Objective To analyze the prevalence of cardiovascular disease (CVD) risk factors among nurses with high job stress in a Kunming tertiary hospital. Method The health data from 46 nurses who had gotten a medical examination between August 1 and November 30,2013 in the first people's hospital retrospectively analyzed .Results 76%of 46 nurses enrolled in this study had inordinately CVD risk factors,the top prevalence of CVD risk factors was dyslipidemia (58.9%),followed by hyperviscosity (45.5%),electrocardiographic abnormality (30.8%),overweight (19.2%),and hypertension (9.2%) . Moreover,there was significant differences of CVD risk factors among different departments ( <0.05),which the overall prevalence rate being highest among nurses working in the operating room. Conclusion The nurses with high job stress from tertiary hospital have high risks of CVD,therefore intervention measures should be taken to reduce the risk of CVD.

Objective To analyze the prevalence of diabetes and its impact on the quality of life (QOL) among Jingpo ethinic residents in Yunnan province.Methods Questionnaire survey and fasting blood glucose (FBG) testing were conducted among 1367 Jingpo residents aged ≥ 35 years selected with random sampling method in Mangshi municipality of Dehong prefecture in Yunnan province.The Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) was used in the survey.Results The prevalence rate of diabetes among the Jingpo residents was 4.1％,and 4.2％ for males,4.0％ for females.Among Jingpo diabetic patients,mean scores for the domains of physical functioning (PF),role physical (RP),bodily pain (BP),general health (GH),vitality (VT),social function (SF),role emotional (RE),mental health (MH),physical component summary (PCS) and mental component summary (MCS) were (84.64 ±16.81),(53.13 ±45.24),(71.70 ± 24.28),(49.46 ± 21.38),(65.09 ± 11.02),(90.08 ± 14.00),(79.17 ± 39.98),(70.29 ± 13.73),(57.12 ± 9.39) and (55.07 ± 6.58),respectively.The identified diabetic patients had significantly lower QOL scores for the doamins of PF,RP,BP and PCS than their counterparts,respectively (P＜0.05).The results of the multiple linear regression analysis showed that older Jingpo residents had lower scores in the domain of PCS and MCS (P＜0.01);men has lower scores in the domain of PCS and MCS than women (P＜0.01);the higher the level of education,the higher the scores of PCS and MCS (P＜0.01);married Jingpo residents had higher scores in domain of PCS than those of unmarried and divorced (P＜0.01);the diabetic patients had lower scores of PCS than their counterparts (P＜0.01).Conclusion It is necessary to strengthen the health education for the elderly and people with low level of education,and improve the management of patients with diabetes,so as to effectively improve the QOL of Jingpo ethnic minority residents.

Objective To investigate the diabetes self-management (DSM) ability and influencing factors in patients with type 2 diabetes in Kunming. Methods A face to face questionnaire survey was conducted on type 2 diabetes patients admitted in the 1st Affiliated Hospital of Kunming Medical University from November 2010 to April 2012. Diabetes self-management instrument ( DSMI) was used to test self-management behavior, and psychological status was assessed by Problem Areas in Diabetes (PAID-5).Results 300 patients participated in the survey.The participant population consisted of 120 males (41.8%) and 168 females (58.2%) .A total of 190 patients (68%) suffered from DM related psychological problems.The mean DSM score was 95.23±20.6, and mean scores for the domain of integration DM care into one’s life, self-regulations, interaction with health professionals,self-blood monitoring glucose,and adherence to recommended regimen were 28.11±6.15,25.22± 5.67,23.06±6.41,10.98±2.96,and 8.75±2.21,respectively. There was no significant difference in the mean score between males and females (P>0.05) .Patients with psychological problems had lower scores in five DSM dimensions than those without psychological problems (P<0.05) . The result of multiple regression showed higher level blood glucose was negatively associated with DSM score, whereas patients with higher income was associated with a higher DSM score (P<0.05) .Conclusions The DSM situation is not good among patients with type 2 diabetes in Kunming, and most of the patients suffer from psychological problem. It is necessary to enhance the effective health education among diabetic patients.

Objective To provide regional anatomical data for clinical application through observing the type, length and diameter of variation in the medial cubital vein of upper limb. Methods Dissected the medial cubital vein of upper limb in 35 (70 sides) adult cadavers (male 38, female 7), and observed the morphological structure. The length and vessel diameter of the medial cubital vein were measured. Results The variation of the medial cubital vein of upper limb was divided into six type. TypeⅠincluded 29 cases (41. 43%) of male and 8 cases (11. 43%) of female;Type Ⅱ included 14 cases (20. 00%) of male and 4 cases (5. 71%) of female;Type Ⅲ included 7 cases (10. 00%) of male and 2 cases (2. 86%) of female;TypeⅣincluded 3 cases (4. 29%) of male and 0 cases of female;TypeⅤincluded 2 cases (2. 86%) of male and 0 cases of female;TypeⅥincluded 1 cases (1. 43%) male and 0 cases of female. Conclusion This study enriched anthropology data of the medial cubital vein and it has the role of guiding in clinical applications.

Objective To compare the complication and cost-effectiveness of the deep inferior epigastric perforator(DIEP) flap and transverse rectus abdominis myocutaneous(TRAM) flap.Methods From January 2000 to December 2014,all patients who underwent DIEP flap and TRAM flap in the People's Hospital of Tangshan and the Affiliated Hospital of North China University of Science and Technology, were selected.Eleven patients underwent immediate breast reconstruction with TRAM flaps and 19 patients with DIEP flaps.The treatment cost,length of hospitalization, and complication in the two year after surgery for each group were compared.Results For the major complications,there were 5 cases appeared fat necrosis in TRAM group, and 1 case in DIEP group,the differences was statistically significant(P=0.016).One case appeared flap loss in TRAM group,and DIEP group was zero,both of the two group had no abdominal wall hernia, there was no significant difference (P ＞ 0.05).For the minor complications, there were 4 cases appeared postoperative hematoma in TRAM group, and 1 case in DIEP group, the difference was statistically significant(P =0.047).Two cases appeared wound dehiscence in TRAM group,and DIEP group was 1 case, 1 case happened infection in TRAM group,there was no statistically significant difference(P＞0.05).The treatment costs were (14 133.12±1 546.88)yuan for the TRAM group and (16 838.94± 3 006.05)yuan the DIEP group, the difference was statistically significant (P =0.010).The hospital stay was (17.28± 2.08)days for the pedicled TRAM group and (18.39±2.87) days for the DIEP group,the different was not statistically significant(P＞0.05).Conclusion The DIEP flap has a better clinical outcomes,but more expensive.

In order to obtain glucagon-like peptide-1(GLP-1)analogs which can sustainedly control the levels of glucose, 12 derivatives were designed and synthesized by coupling monomethoxy polyethylene glycol(mPEG, with average molecular weights of 350, 550 and 750)to GLP-1 analogs. Preliminary pharmacological activities showed that all compounds retained GLP-1 receptor agonist activities, and the hypoglycemic activity of compound I-12 was similar to those of Ex-4 and Liraglutide, suggesting I-12 could be a potential long-acting GLP-1 receptor agonist.

Objective we assessed our institutional outcomes of hybrid treatment for aortic arch disease with supra-aortic debranching and endovascular stent graft repair.Methods From March 2016 to November 2016,6 patients underwent Hybrid total aortic arch repair:1 had aortic arch pseudoaneurysm;1 had type Ⅲ aortic dissection;4 had aortic arch aneurysm because of hypotension,of whom 1 with aneurysm prerupture and 1 with Aortic intramural hematoma.Supra-aortic vessels were involved and high-risk for traditional operations in all patients.Bifurcated artificial vessels were used,main vessel was end-to-side anastomosed with ascending aorta.Branching vessel were end-to-end anastomosed with right innominate artery and left subclavian artery,end-to-side anastomosed with left common carotid artery.Then,stent graft was implanted into ascending aorta and aortic arch.All patients were followed postoperatively,with regularly contrast computed tomography angiogram (CTA) and echocardiography(discharge,three months,six months,and yearly).Results Hybrid procedure with supra-aortic debranching and endovascular stent graft repair were completed in all patients,technical success rate was 100％.There were no perioperative obvious morbidity and mortality,follow-up period were 2-9 months.1 patients had stroke during follow-up period,condition improved after treatment.Supra-aortic vessels were patency and there were no endoleak in all patients.There were no recurrent aortic disease during follow-up period.Conclusion Hybrid aortic arch replacement can be performed with good postoperative and early results in high-risk patients for traditional open repair.

Objective　To understand the impact of early and timely treatment and initial antiviral treatment regimen on mortality and attrition of antiretroviral therapy. Methods A retrospective cohort study was conducted using download data on antiretroviral therapy for HIV-infected patients in Liuzhou City, Guangxi Province, from the database of the Basic Information System for AIDS Control and Prevention (BISAC) from 2010 to 2020. The Cox proportional risk regression model was used to analyze the influencing factors of mortality and attrition. Results A total of 15 713 infected patients were included, including 53.4% aged 18-<50 years, 69.4% male, 61.0% farmer, 75.1% CD4 count <350 cells /μL before initial antiviral treatment, the overall mortality rate was 4.30/100 person-years, and the overall attrition was 2.42/100 person-years. The results of Cox regression analysis showed that the influencing factors of mortality were pretreatment CD4 counts of 350-<500 cells/μL(AHR=0.72, 95%CI: 0.63-0.81) and ≥500 cells/μL (AHR= 0.64, 95%CI: 0.55-0.76); duration from diagnosis to initial antiviral treatment 91-180 days (AHR=1.25, 95%CI: 1.08-1.45), 181-365 days (AHR=1.26, 95%CI: 1.08-1.47), and ≥365 days (AHR=1.26, 95%CI: 1.11-1.44); initial antiviral treatment regimens of D4T+3TC+EFV/NVP (AHR=1.47, 95%CI: 1.32-1.63) and AZT/D4T/TDF+3TC+LPV/r (AHR=1.73, 95%CI: 1.50-1.99). Factors affecting attrition were pretreatment CD4 counts of 350-499 cells/μL (AHR=1.32, 95%CI: 1.16-1.50) and ≥500 cells/μL (AHR=1.28, 95%CI: 1.10-1.50); interval from HIV positivity confirmation to initial dosing ≥365 days (AHR=1.21, 95%CI: 1.04-1.40), initial antiviral treatment regimens of TDF+3TC+NVP (AHR=1.32, 95%CI: 1.13-1.55), AZT+3TC+EFV/NVP (AHR=1.43, 95%CI: 1.26-1.62) and AZT/D4T/TDF+3TC+LPV/r (AHR=1.33, 95CI%: 1.06-1.67). Conclusions　Early and timely treatment and the initial antiviral treatment regimen of TDF+3TC+EFV have good efficacy, but attention should be paid to the high risk of attrition of HIV-infected people with high CD4 count before treatment.

Objective To evaluate the effects of the quality-improving program on reducing the bloodstream infection of preterm infants in NICU.The program included emphasizing hand hygiene,strictly controlling the use of antibiotics and following the extubation indications of peripherally inserted central catheter (PICC).Method From October 2016 to March 2017,preterm infants admitted to NICU after the implementation of quality improvement program were assigned into the intervention group,and the infants admitted from April 2016 to September 2016 without the program were in the control group.The x2 test and t test were used to analyse the effects of the program,the rate of bloodstream infection and related complications.Result A total of 432 cases were enrolled in this study.Among them,221 cases were in the intervention group and 211 cases the control group.The rate of hand hygiene in the intervention group was significantly higher and the duration of antibiotic use per 1 000 hospitalization days and the average days of retaining the PICC were significantly shorter than the control group (P ＜ 0.001).The incidence of bloodstream infection in the intervention group was lower than the control group (5.9％ vs.11.4％,P =0.047),and the duration of non-invasive ventilation,parenteral nutrition,average hospitalization days,and the incidence of stage 11 and above necrotizing enterocolitis were lower than the control group (P ＜ 0.05).Conclusion The evidence-based quality improvement program has positive effects on reducing the bloodstream infections and related complications of preterm infants in NICU.

Objective Assessment of fenestration in the aortic arch disease .Methods 13 patients with aortic arch dis-ease underwent fenestration operation to reconstruct affiliated vessels , aortic arch aneurysm in 5 patients, aortic anch ulcer in 4, Ⅲ type aortic dissection in 3 and Ⅰ type leakage after aortic stent graft in 1 patient.All patieuts were divided into 2 groups.8 patients in pre-fenestration group, 5 patients in in-situ fenestration group.Only left subclavian artery was rebuilded in 9 patients, both left carotid common artery and left subclavian artery were rebuilded in 3 patients, all three affiliated vessels of arch were rebuilded in 1 patient.Results Branch vessels of aortic arch were successfully rebuilded in all 13 patients.There were no endoleak, stenosis of branch vessels, graft diaplacement or deaths peri-operative period.During follow-up, no postop-erative complications occurred and all target vessels remained patent .No fenestration related endoleaks were observed.Conclu-sion Fenestration may be a viable alternative for patients with aortic arch disease .