact on the level of SLE disease-related knowledge. Higher educational level and longer working years were associated with the higher knowledge level of SLE treatment goals (χ2=6.054, 4.296; P<0.05). Knowledge scores regarding side effects of glucocorticoid were slightly higher in GPs who were working for a longer time and in senior positions (χ2=6.048,5.499;P<0.05). In addition, the study also identified SLE patients in 5 community health centers and 15 community health service stations, who were given medications of glucocorticoids and immunosuppressants. Fewer SLE patients presented to the community health service and lack of learning resources mainly affected the GPs′ perception of SLE, as well as patient management. Besides, 79.6%(179/225) of GPs perceived that community management of SLE patients is necessary and they would be interested in receiving further training on SLE. The most preferred method of training delivery was short courses and lectures.@*Conclusion@#The knowledge and practice of SLE need improvement among GPS, especially early identification and long-term management. Fewer patients and lack of learning resources are the primary barriers. The results of the study are of practical significance for the training of general practitioners in the future.

Online questionnaire survey on knowledge of systemic lupus erythematosus among general practitioners in Beijing Dongcheng district / 中华全科医师杂志

Objective To survey knowledge of systemic lupus erythematosus (SLE) among general practitioners in Beijing Dongcheng district.Methods In November 2017,an online questionnaire survey on knowledge of SLE was conducted among 226 general practitioners from 7 community health service centers and 44 community health service stations in Beijing Dongcheng district.The questionnaire included three parts:the basic information of participants,SLE-related knowledge and the demand of continuing education for SLE.Results Total 225 valid questionnaires were received with a retrieval rate of 99.6％.The overall accuracy rate was 47.0％(1 269/2 700).And the rates of correct answer for SLE diagnosis,treatment and management were 28.3％ (191/675),58.4％(526/900) and 49.0％(551/1 125),respectively.Educational background,professional titles and working years had a certain impact on the level of SLE disease-related knowledge.Higher educational level and longer working years were associated with the higher knowledge level of SLE treatment goals (x2=6.054,4.296;P＜0.05).Knowledge scores regarding side effects of glucocorticoid were slightly higher in GPs who were working for a longer time and in senior positions (x2=6.048,5.499;P＜0.05).In addition,the study also identified SLE patients in 5 community health centers and 15 community health service stations,who were given medications of glucocorticoids and immunosuppressants.Fewer SLE patients presented to the community health service and lack of learning resources mainly affected the GPs' perception of SLE,as well as patient management.Besides,79.6％(179/225) of GPs perceived that community management of SLE patients is necessary and they would be interested in receiving further training on SLE.The most preferred method of training delivery was short courses and lectures.Conclusion The knowledge and practice of SLE need improvement among GPS,especially early identification and long-term management.Fewer patients and lack of learning resources are the primary barriers.The results of the study are of practical significance for the training of general practitioners in the future.

Effects of intrathecal injection Roscovitine on the pain behavior and the expression of ERK1/2 and PPARγ protein in spinal cord in rats with neuropathic pain / 中华行为医学与脑科学杂志

Objective To investigate the effects of intrathecal injection of Roscovitine on the pain behavior and the expression of pERK1/2 and pPPARγ receptor in spinal cord in rats with neuropathic pain.Methods Fifty-two male adult Sprague-Dawley rats of 220～ 250 g were randomly divided into 4 groups:Sham+DMSO group (dimethyl sulfoxide,S+D group),Sham+Roscovitine (S+R) group,CCI+ DMSO group (I+D),CCI+ Roscovitine (I+R) group.The corresponding drugs were administered by intrathecal injection from the seventh day after CCI once a day for 14 days.The right hind paw mechanical threshold value (PMWT) was measured by Von Frey filament and paw thermal withdrawal latency(PWTL) was measured by Hargreaves methods before 1 day and 3 d,7 d,10 d,14 d after surgery.The spinal cord lumbar enlargement was taken at 14 d after surgery,and Cdk5,p35,phosphorylated ERK protein (pERK),total ERK protein (ERK),phosphorylated PPARγprotein (pPPARγ) and total PPARγ protein (PPARγ) were detecteded by Western blot.Results Roscovitine was administered by intrathecal injection alleviated mechanical allodynia and thermal hyperalgesia of CCI rats.Compared with I+D group,PWMT in I+R group at 7 d,10 d,14 d after administration((4.65±0.08)g,(6.47±0.12)g,(7.90±0.19)g,) vs ((3.71 ±0.06)g,(2.45±0.17)g,(2.31±0.15)g) (Fgroup =505.71,P＜0.05,Ftime×group =15.33,P＜0.05),PWTL((9.22±0.33) s,(13.52±0.43) s,(12.63±0.88) s) vs ((8.02±0.20) s,(5.90±0.28) s,(5.40±0.38) s) (Fgroup =355,P＜0.05,F time×group =8.589,P＜0.05) were significantly increased.Compared with I+D group(p35 (0.58±0.02),pERK (1.12±0.13),pPPARγ (0.77±0.16)),p35 (0.46±0.04,F=11.06,P＜0.05) and pERK(0.79±0.11,F =22.91,P＜ 0.05) in I+ R group,were significantly dereased,and the expression of pPPARγ(0.99±0.13,F =17.62,P＜0.05))was significantly increased.Conclusion Intrathecal injection Roscovitine can alleviate both mechanical allodynia and thermal hyperalgesia in rats with neuropathic pain,and its mechanisms may be related to the inhibition of Cdk5/p35 and ERK activity,enhancement of PPARγ activity in the spinal dorsal horn.

Study progress on non-adherence to drug therapy in patients with systemic lupus erythematosus and its influencing factors / 中华全科医师杂志

In order to avoid persistent disease activity,relapse and unnecessary treatment escalation,patients with systemic lupus erythematosis (SLE) need long-term adherence to prescribed medication.However,in the clinical practice,a considerable number of SLE patients have poor medication adherence,which may be related to disease cognition,medication types,economical status,education level and depressive state.This review summarizes several related factors affecting medication adherence in SLE patients to provide reference for clinicians.

Progress on low-dose rituximab for systemic lupus erythematosus / 中华全科医师杂志

As a targeted immunosuppressive drug,rituximab is commonly used in the treatment of lymphoma.Recently,its efficacy in the treatment of rheumatic diseases has been concerned.However,studies have found that the dosage of rituximab for systemic lupus erythematosis (SLE) simply followed that for B-cell lymphoma may lead to increased infection risk.This article reviews the clinical application of lowdose rituximab in treatment of SLE with refractory thrombocytopenia,thrombotic thrombocytopenic purpura,lupus nephritis or neuropsychiatric lupus,which suggests that the low-dose rituximab has achieved satisfactory efficacy with good safety and tolerability.

Clinical features of adult patients with chronic active Epstein-Barr virus infection / 中华内科杂志

Objective To investigate the clinical features of adult-onset chronic active Epstein-Barr virus infection (CAEBV). Methods A total of 21 adult patients with CAEBV who were admitted to the department of General Internal Medicine at Peking Union Medical College Hospital from January 2006 to January 2016 were retrospectively analyzed. Demographic data, disease duration, clinical manifestations, laboratory findings, treatments and prognosis were reviewed. Results Eighteen females and 3 males were enrolled with a mean age of 39 years. The most common clinical manifestations included fever in 20 patients, splenomegaly in 20 patients, lymphadenopathy in 18 patients, and hepatomegaly in 10 patients, followed by laryngopharyngeal disorders in 6 patients, pleural effusion and peritoneal effusion each in 5 patients, rash in 4 patients, interstitial lung disease in 3 patients, gastrointestinal hemorrhage in 2 patients, and peripheral neuropathy and pulmonary hypertension each in 1 patient. Six patients were complicated with hemophagocytic lymphohis-tioncytosis(HLH) that developed 5-17 (mean: 9) months following CAEBV onset, all of whom experienced hyperpyrexia, pancytopenia, lymphadenopathy, splenomegaly, and liver dysfunction, 3 with hepatomegaly. Nineteen of the 21 patients had received steroid therapy including 10 combined with immunosuppressive agents, 11 with antiviral therapy, and 8 with intravenous immunoglobulin. Thirteen patients died, including 10 of multiple organ failure, (including 6 of HLH) 2 of severe pulmonary infection, and 1 of lymphoma. Six patients remained on follow-up, yet 2 were missing. Conclusions CAEBV is expected with severe condition and poor prognosis, which is likely to be complicated with HLH. Clinical physicians should pay attention to adult patients with fever, hepatosplenomegaly and lymphadenopathy, which suggests possible CAEBV.

Analysis on clinical effect of different kinds of internal fixation mode in treating Robinson type 2A and 2B midshaft clavicle fracture / 重庆医学

Objective To investigate the clinical efficacy of Kirschner wire,reconstruction plate and locking compression plate internal fixation in the treatment of Robinson type 2A and 2B midshaft clavicle fracture.Methods One hundred and fifty patients with midshaft clavicle fracture in the hospital from August 2006 to August 2015 were selected and divided into the group A,B and C.The group A adopted Kirschner wire,group B adopted the reconstruction plate and group C adopted the locking compression plate internal fixation.Then the incision length,operative time,intraoperative blood loss,fracture healing time,postoperative Constant-Murley scores and DASH scores and postoperative complications incidence rate were compared among the three groups.Results The incision length,operative time and intraoperative blood loss in the group A and C were significantly better than those in the group B(P＜0.05).The fracture healing time,postoperative activity,muscle strength and daily life score,postoperative complications incidence rate,postoperative DASH score in the group C were significantly better than those in the group A and B(P＜0.05).Conclusion The locking compression plate in the treatment of Robinson type 2A and 2B midshaft clavicle fracture can effectively reduce the surgical trauma,shortens the fracture healing time and decreases the postoperative complications.

Analysis of 139 patients with wide QRS complex tachycardia in emergency departent / 中华急诊医学杂志

Objective To study the clinical characterics of 139 patients with wide QRS complex tachycardia.Methods Retrospective analysis was performed on 139 patients with QRS wave tachycardia treated by radiofrequency ablation at TEDA International Cardiovascular Hospital.The patients were divided into supra-ventricular tachycardia with intra-ventricular aberrany group (group A,n =84) and ventricular tachycardia (group B,n =55).The clinical data,electrocardiogram (ECG) and echocardiographic features between the two groups were compared.Results There was no statistical significance between the two groups in terms of gender,height,weight and ventricular rate (P ＞ 0.05).The difference in the course of disease,blood pressure,age,QRS duration,left ventricular diameter by echocardiography and ejection fraction was statistically significant (P ＜ 0.05).Radiofrequency ablation result showed that 81 (96.4％) cases were successful in group A,and 37 (67.3％) cases were successful in group B.The difference in the success rate was statistically significant (P ＜0.05).After 1 year of follow-up,4 (2.9％) cases in group A were recurred,13 (23.6％) cases in group B were recurred.The difference in the recurrence rate was statistically significant.Conclusion The wide QRS wave tachycardia is often accompanied with left ventricular diameter enlargement and left ventricular ejection fraction reduction,The success rate of radiofrequency ablation is low,and the recurrence rate is high when diagnosis is ventricular tachycardia.

Effect of ultrasound microbubble mediated miRNA delivery on the ability of migration ,invasion and clon-ing of human hepatoma HepG2 cells / 实用医学杂志

Objective To invstigate the effect of ultrasound microbubble mediated miRNA delivery on mi-gration,invasion and cloning ability of human hepatoma HepG2 cells. Methods The migration,invasion and col-ony forming ability of HepG2 cells were measured after transfection with antisense miRNA-21/221 and miRNA-199a mimic via the optimal ultrasound microbubble transfection method. Results Compared with the control group ,the migration ,invasion and cloning ability of cells were significantly inhibited after transfection with miRNA mimics(P < 0.05,respectively),especially for miR-199a(relative cell migration rate was 31.05%,the number of invasive cells were 38.67 ± 4.51 and the number of clones were 105.67 ± 5.86). Conclusion The pres-ent study may provide new ideas and clues for gene therapy and prognosis of hepatocell ular carcinoma through ana-lyzing the effect of miRNAs on the biological characteristics of human hepatoma HepG2 cells.

Observation on the therapeutic effect of Yiqi Congming decoction in treating / 中国生化药物杂志

Objective To observe the curative effect of Yiqi Congming Decoction on tinnitus and deafness. Methods From May 2015 to May 2017 in the first affiliated hospital of Tianjin university of traditional Chinese medicine 74 cases of tinnitus and deafness patients, all patients were diagnosed as tinnitus, deafness, and has been hearing examination, examination and imaging examination of tympanic membrane. All patients were treated with Yiqi Congming decoction, 2 weeks for a course of treatment, a total of 3 courses of treatment. The therapeutic effect of the patients was observed. Results After 3 courses of treatment, 44 cases were markedly effective (59.46%), effective in 22 cases (29.73%), ineffective in 8 cases (10.81%), and the total effective rate was 89.19%. At the same time, follow-up studies were conducted on patients with significant efficacy and no recurrence was observed. Conclusion The method of Yiqi Congming decoction has better curative effect in the treatment of tinnitus and deafness.

Clinical features of non-Hodgkin's lymphoma in cheek misdiagnosed as inflammatory myopathy / 中华全科医师杂志

Objective To assess the clinical features of non-Hodgkin's lymphoma in cheek misdiagnosed as inflammatory myopathy.Methods Six patients presenting with unilateral swollen cheek were admitted at the Department of General Internal Medicine,Peking Union Medical College Hospital between January 2010 and December 2014.These patients were misdiagnosed as inflammatory myopathy and finally confirmed as Non-Hodgkin's lymphoma.The clinical characteristics,findings of laboratory tests and the diagnostic procedures were retrospectively analyzed.Results The median age of 6 patients (3 males and 3 females) was 30 years.The median duration from onset of unilateral swollen cheek to the final diagnosis was 13 months;the patients were referred to average 4 hospitals and experienced average 3 biopsies before admission.All patients had been treated with prednisone at a dose of 1 mg/kg or 0.5mg/kg per day.However,the symptoms relapsed in all patients after glucocorticoid tapering.No patient presented with proximal muscle weakness or myalgia.Two of 6 patients presented with unilateral forearm swollen.Creatine kinase was mildly elevated in 3 patients.Electromyographic abnormalities were seen in 4 patients.The biopsy showed muscle fiber necrosis,degeneration and a large amount of lymphocytes infiltration with or without vessel wall involvement.Erythrocyte sedimentation rate and high-sensitive C-reactive protein levels were normal.Anti-Jo-1,ANA and anti-U1RNP were all negative.EBV-DNV was significantly elevated in peripheral blood in 5 patients and it was positive in biopsy specimen in 3 patients.PET-CT scan was performed in 3 patients and suggested high metabolic activity with a SUV of 2.0-8.5 in cheek region.The biopsy specimen taken before admission did not show evidence of lymphoma.Repeated biopsies from cheek regions (3/6),lips (2/6) and forearm confirmed the final diagnosis as Non-Hodgkin's lymphoma,including 2 cases of T-cell lymphoma and 4 cases of NK/T cell lymphoma.Conclusion When patients present with unilateral swollen cheek without proximal skeletal muscle weakness or myalgia,even the pathologic evaluation implies inflammatory myopathy,non-Hodgkin's lymphoma should be considered.Repeated biopsy may be necessary to confirm the diagnosis.

Effects of Sodium Chloride Injection and Glycerine Enema on Postoperative Defecation in Patients with Com-plex Anal Fistula / 中国药房

OBJECTIVE:To observe the effects of Sodium chloride injection and Glycerine enema on the relief of postoperative defecation pain,edema around wound and incision in patients with complex anal fistula. METHODS:100 patients with complex anal fistula were selected and divided into group A(33 cases),B(33 cases)and C(34 cases)according to random number table. Group A was given Sodium chloride injection 300-500 ml,water bath heated to 35-37℃,into the rectum via enema bag before defecation,and defecated after controlling defecation for 5-10 min. Group B was given Glycerine enema 110 ml into the rectum,and defecated after controlling defecation for 5-10 min. Group C could defecated directly when they felt obvious defecation desire. VAS score of initial defe-cation,defecation frequence and time within 24 h after initial defecation,edema around wound and incision within a week after initial defecation were observed in 3 groups as well as the occurrence of ADR. RESULTS:VAS score of initial defecation,defecation fre-quence and time,edema around wound and incision in group A and B were significantly lower/shorter than in group C,with statistical significance(P0.05). No obvious ADR was found in group A and B during treatment. CONCLUSIONS:Both Sodium chloride injection and Glycerine enema can relieve postoperative defecation pain in patients with complex anal fistula,and reduce edema around wound and incision with good safety. The two drugs should be selected according to patient’s condition.

Clinical characteristics of systemic lupus erythematosus associated thrombotic thrombocytopenic purpura / 中华全科医师杂志

We retrospectively reviewed the clinical records of 12 systemic lupus erythematosus (SLE) patients with thrombotic thrombocytopenic purpura (TTP) admitted into Peking Union Medical College Hospital (PUMCH) during October 2008 to September 2013.TTP occurred in 0.45％ (12/2 693) of patients with SLE.The median age (2 males,10 females) was 23 years.Their SLEDAI scores ranged from 12 to 30.All patients had significant thrombocytopenia and renal abnormalities.Ten of them bad acute renal failure.Cardiac involvement and neurological deficits were observed in 9 and 8 of them respectively.Eight of them had injuries of more than 4 organs.Renal biopsy of 3 patients revealed lupus nephritis (type Ⅳ,n =2 ; type Ⅴ,n =1) and thrombotic microangiopathy.Eleven TTP patients received steroid pulse therapy (1 g/d,3 days) and six of them survived.Six patients were rescued by therapeutic plasma exchange and 4 of them recovered.Among another 6 patients not on plasma exchange therapy,only 3 recovered.Finally 2 died,3 gave up with exacerbated symptoms after therapy and 7 survived.

An analysis of disease spectrum of patients admitted to the General Internal Medicine Unit at Peking Union Medical College Hospital from 2004 to 2008, and the value of general internal medicine unit in comprehensive hospitals / 中华内科杂志

Objective To analyze the disease spectrum of patients admitted to the General Internal Medicine Unit at Peking Union Medical College Hospital, which is the first academic division of general internal medicine in the department of medicine within Chinese medical colleges and universities, and the value of general internal medicine unit in comprehensive hospitals. Methods A retrospective data review of patients admitted to the General Internal Medicine Unit from 2004 to 2008 was conducted from hospital information system and partially by chart review manually. Analysis of disease spectrum was performed thereafter. Results A total of 2593 patients were included in our study. It consisted of 1075 men and 1518women, with an average age of 45.1 years old. Forty point three percent of these patients were from Beijing,the local city, and the remaining 59.7% were from outside of Beijing. Sixty-four point nine percent (1683/2593)of these patients did not have a clear diagnosis on admission, including 758 fever of unknown origin (FUO) cases and 925 non-FUO cases. The final diagnostic rate of the FUO cases was 89. 2% [676/758, with the first three leading causes as diseases of the musculoskeletal system and connective tissue (29. 8%), certain infectious and parasitic diseases(26.3%), and neoplasm (14. 5%)] . The final diagnostic rate of the 928 non-FUO cases was 86. 8%(803/925), with the first three leading causes as musculoskeletal system and connective tissue(24.9%), neoplasm (15.5%), and diseases of blood and blood-forming organs(11.4%). Despite most diagnoses fitting into the above categories, the array of diseases was broad with as many as 550 discharge diagnoses from 2004 to 2008. Conclusions During 2004 -2008, there was a high proportion of cases that presented to the General Internal Medicine Unit at Peking Union Medical College Hospital with an unclear diagnosis, and the spectrum of diseases diagnosed was very broad. This kind of patient admitting model might not only benefit patients with no clear admission diagnosis and patients with multidisciplinary medical problems for whom it is usually difficult to be admitted by a specialty unit, but would also benefit medical students and residents by providing a good clinical medicine teaching base. These features show the value of general internal unit in comprehensive hospitals.

Development of RT-PCR-ELISA assay for detecting Cryptosporidium hominis / 中国人兽共患病学报

To establish a highly sensitive and specific method to detect the presence of Cryptosporidium homini, the RT-PCR-ELISA assay was tried, in which the primer with a biotin-labeled probe was designed to amplify fragment containing the highly variable region by multiple alignment between p23 gene of C.hominis and other Cryptosporidium spp. The RT-PCR was used to amplify the target fragment, and the amplified product was used to hybridize with the probe primer. The hybridized product was then captured on micro-plate wells coated with streptavidin and reacted with anti-digoxin antibody labeled with horse-radish peroxidase. This method of testing was then used for the detection of C.hominis in 22 clinical specimens and compared with the conventional methods of testing. It was demonstrated that the RT-PCR--ELISA for the detection of C.hominis was proved to be quite sensitive and specific. Its sensitivity was 100 times higher than that of the general PCR. From the result of clinic detection, the detection rate of RT-PCR-ELISA assay attained to 86%(19/22), while those of RT-PCR, sucrose floating method and anti-acid staining were 27%, 27% and 50% respectively. This result indicates that the RT-PCR-ELISA assay is more sensitive to detect C.hominis than the other three methods of testing.

Contribution of history-taking, physical examination and laboratory investigation to diagnoses for medical outpatients / 中华全科医师杂志

Objective To quantitatively evaluate relative contribution of medical history,physical examination and laboratory investigation to diagnoses for medical outpatients.Methods In total,145 medical visitors to the outpatient department of Peking Union Medical College Hospital (PUMCH) during October 10 to 16,2008 were recruited and followed-up for 12 months.Results Nineteen of 145 visitors (13.1%) were lost during the period of follow-up and diagnoses were established for 86 of them (68.3%)finally with medical history and for 20 (15.9%) with physical examination or laboratory investigation,respectively.Confidence index of internists in their correct diagnosis increased to 7.3 with medical history and to 7.9 and 8.7 with physical examination and laboratory investigation in average,respectively.Conclusions Most visitors to internal medicine department could be diagnosed correctly with medical history only.On the basis of physical diagnosis,selection of adequate laboratory investigation for them is critical to improvement of clinical diagnosis.