The relationship between sleep arousal, ambulatory blood pressure and heart failure in elderly patients with obstructive sleep apnea / 中华老年医学杂志

Objective:To evaluate the relationship between sleep arousal, ambulatory blood pressure and new-onset heart failure(NOHF)in elderly patients with obstructive sleep apnea(OSA).Methods:A total of 584 elderly patients with OSA who were diagnosed and treated in our hospital between March 2015 and March 2019 were prospectively and consecutively selected, with a mean age of(70.1±7.2)years.Polysomnography(PSG)results were obtained at baseline, and the arousal index(AI)was calculated.Based on the quartiles of AI, patients were divided into 4 groups: a low-level group(AI<18.4/h, 186 cases), a low-medium level group(18.4-29.1/h, 177 cases), a medium-high level group(29.2-41.2/h, 137 cases)and a high-level group(>41.2 /h, 84 cases). Participants were followed up for 18 months, the results of ambulatory blood pressure were recorded and compared, and the relationship between AI and the risk of NOHF was analyzed.Results:Compared with the low-level group, patients in the low-medium, medium-high, and high-level groups were older(70.1, 70.3, 73.3 vs.68.7 years, F=2.726, P=0.043)and had more smokers(43.8%, 49.6%, 54.8% vs.38.2%, χ2=8.809, P=0.032), a larger body mass index(26.3, 26.7, 27.6 vs.25.4 kg/m 2, F=2.731, P=0.042), a higher Epworth sleepiness scale score(7.83, 8.50, 9.91 vs.7.64, F=5.124, P=0.018), a higher apnea hypopnea index(23.5, 34.8, 52.7 vs.17.6, F=5.632, P=0.007), lower nocturnal oxygen saturation(80.2, 75.3, 72.1 vs.83.7 mmHg, F=4.811, P=0.024), and higher N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels(317.5, 337.5, 359.2 vs.267.5 pg/L, F=4.307, P=0.033). At the median follow-up(18 months, 14-24 months), the results of ambulatory blood pressure monitoring showed that 24-hour systolic blood pressure(24 h SBP)(147.3, 148.6, 156.2 vs.143.8 mmHg, F=5.4311, P=0.013), 24-hour diastolic blood pressure(24 h DBP)(80.1, 79.5, 83.7 vs.76.5 mmHg, F=5.679, P=0.011)in the low-medium, medium-high and high-level groups were higher than those in the low-level group.The results of survival analysis showed that there were 75(12.8%)cases of NOHF, mostly with preserved ejection fraction(47 cases)or mid-range ejection fraction heart failure(20 cases). The incidences of NOHF were 6.5%, 12.4%, 16.1% and 22.4%, respectively for the low level, low-medium, medium-high and high-level groups, and the risk of NOHF in the low-medium, medium-high and high-level groups was significantly higher than in the low level group(log-rank χ2=11.624, P=0.007). Variables with P<0.2 in the univariate analysis, age and sex were included in the multivariate Cox regression analysis.The results showed that age( HR=1.724, 95% CI: 1.216-3.135), diabetes( HR=1.514, 95% CI: 1.127-3.058), NT proBNP( HR=1.517, 95% CI: 1.232-2.366), nocturnal diastolic blood pressure( HR=2.004, 95% CI: 1.332-4.638), and middle-high AI level( HR=1.611, 95% CI: 1.204-2.967)and high AI level( HR=1.863, 95% CI: 1.272-3.538)were independent factors of NOHF in elderly OSA patients. Conclusions:Sleep arousal in elderly patients with OSA increases blood pressure levels and the risk of NOHF.

Dead space fraction for treatment guidance and prognosis evaluation of acute respiratory distress syndrome / 中华危重病急救医学

Acute respiratory distress syndrome (ARDS) is a common cause of critical illness and high mortality from respiratory failure. Increased dead space fraction (VD/VT) was independently associated with lung injury and mortality of ARDS. VD/VT is readily obtained by bedside measurements of arterial blood gas and end-tidal carbon dioxide. Early attention and application of VD/VT as an indicator will help to better understand the pathophysiological of ARDS, guide clinical treatment, and better assess the severity and clinical prognosis of the disease.

Investigationon the male nursespractice environment and turnover intention in Qinghai Province / 中国实用护理杂志

Objective:To investigate the current practice environment of male nurses in Qinghai province, and understand the professional environment and turnover intention of male nurses, provide ideas and theoretical basis for continuous improvement of the working environment of male nurses in hospitals.Methods:From September to October 2020, the practice environment and turnover intention of male nurses in Qinghai Province were investigated by using the method of convenience sampling and using the general data questionnaire, the Nurse Practice Environment Assessment Scale and the turnover intention table.Results:A total of 155 registered male nurses in Qinghai Province participated in this survey, and the overall evaluation score of the practicing environment of nurses in Qinghai Province was (74.38±22.63) points, among which the highest score was that nurses could write nursing records in time (85.24±20.99) points, and the lowest score was that nurses had the opportunity to participate in the internal management of the hospital (55.03±30.55) points. The total score of resignation intention was (14.34±4.35) points.Conclusion:The overall evaluation of the practicing environment of male nurses in Qinghai Province is fair, and their turnover intention is high. Nursing managers should attach importance to the cultivation of male nurses' feelings towards hospitals and professions, so as to reduce their turnover intention and stabilize the nursing team of male nurses.

Study on the effect of the quality control circle teaching mode in the midwife internship teaching / 中国实用护理杂志

Objective To explore the quality control circle (QCC) in midwife practice teaching activities for improving the quality of teaching effect, innovate the method for obstetric practice teaching and provide reference for other practice teaching methods. Methods Take the 84 midwifery interns as research object who entered the maternity ward within two years after the implementation of the QCC activities, and randomly divided into the experimental group and the control group and each group included 42 people. The experimental group adopted the teaching mode of integrating daily teaching into the QCC. The control group adopted the traditional one-on-one teaching mode based on teaching, and compared the learning effects of the two groups of interns. Results After the internship, the three levels of the Koch′s four-level training evaluation model method were used to evaluate the teaching effect. The reaction layer was evaluated through five aspects: teaching plan, teacher resources, internship environment, teaching form and content, and appraisal evaluation. It was found that the satisfaction of the teaching plan and teaching form evaluation of the experimental group was significantly higher than that of the control group; the learning level passed the theoretical test. The results of the scores, skills test scores and overall care were evaluated. It was found that the three results of the internship group were significantly higher than those of the control group. The behavioral level was evaluated by the satisfaction of the client and the maternal was proficient in the operation of the experimental group. The satisfaction evaluation of the mission and the mission was significantly higher than the control group. The difference in the above evaluation results was statistically significant (P<0.05). Conclusions The quality control circle teaching mode is feasible in the midwife internship teaching in the delivery room, which transforms the traditional passive teaching mode into a common and active participation teaching mode for teachers and students, enhances the level and enthusiasm of teachers to teach, and enhances service awareness and quality of care. It also plays a role in cultivating management talents and is worthy of further exploration and promotion.

Study on the effect of the quality control circle teaching mode in the midwife internship teaching / 中国实用护理杂志

Objective@#To explore the quality control circle (QCC) in midwife practice teaching activities for improving the quality of teaching effect, innovate the method for obstetric practice teaching and provide reference for other practice teaching methods.@*Methods@#Take the 84 midwifery interns as research object who entered the maternity ward within two years after the implementation of the QCC activities, and randomly divided into the experimental group and the control group and each group included 42 people. The experimental group adopted the teaching mode of integrating daily teaching into the QCC. The control group adopted the traditional one-on-one teaching mode based on teaching, and compared the learning effects of the two groups of interns.@*Results@#After the internship, the three levels of the Koch′s four-level training evaluation model method were used to evaluate the teaching effect. The reaction layer was evaluated through five aspects: teaching plan, teacher resources, internship environment, teaching form and content, and appraisal evaluation. It was found that the satisfaction of the teaching plan and teaching form evaluation of the experimental group was significantly higher than that of the control group; the learning level passed the theoretical test. The results of the scores, skills test scores and overall care were evaluated. It was found that the three results of the internship group were significantly higher than those of the control group. The behavioral level was evaluated by the satisfaction of the client and the maternal was proficient in the operation of the experimental group. The satisfaction evaluation of the mission and the mission was significantly higher than the control group. The difference in the above evaluation results was statistically significant (P<0.05).@*Conclusions@#The quality control circle teaching mode is feasible in the midwife internship teaching in the delivery room, which transforms the traditional passive teaching mode into a common and active participation teaching mode for teachers and students, enhances the level and enthusiasm of teachers to teach, and enhances service awareness and quality of care. It also plays a role in cultivating management talents and is worthy of further exploration and promotion.

Efficacy and safety of active transfer of plaque versus provisional stenting with drug-eluting stents for the treatment of coronary bifurcation lesions / 中华心血管病杂志

Objective@#To compare the efficacy and safety of active transfer of plaque (ATP) versus provisional stenting (PS) with drug-eluting stents (DES) for the treatment of coronary bifurcation lesions.@*Methods@#A total of 1 136 patients with bifurcation lesions hospitalized in 6 selected hospitals between January 2010 and January 2014 were included in this prospective observational trial, patients were divided into either ATP (n=560) or PS group (n=576) accordingly. The primary endpoint was target lesion revascularization within 1 year, and the second endpoints were all-cause death, cardiogenic death, myocardial infarction, stent thrombosis, stroke, recurrent angina within 1 year.@*Results@#There were no significant differences in age, sex, hypertension, diabetes, hyperlipidemia and smoking history between the two groups (P>0.05). The incidence of TIMI blood flow <3 grade in the side branch (1.6%(9/560) vs. 7.5% (43/576), P<0.01), acute occlusion of the side branch (1.3%(7/560) vs. 7.1%(41/576), P<0.01) and implanted stents of side branch (1.8%(10/560) vs. 7.8% (45/576), P<0.01) were significantly lower in the ATP group than those in the PS group. During the one year follow up, the rate of target lesion revascularization was similar between ATP group and PS group (4.6%(26/560) vs. 4.0%(23/576), P=0.66).@*Conclusions@#The effectiveness and safetyof ATP techniquein the patients with coronary bifurcation lesions is comparable to the PS technique. However, ATP technique is superior to PS technique on effectively reducing the incidence of implanted stents in the side branch.

Trends of in-hospital mortality and constituent ratio of patients with acute myocardial infarction / 中华心血管病杂志

Objective@#To analyze the trends on constituent ratio of non-ST-segment-elevation (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI) and related in-hospital mortality in acute myocardial infarction (AMI) patients hospitalized in Beijing Anzhen Hospital from 2004 to 2014.@*Methods@#This is a single-center, retrospective study. We reviewed all patients hospitalized for AMI in Beijing Anzhen Hospital from January 1 2004 to December 31 2014, and collected all related information including hospitalization stay, the type of AMI, revascularization and in-hospital mortality. We analyzed the trends of constituent ratio of NSTEMI and STEMI, and their in-hospital mortalities during the 11 years.@*Results@#Data from a total of 23 864 patients with AMI, including 5 539 STEMI and 18 325 NSTEMI, were analyzed. Compared with STEMI patients, NSTEMI patients were older, less likely to be male (P<0.001), had higher prevalence of hypertension, hyperlipidemia, diabetes (P<0.001), and lower prevalence of smoking (P<0.001). Additionally, patients with NSTEMI were more likely to have prior history of MI (12.6% (695/5 539) vs. 7.4% (1 354/18 325), P<0.001) and coronary artery bypass graft surgery (2.7% (152/5 539) vs. 0.7% (124/18 325), P<0.001). The constituent ratio of NSTEMI was significantly increased during the observation period, rising from 15.8% (107/802) in 2004 to 35.7% (1 273/3 583) in 2014 (P value for trend <0.001). The in-hospital mortality of NSTEMI patients was significantly lower compared with those with STEMI (1.84% (102 cases) vs. 2.74% (502 cases), P<0.001). The mortality of both STEMI and NSTEMI were significantly decreased during the 11 years (both P value for χ2 trend test <0.001). After adjusting for other risk factors, NSTEMI was independently associated with lower in-hospital mortality (OR=0.50, 95%CI 0.40-0.63, P<0.001).@*Conclusions@#In patients with AMI, the constituent ratio of NSTEMI versus STEMI is increased during the 11 years. The in-hospital mortality is decreased for both STEMI and NSTEMI patients in the past 11 years, and the in-hospital mortality rate of NSTEMI patients is lower than STEMI patients in this patient cohort during the observation period.

Subgroup identification based on the Logistic model / 南方医科大学学报

We propose a subgroup identification method based on the Logistic model for data from a two-arm clinical trial with dichotomous outcome variables.In this method, binary Logistic regression models are established for each group to calculate the outcome probabilities of each patient for comparison.According to the established rules, the patients are classified into their corresponding subgroups to establish a multinomial Logistic regression model.We simulated the false rate, correct judgment rate, coincidence rate and model correct judgment rate for different sample sizes and carried out an example analysis.The results of simulation showed that for different sample sizes, the false rates of this method were below 0.07 and the correct judgment rates were all above 0.75 with adequate coincidence rates and model correct judgment rates, demonstrating the effectiveness and reliability of the proposed method for subgroup identification.

Effect comparison between open reduction internal fixation and primary arthrodesis for treatment of Lisfranc injuries combined with first tarsal joint dislocation / 中华创伤杂志

Objective To compare the effect and prognosis outcome of open reduction internal fixation and primary arthrodesis in treatment of Lisfranc injuries combined with the first tarsal jointdislocation.Methods A retrospective case control study was conducted on the clinical data with complete follow up data of 126 patients with Lisfranc injuries combined with the first tarsal joint dislocation in nine ankle surgery centers of China from January 2009 to June 2015.There were 76 males (60.3％) and 50 females (39.7％) with an average age of 45.5 years (range,20-87 years).Among the 126 cases,simple dislocation occurred in 41 cases (32.5％),and fracture dislocation in 85 cases (67.5％).The duration from injury to surgery was 11.7 days (range,4-26 days).According to surgery method,the patients were divided into open reduction internal fixation group (n =92) and primary arthrodesis group (n =34).The outcomes were evaluated by American Orthopedic Foot and Ankle Society(AOFAS) score,36-items short form health survey (SF-36),and visual analogue score (VAS).Complications were also followed up.Results All patients were followed up for 18-80 months,with an average of 29.5 months.Primary union was seen in all the patients.At the last follow up,the mean AOFAS midfoot score was (79.4 ± 6.7) points in open reduction and internal fixation group and (85.1 ±8.3) points in primary arthrodesis group (P ＜ 0.05).The mean VAS was (3.1 ± 0.6) points in open reduction and internal fixation group and (2.2± 0.3)points in primary arthrodesis group(P ＜ 0.05).The physiological function of SF-36 was (80.3 ± 5.3) points in open reduction and internal fixation group and (83.5 ± 6.9) points in primary arthrodesis group(P ＞ 0.05).The body pain score of SF-36 was (76.1 ±4.6) points in open reduction and internal fixation group and (84.6 ± 8.7) points in primary arthrodesis group (P ＜ 0.05).In open reduction and internal fixation group,there were five cases (5％) with internal fixator loosening or fracture,16 cases (17％) with redislocation,36 cases (39％) with obvious pain of the middle foot during walking,and eight cases (6％) with tarsal joint traumatic arthritis which was given phase Ⅱ arthrodesis.In primary arthrodesis group,two patients (6％) reported pain due to internal fixation,and the pain was relieved after fixator removal.No re-dislocation,loosening of internal fixation,or traumatic arthritis were found (P ＜ 0.05).Conclusion For Lisfranc injuries combined with first tarsal joint dislocation,primary arthrodesis can stabilize the first tarsal joint and avoid complications or adverse consequences such as redislocation,pain,internal fixation failure,or reoperation.

Fluoxetine regulates hippocampal synaptic plasticity in CUMS depression rats / 中国病理生理杂志

AIM: To investigate the role of fluoxetine in the hippocampal synaptic plasticity in chronic unpre-dictable mild stress (CUMS) depression rats and its effect on mTOR and autophagy signaling pathways.METHODS:Male Sprague-Dawley rats (n =60) were randomly divided into normal control group, CUMS group and fluoxetine group. The CUMS rat model was established through CUMS combined with solitary raising, and fluoxetine (20 mg? kg -1? d -1 ) was administered via intragastric gavage.The changes of body weight, the ratio of sugar intake and the results of the behav-ioral test were recorded to identify the modeling.Moreover, the expression of synaptic plasticity-related proteins glial fibril-lary acidic protein (GFAP) and synaptophysin (SYP), apoptosis-related proteins Bcl-2 and caspase-3, mTOR signaling proteins mTOR and 4EBP1, and autophagy-related proteins beclin 1 and LC3 were examined by RT-PCR and Western blot. RESULTS: Compared with control group, the body weight, sucrose intake, and total distance and intermediate residence time in the open field test were significantly decreased in CUMS group.The results of RT-PCR and Western blotting showed that the mRNA and protein levels of SYP and GFAP in CUMS group were significantly down-regulated compared with con-trol group.The expression of Bcl-2 in CUMS group was downregulated, while the protein level of cleaved caspase-3 in-creased.Decreased phosphorylation levels of mTOR and its downstream target molecule 4EBP1 were observed in CUMS group.Besides, the autophagy-related proteins beclin 1 and LC3 were significantly upregulated at mRNA and protein lev-els.All these results(upregulation or downregulation) were attenuated by the treatment with fluoxetine, and the difference was statistically significant.CONCLUSION: Fluoxetine might improve hippocampal synaptic plasticity and alleviate symp-toms of depression by supressing apoptosis/autophagy signaling pathways and upregulating mTOR signaling pathway.

"""Logsplitter"" injury in clinical treatment and prognosis evaluation in ankle fractures" / 中华骨科杂志

aration caused by varieties of violence does not catch the attention of domestic orthopedic surgeons enough in the past years.This passage is to discuss the damage mechanism,clinical treatment and prognosis evaluation of this kind of injury through the analysis of the case of Logsplitter injury.Methods Retrospective analysis 23 patients of Logsplitter injury from December 2006 to December 2014,male in 17 cases,female in 6 cases,average age (43.68±12.67) years (21-60 years).Hurt injury in 9 cases,sports injury in 1 case,falling injury in 2 cases,traffic injuries in 10 cases,crushing injury in 1 case.Open injures in 10 cases,of which the Gustilo Ⅱ type in 7 cases,Gustilo Ⅲ A type or above in 3 cases,closed injuries in 13 cases.According to the AO/OTA fracture classification,44c type in 19 cases,44b type in 3 cases,44a type in 1 case.Fibula fractures in 22 cases,19 cases of medial malleolus fracture.Results 23 patients received follow-up,with an average period was (0.91±0.26) years (0.4-2.37 years).21 cases underwent open reduction internal fixation (ORIF),2 cases underwent closed reduction external fixation and K-wire fixation.17 cases were fixed with the syndesmosis screws,among them,1 screw was used to fix 14 cases,two screws were used to fix 3 cases;the utilization rate of 3.5 mm screws is higher,at 94.1％,and all screws were entered through 3 layers of cortical;Combined with medial malleolus fracture cases were fixed with cannulated screws/K-wire internal fixation.Average healing time of the skin surrounding the ankle skin was (2.26±1.91) weeks;average healing time of fracture was (15.34±5.13) weeks;Joint pain ocurred combined with joint space narrowing after loading in 18 cases,at 78.3％;Postoperative infection,2 cases,the proportion was 8.7％;Fracture delayed union 1 case.Functional examination of the ankle joint (angle measurement method):Dorsiflexion average angle (23.9±2.21)degrees,Plantar flexion average angle (32.1 ±4.13) degrees.Average angle of introversion was (23.91 ±2.24) degrees.Hallux valgus average angle (27.6±3.81) degrees.75 points and over were got in AOFAS in 21 cases,the ratio of excellent was 91.3％.Conclusion Logsplitter injury represents a kind of important and unique ankle fracture,dislocation and the inferior tibiofibular syndesmosis separation caused by varieties of violence,accompany with potentially soft tissue injury and platford injury,according to existing treatment principle and treatment strategy summarizied by us,the clinical therapeutic effect of this damage is ideal,functional recovery is relatively satisfactory prognosis.

Polymorphisms of intercellular adhesion molecule-1 gene K469E and platelet endothelial cell adhesion molecule-1 gene C373G in patients with preeclampsia / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the distributions of genotypic and allelic frequencies of intercellular adhesion molecule-1 (ICAM-1) gene K469E and platelet endothelial cell adhesion molecule-1 (PECAM-1) gene C373G in patients with preeclampsia.</p><p><b>METHODS</b>Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) and DNA sequencing were used for detecting ICAM-1 gene K469E and PECAM-1 gene C373G genotypes in 110 women with preeclampsia and 110 normotensive pregnant women in comparison with their clinical characteristics.</p><p><b>ESULTS</b>The distributions of observed and expected genotype frequencies were consistent with Hardy-Weinberg equilibrium. No significant differences were found in the genotype and allele frequencies of ICAM-1 gene K469E between the two groups (P>0.05), but the CC and the CG genotype frequencies of PECAM-1 gene C373G were significantly different between them (P<0.05). The relative risk for preeclampsia of CG genotype was 1.959 folds of that in CC genotype carriers (OR=1.959, 95%CI: 1.090-3.520, P=0.024), and this association still existed after adjustment for age, gravidity, parity and BMI in logistic regression models. The C373G allele frequencies showed no significant difference between the two groups (P>0.05).</p><p><b>CONCLUSIONS</b>The CG genotype of PECAM-1 gene C373G genetically predispose the carriers to preeclampsia, while ICAM-1gene K469E polymorphisms is not associated with preeclampsia.</p>

Investigation on developing a computerized imitating system of pediatric clinical patients / 中华医学教育探索杂志

The computerized imitating system constructed by the Second Affiliated Hospital of Guangzhou Medical University contains four blocks:administration of student infomation,administration of question bank,on-line tests and administration of score inquiry.It's designed to imitate typical pediatric cases,so that the medical students may put themselves into the practical clinical scenario and solve the challenges step by step in one-direction procedure.Teaching with computerized clinical scenario imitating patients can improve students' test resuhs and activate students' learning enthusiasm significantly.It not only helps to solve the contradiction between increasing number of medical students and clinical typical teaching case shortage but also improves the clinical thinking ability of the medical students.This system can also be used as a test bank for pediatric technical skills examination.

Impact of invasive treatment strategy on health-related quality of life six months after non-ST-elevation acute coronary syndrome / 老年心脏病学杂志（英文版）

BackgroundFew studies have compared change in the health-related quality of life (HRQL) following treatment of non-ST-elevation acute coronary syndrome (NSTE-ACS) with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up (P<0.001), the CABG relative to PCI group showed more significant improvements in angina frequency (P= 0.044) and quality of life (P= 0.028). In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency (OR: 1.62, 95%CI: 1.09-4.63,P= 0.042) and quality of life (OR: 2.04, 95%CI: 1.26-6.92,P= 0.038) relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.

Effects of molluscicides at different environments on Oncomelania hupensis snail control in Danyang City / 中国血吸虫病防治杂志

Objective To evaluate the effects of continuous application of niclosamide ethanolamine salt on Oncomelania hu-pensis snail control in a marshland,river and channel. Methods The Beiwei marshland in Houxiang Town,the Xiaoliang River in Lingkou Town and Laomiao channel in Yunyang Town in Danyang City were selected as study sites,and 4%niclosamide etha-nolamine salt and 26%niclosamide powder were used to kill the snails. Based on the historical records and field investigations, the effects of continuous application of niclosamide ethanolamine salt on snail control were evaluated. Results Compared with the first time of snail repetition,the snail areas decreased by 82.80%,63.14%and 70.00%in the Beiwei marshland,Xiaoliang River and Laomiao channel,respectively,in 2013. There was a positive correlation between the area and density of snails(r=0.931, 0.975 and 0.916,respectively;all P values < 0.05). The average densities of living snails decreased significantly by 92.34%, 87.91%and 97.66%,respectively. There was a negative correlation between the corrected mortality of snails and the average densi-ty of living snails in the following year,and a negative correlation between the reduction rate of living snail density and the average density of living snails in the following year. Conclusion Molluscicides plays an important role in compressing the snail area,re-ducing the snail density,and controlling the schistosomiasis transmission.

The epidemiology and risk factor of dyslipidemia for people in multiple physical examination center in Lanzhou / 国际检验医学杂志

Objective To explore the status and risk factors of the dyslipidemia among health examination population of Lanzhou for providing the intervention measures .Methods According to the stratified cluster random sampling method ,4 505 health exami-nation individuals were recruited for the study from 5 hospitals in the Lanzhou region through questionnaire ,biochemical analysis . Results Prevalence of dyslipidemia of the population was 45 .79% ,high TG was the main type .The level of serum TC ,TG ,HDL-C and LDL-C were (5 .27 ± 1 .08) ,(1 .74 ± 1 .38) ,(1 .41 ± 0 .43) and (2 .83 ± 0 .82)mmol/L .The prevalence was 53 .49% in male , and 34 .93% in female .The prevalence was higher among the group of 35- <45 years old for male and 55- <65 years old for fe-male .The level of HDL-C was low among young people .There was aggregation of risk factors among the participants with dyslipi-demia .Non-conditional logistic regression analysis showed that the risk factors were age (OR=1 .701) ,overweight (OR=5 .560) , abdominal obesity(OR=2 .398) ,smoking(OR=0 .545) ,intake of greasy diet(OR=5 .313) ,sleep quality(OR=2 .005) and diastolic blood pressure(OR=3 .061) .Conclusion Lipid disorders becomes a serious problem in the health examination population ,measures such as rational diet ,weight control ,sleep improvement ,pressure control and quiting smoking must be taken .

Exploration of compensatory mechanism in public medical institutions in Shanghai SongJiang District / 中华医院管理杂志

The paper introduced the exploration made by Shanghai SongJiang District in its compensation mechanism for public hospitals and community health centers.This attempt aimed at increasing government financial support,identifying public health needs in the development of public medical institutions,developing the compensatory measures to fit the task completed,and the service provided and individual items.It took such factors as the present personnel,workload,population and area taken into account.All these are designed to make the mechanism more appropriate and fair.

Analysis of prenatal diagnosis results of 206 thalassemia families / 中华围产医学杂志

Objective To summarize the geographical distribution,phenotype and genotype data of 206 thalassemia families underwent prenatal diagnosis to provide information for clinical genetic counseling and avoid the birth of severe thalassemia children.MethodsTotally,206 thalassemia families were collected from Southern Medical University Nanfang Hospital from January 2008 to December 2009.Genomic DNA was extracted from peripheral blood,villus,amniotic fluid or cord blood from the couples or the fetuses.Gap-polymerase chain reaction (gap-PCR) and reverse dot blot (RDB) technology were used to detect the common α and β-thalassemia mutations.DNA sequencing was used to detect the rare mutations.Follow-up visit were done half a year after the fetuses were born. Results The 206 thalassemia families came from 12 provinces and areas across China,including Heilongjiang province.Mutations detected in α-thalassemia families included --SEA/,-α3.7/,-α4.2/,αCS α/ and αQS α/,which were all included in the testing kit. While there were 4 kinds of β-thalassemia mutations,Gγ+ (A γδβ)0,-28(A→C),CD54-58(-TATGGGCAACCCT) and CD37(G→A),could not be identified with routine testing kit. The 57 α-thalassemia families consisted of 11(19.3％) severe thalassemia,induding 8 Bart's hydrops syndrome and 3 Hb H disease,26(45.6％) heterozygote and 20(35.1％) normal infants,and the 149 β-thalassemia majors families consisted of 28 (18.8％) severe thalassemia,82(55.0％) heterozygote and 39 (26.2％) normal infants.Among the β-thalassemia heterozygotes,there was one 13-trisomy.Follow-up visit found that babies with Bart ' s hydrops syndrome (n =8),Hb H disease (n =3),β-thalassemia majors (n =28) and β thalassemia heterozygote combined with 13-trisomy(n=1) were aborted.Conclusions Thalassemia was found in some north area other than south of China,which should be paid more attention by clinicians.Gap-PCR and PCR-RDB technology are effective measures for thalassemia prenatal diagnosis in identifying major thalassemia fetuses before their birth,thus reduce the birth rate of thalassemia baby.But missed diagnosis might exist during the screening,so it is necessary to perform DNA sequencing on those patients with positive symptoms and negative common genetic diagnostic results.At the same time,prenatal diagnosis of chromosomal disorders should not be neglected for high-risk families.

Application of computerized imitating patients in training of pediatric respiratory system / 中华医学教育探索杂志

Objective A computerized clinical scenario imitating patients and clinical course variation for situation simulating teaching were established due to lack of typical patients,inadequacy of resourees in pediatric teaching probation and simplification in traditional teaching pattern.Methods Data of clinical typical patients were collected and recorded into video,and then these data were synthesized and put into computer,designing a computerized clinical setting imitating patients' set.216 uodergraduate students from grade 2008 were randomly divided into 2 groups.The patients in experimenial group were taught with computerized clinical scenario imitating patients,while traditional clinical probation in the hospital ward was carried out for those in the control group.Examination and questionnaire survey were performed at the end of the study.t test was used in statistical analysis.Results Comparison between the two groups using questionnaire survey showed that the learning motivation encouragement,active participation in teaching,guidance of clinical logical thinking and judgment,improvement of clinical thinking capacity,acceptance rate in classroom,preference rate were better in the experimental group than those in the control group (P ＜0.05).Student's performance in examination in the experimental group was higher than those in the control group ( P ＜ 0.05).Conclusion Teaching with computerized clinical scenario imitating patients is a teaching method closely related to clinical situation.It can significantly activate student's learning enthusiasm,improve clinical thinking and judgment capability,avoid risk of medical care and establish a new teaching setting for clinical pediatric teaching.

Diagnostic value of radom spot albuminuria to creatinine ratio in women with preeclampsia / 中华妇产科杂志

Objective To investigate the correlation between spot albuminuria to creatinine ratio (ACR) and 24 h urinary protein excretion in women with preeclampsia and determine the optimal cut-off values of spot ACR in mild preeclampsia and severe preeclampsia.Methods Twenty-eight women with mild preeclampsia and 22 with severe preeclampsia at Nanfang Hospital,Southern Medical University between October 2010 and June 2011 were recruited.Maternal serum cystatin,uric acid,mea nitrogen,creatinine and albumin levels were collected and analyzed.Twenty-four hours urinary protein excretion was measured with immunoturbidimetric assay and ACR with automatic analyzer DCA2000.The correlation between ACR and 24 hours urinary protein excretion was explored.And the optimal cut-off values of the spot ACR for mild and severe preeclampsia were determined with receiver operating characteristic curve.Results ( 1 )Maternal serum biochemical parameters:uric acid levels in mild and severe preeclampsia were (359 ± 114)μmol/L and (450 ± 132) μmol/L,while cystatin levels were ( 1.3 ±0.3) mg/L and ( 1.6 ±0.5) mg/L respectively.The differences were statistically significant ( P ＜ 0.05 ).Serum urea nitrogen,creatinine and albumin in mild preeclampsia were(3.6 ± 1.6) mmol/L,(52 ± 38 ) μmol/L and ( 33 ± 3 ) g/L,while in severe preeclampsia were( 6.2 ± 3.1 ) mmol/L,( 78 ± 59 ) μmol/L and ( 29 ± 6 ) g/L respectively.There were no statistical significant differences ( P ＞ 0.05 ).(2) Twenty-four hours urinary protein excretion and ACR:24 hours urinary protein levels in mild and severe preeclampsia was (700 ± 160) mg and (4800 ±2200) mg (P＜0.05).ACR in mild and severe preeclampsia was (72.7 ± 12.4) mg/mmol and (401 ±245) mg/mmol respectively (P ＜ 0.05 ).(3) There was a strong correlation between the spot ACR and 24hours urine protein excretion ( r =0.938 ; P ＜ 0.05 ).( 4 ) The optimal spot ACR cut-off point for the diagnosis of preeclampsia:the optimal spot ACR cut-off point was 22.8 mg/mmol for 300 mg/24 hours of protein excretion in mild preeclampsia,the area under curve was 0.956,with a sensitivity,specificity of 82.4％,99.4％ respectively.And the optimal spot ACR cut-off point was 155.6 mol for 2000 mg/24 hours of protein excretion in severe preeclampsia,the area under curve was 0.956,with a sensitivity,specificity of 88.6％,91.3％ respectively.Conclusions Compared with 24 hours urinary protein excretion,the spot ACR may be a simple,convenient and accurate indicator of early diagnosis of preeclampsia.Spot ACR may be used as a replacement for 24 hours urine protein excretion in assessment of preeclampsia.The optimal spot ACR cut off points were 22.8 mg/mmol for mild preeclampsia and 155.6 mg/mmol for severe preeclampsia.