Clinical features and risk factors of pulmonary hemorrhage in extremely preterm infants / 中国新生儿科杂志

Objective:To study the clinical features and risk factors of pulmonary hemorrhage in extremely preterm (EPT) infants.Methods:From February 2018 to January 2022, EPT infants admitted to NICU of our hospital and diagnosed with pulmonary hemorrhage were retrospectively assigned into the observation group and those without pulmonary hemorrhage were assigned into the control group. Univariate analysis and multivariate logistic regression analysis were used to compare the clinical features and determine risk factors of pulmonary hemorrhage in EPT infants.Results:A total of 114 EPT infants were included, including 28 cases (24.6%) in the observation group with pulmonary hemorrhage and 86 cases in the control group. Pulmonary hemorrhage mainly occurred within the first week after birth. Univariate analysis showed that the observation group had higher incidences of following events than the control group: birth asphyxia, delivery room intubation, severe respiratory distress syndrome, hyperglycemia, thrombocytopenia, severe acidosis, shock, score for neonatal acute physiology with perinatal extension-Ⅱ (SNAPPE-Ⅱ) ≥37 and the highest lactate level. Birth weight was lower in the observation group than the control group ( P<0.05). Logistic regression analysis showed that SNAPPE-Ⅱ≥37, shock and hyperglycemia were risk factors of pulmonary hemorrhage ( OR=4.081, 4.610 and 3.355, respectively, all P<0.05). The incidences of mortality and intracranial hemorrhage in the observation group were higher than the control group. The duration of mechanical ventilation in the observation group was longer than the control group ( P<0.05). No significant differences existed in the duration of nasal continuous positive airway pressure, assist mechanical ventilation and total oxygen use, the incidences of grade Ⅱ-Ⅲ bronchopulmonary dysplasia, retinopathy of prematurity and the length of hospital stay ( P>0.05). Conclusions:SNAPPE-Ⅱ≥37, shock and hyperglycemia are early risk factors for pulmonary hemorrhage in EPT infants. EPT infants with pulmonary hemorrhage have higher incidences of mortality and intracranial hemorrhage, requiring longer periods of mechanical ventilation.

Early mirror therapy and the functional recovery of hemiparetic stroke survivors / 中华物理医学与康复杂志

Objective To investigate the effect of early intervention with mirror therapy on hemiparetie survivors of ischemic stroke.Methods Thirty-six hemiplegic patients within one month after a stroke were randomly divided into a mirror therapy group (MT group,n=18) and a routine rehabilitation control group (RRC group,n=18).The participants in the MT group received MT for 45 min/d,5 d/wk for 3 weeks in addition to conventional stroke rehabilitation.Those in the RRC group received exercise therapy at the same frequency without the mirror protocol.The Fugl-Meyer assessment (FMA),Wolf motor function test (WMFT),functional ambulation category scale (FAC),Brunnstrom stages of motor recovery,and the modified Ashworth scale (MAS) were used to assess changes in the upper limb,gross hand dexterity and lower limb recovery before and right after the interventions,as well as one and two months after the treatment.Results Significant improvement was observed in the limb function of both groups after the treatment.Compared with the RRC group,there was significantly greater improvement observed in the MT group.This was true of the FMA ratings at all time points,the average WMFT scores one and two months after the intervention,the FAC ratings two months after the intervention,and the Brunnstrom stages at both one and two months after the intervention.However,no significant difference between the two groups in terms of the average MAS scores was observed at any time point.Conclusion Early intervention with MT can significantly accelerate the recovery of a paretic upper limb aud improve walking ability after stroke.Such intervention is worthy of promotion and application in clinical practice.

Analysis of the Efficacy and Safety of Video Assisted Thoracic Surgery and Thoracic Surgery in the Treatment of Myasthenia Gravis / 现代生物医学进展

Objective:To investigate the efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis.Methods:60 patients with myasthenia gravis were selected and randomly divided into two groups.The observation group(32 cases) received video assisted thoracic surgery.The control group(28 cases) received thoracic surgery.The efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis was evaluated by perioperative indexes,QMG scores before operation,after 3 months,6 months operation and complications during 6 months follow-up.Results:During the perioperative period,there was no statistical significance in the operation time between two groups(P＞0.05).The bleeding volume of observation group was less than that of the control group (P＜0.05).The drainage time,hospitalization and incision length of observation group were shorter than those of the control group (P＜0.05).Before operation,there was no statistical significance in the QMG scores.At 3 months,6 months after operation,the QMG scores were decreased in both groups.The QMG score of observation group was lower than that of the control group (P＜0.05).During 6 months' follow-up,complications were observed in 7 cases of the observation group and 17 cases of the control group,the major complication was pulmonary infection.The incidence of complications in the control group was higher than that of the observation group (P＜0.05).Conclusion:Video assisted thoracic surgery had advantages of smaller surgical incision,faster recovery and higher safety in the treatment of myasthenia gravis.

Investigation of the infection of Rotavirus in children in Hangzhou area / 中国基层医药

Objective To research the infection of Rotavirus in children in Hangzhou area and to get the message of the feature of epidemiology. Methods Stool specimens of 156 children with suspected acute viral enteritis in Hangzhou between September 2006 and January 2008 were collected. Rotavirus were detected for all specimens by enzyme linked immunosorbent assay(ELISA). Results Rotavirus was detected in 86 of 156(55. 1% ) specimens;all the 86 strains belonged to group A. The highest frequency of group A RV detected was 57% (70/123) in patients aged 6 ～ 24 months. Conclusion The major pathogen of acute viral enteritis in children in Hangzhou area between September 2006 and January 2008 was RV. Children under the age of 2 years seemed to be more susceptible to RV infection than those of other age groups. The symptoms of RV enteritis were more severe than those of other viral enteritis.

Analytical study of community health services quality based on 5-gap model / 中华全科医师杂志

In the marketing theory, service disparity model is a simple effective tool, capable of figuring out the five clusters of reasons leading to service failure. This article applies it in the community health service domain. Through the efforts of healing the five gaps in service delivery, including Consumer expectation-management perception gap, Management perception-service quality specification, Service quality specifications-service delivery gap Consumer expectation-management perception gap and Service delivery-external communications gap, we hope to improve the community health service quality radically.

Investigation and Analysis on Status of Rehabilitation Services in Comprehensive Hospitals of Capital Cities in China Mainland / 中国康复理论与实践

@#Objective To investigate the status of the establishment and service of the rehabilitation departments in comprehensive hospitals in China mainland.Methods A questionnaire survey was conducted in 240 comprehensive hospitals with different grades distributed in the capital city of 31 provinces, autonomous regions, and municipality cities in China mainland in a stratified sampling way. The contents investigated are the settings of rehabilitation departments, the performances of the rehabilitation services, the staffing of the rehabilitation workers and the problems faced in rehabilitation. Then, statistical analysis were done between the developed eastern regions and economically less developed middle-western regions, as well as different grades of comprehensive hospitals. Results In total, 216 valid questionnaires were collected (72 tertiary hospitals, 72 secondary hospitals and 72 primary hospitals), and there are no statistically difference between eastern regions and middle-western regions(P=0.61). About 69% of the hospitals surveyed have built up the rehabilitation departments, and there are no statistically difference between different regions (P=0.30). As far as the performance of the rehabilitation services are concerned, 97.2% of them have carried out rehabilitation service, 60% of them can satisfy the demands of the patients, and there are no difference between the different grades and between the eastern and middle-western regions(P>0.05). In addition, 76.4% of them have rehabilitation doctors, 68.4% have physiotherapists(PT), 52.3% have traditional Chinese medicine doctors, 50.5% have occupational therapists(OT), 36.9% have speech therapists(ST), 17.8% have psychologists, and only 2.3% have social workers. The staff status on PT, OT and ST of the hospitals in eastern regions are significantly better than that in middle-western regions(P<0.01), and the staff status on rehabilitation doctors, PT, OT, ST and psychologists in the tertiary hospitals are significantly better than that in the secondary hospitals and primary hospitals(P<0.01). Finally, the first five problems the rehabilitation department faced are following: short of professional workers(63.9%), lack of training areas(51%), lack of modern rehabilitation service management system (50.5%), out-of-date equipments(49.5%) and low fees of rehabilitation treatment(49.1%). Conclusion Many problems exists in the rehabilitation departments of comprehensive hospitals, such as the development of rehabilitation departments, the professional workers, the quality and width of the service, the efficient use of rehabilitation resources, rehabilitation management and profession permission, the relative policies and regulations, personnel training and so on. Therefore, the government should enhance to put the supported policies into practice, and reinforce investment to the comprehensive hospitals, in particular, enhance the support of the comprehensive hospitals in middle-western regions, as well as the primary hospitals and the secondary hospitals, all of which will play a much more efficient role in rehabilitation for the disabled in the comprehensive hospitals.