OBJECTIVE: To eludicate the risk factors of mechanical ventilation and prolonged mechanical ventilation in patients with severe multiple injuries. METHODS: Consecutive patients with severe multiple injures who were treated in Peking University People's Hospital Trauma Medical Center between December 2016 and December 2019 were enrolled in this restropective chart-review study. According to mechanical ventilation and ventilatory time, the patients were divided into mechanical ventilation (MV) group and non-mechanical ventilation (NMV) groups, prolonged mechanical ventilation (PMV) group and shortened mechanical ventilation (SMV) groups. Clinical data such as gender, age, base excess, mechanism of injury, Glasgow Coma Scale (GCS), abbreviated injury scale (AIS) and injury severity score (ISS) were collected. To indentify the risk factors of mechanical ventilation and prolonged mecha-nical ventilation, univariate and multivariate Logistic analyses were carried out. RESULTS: In the present study, 112 patients (82 male, 30 female) with severe multiple injuries having a median age of 52 (range: 16-89 years) and a median ISS of 34 (range: 16-66) were enrolled. The primary mechanism of injury was traffic accident injury and falling injury. In the study, 62 and 50 patients were assigned to MV and NMV groups, respectively. Logistic analysis showed that GCS (OR=0.72, 95%CI: 0.53-0.92, P=0.03), base excess (OR=0.56, 95%CI: 0.37-0.88, P=0.002) and multiple rib fracture (OR=1.72, 95%CI: 1.60-2.80, P=0.012) were independent significant risk factors for mechanical ventilation after severe multiple injuries. Within the mechanical ventilation group, 38 and 24 patients were assigned to PMV and SMVgroups, respectively. Compared with the SMV group, the PMV group had a higher ISS and higher rate of severe head trauma. The length of hospital stay of PMV group was longer than that of SMV groups. Meanwhile, the incidence of tracheotomy in PMV group was high. CONCLUSIONS GCS, base excess and rib fracture might be independent risk factors for mechanical ventilation. Higher ISS and lower GCS might prolong the ventilatory time and the length of hospital stay. Meanwhile, the incidence of tracheotomy was high in PMV group because of the longer ventilatory time and poor consciousness.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Multiple Trauma ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Young Adult

Objective To measure the serum selenium levels in patient with Keshan disease(KSD)and in healthy controls in Shandong,Sichuan and Inner Mongolia KSD areas,to monitor the long-term dynamic changes of hair and serum selenium levels in Shandong KSD areas,and to provide scientific basis for preventing KSD.Methods A cross-sectional survey was carried out in KSD areas of Shandong,Sichuan and Inner Mongolia in 2009.The research subjects which come from KSD areas were 77 cases and 63 healthy controls from Shandong;35 patients and 36 healthy controls from Sichuan;and 17 patients and 18 healthy controls from Inner Mongolia.Additional 33 healthy people from Jinan city were selected as controls of non-KSD areas.Blood and hair samples were collected and selenium levels were measured by 2,3-diaminonaphthalene fluorescence spectrometry.Retrospective method was used to analyze the hair and serum selenium data collected between 1976 and 2004 in Shandong KSD areas.and these data were eompard with the data of 2009 to observe the long-term dynamic changes.Results ① The serum selenium levels of KSD patients in Shandong and Inner Mongolia were significantly lower than that of healthy subjects of KSD areas[(0.0773±0.0113)vs(0.0895±0.0256),(0.0347±0.0107)vs(0.0469±0.0161),t=3.52,3.87,all P<0.01].No significant difference was found between KSD patients and healthy people in Sichuan[(0.0792±0.0162)vs(0.0774±0.0103),t=0.55,P>0.05].②The serum selenium levels of KSD patients in Shandong,Sichuan and Inner Mongolia KSD areas were lower than that of non-KSD area[(0.0988±0.0231)mg/L,q=6.74,5.83,19.47,all P<0.01].The serum selenium levels of healthy people in Sichuan and Inner Mongoha KSD areas were significantly lower than that of non-KSD area(q=6.68,16.36,all P<0.01).The serum selenium levels of healthy controls in Inner Mongolia were lower than that of in Shandong and Sichuan(q=13.63,14.74,13.62,1.46,all P<0.01).③From 1976 to 2009,the hair and serum selenium levels of Shandong resident were increased 1.68 times(0.343/0.128-1)for hair and 0.98 times(0.091/0.046-1)for serum,respectively.But there was no significant difference between the average growth rate of hair and serum selenium levels(χ2=1.38,P>0.05).Conclusions ①The hair and serum selenium levels of KSD patients are lower than that of healthy controls in non-KSD area.②The serum selenium levels of Shandong,Sichuan and Inner Mongolia are different between KSD patients and healthy controls in the diseased areas.③The hair and serum selenium data of Shandong resident show an upward vend over the past 30 years.We suggest to continue the comprehensive measures of adding selenium in KSD areas.

Objective To observe the incidence and clinical characteristics of chronic Keshan disease in recent years, and to provide evidence for diagnosis of the disease. Methods From March to August 2009, 163 patients with chronic Keshan disease were chosen from Shandong, Sichuan, Inner Mongolia and Cansu. Of these patients, 62 cases were from Shandong, 34 cases from Sichuan, 37 cases from Inner Mongolia, and 30 cases from Gansu. All of the subjects underwent detailed natural history of the disease, careful physical examination and electrocardiogram (ECG), X-ray chest radiography and cardiac ultrasound examination. The incidence and clinical features were analyzed. Results Adults accounted for 98.8%(161/163) and children for 1.2%(2/163) in 163 cases of chronic Keshan disease, with an average age of 45.8 years. Slow onset accounted for 62.6%(102/163), other types that evolved into chronic-type accounted for 37.4%(61/163). Low blood pressure( 116.5/72.4 mmHg),often with cardiac function grade Ⅱ accounted for 65.6%(107/163). Common symptoms were: palpitation[86.5%(141/163)], asthma [76.7% (125/163)], fatigue[76.1%(124/163)], precordial discomfort [54.6% (89/163)], dizziness[50.3%(82/163)], edema of lower limbs[44.8%(73/163)], and anorexia[38.0%(62/163)]. Common signs were: low-weak first heart sound[66.9%(109/163)], heart enlargement[64.4%(105/163)], apical pulse dispersion[42.3%(69/163)], arrhythmia[40.5%(66/163)], hepatomegalia[39.3%(64/163)], systolic murmur [25.2%(41/163)], and edema[20.9%(34/163)]. Abnormal ECG detection rate was 93.9%(153/163), with common types followed by ST-T changes[ST-T changes, ST segment changes, Tchange, 36.2%(59/163)], ventricular premature [occasional and frequent ventricular premature, 26.4% (43/163)], complete right bundle branch block [25.8% (42/163)], atrial fibrillation[19.0%(31/163)], and atrioventricular conduction block[8.6%( 14/163)]. X-ray results showed that significant and moderate heart enlargement were common, accounting for 73.4%( 105/143), followed by mild enlargement of 25.2%(36/143). Color doppler ultrasound examination results showed that the atrio-ventricular cavity diameter increased, followed by left ventricular end-systolic diameter increased[81.3%(52/64)], left ventricular end-diastolic diameter increased[65.6%(42/64)], left atrial enlargement[51.6%(33/64)], right atrial enlargement [43.8%(28/64)], and right ventricular enlargement[32.8%(21/64)]. Left ventricular wall and interventricular septum thinning accounted for 15.6%( 10/64) and 7.8%(5/64), respectively. Conclusions In recent years, most cases of chronic Keshan disease occur as natural chronic type, and at older age at onset with low blood pressure.Main clinical features of the disease are cardiac enlargement, inadequate tissue perfusion, and venous stasis performance caused by cardiac decompensation. Correct diagnosis of chronic Keshan disease can be made based on these clinical features.

OBJECTIVETo understand the knowledge and prevalence of domestic violence (DV) among married women in rural China.

METHODSProportional to Population Size(PPS) sampling method was conducted to select 3998 women aged 18 years old and above from Jilin, Anhui and Chongqing. All the women were interviewed using a standardized questionnaire during Nov. 2004-Jan. 2005.

RESULTSThe prevalence of spousal violence against women was 64.8 % in a lifetime and 42.6% in the past 12 months before the survey. Psychological violence was the most common type, followed by physical violence and sexual abuse. The prevalence rates for psychological, physical and sexual violence in a life time were 58.1%, 29.7%, 16.7%, while 37.2%, 14.0%, 7.7% in the past 12 months before the survey. All the total DV, psychological violence and sexual violence were more commonly seen in Jilin province, while physical violence was more prevalent in Chongqing city. The prevalence rate of violence was different among people with different social-demographic characteristics. Sexual abuse became more common with the improvement of education. In total, about 1/3 women suffered two or three categories of violence at the same time. Most sexually abused women suffered one kind of violence, while half of the physically and psychologically abused women suffering two and more kinds of violent behaviors at the same time. Married women had relatively little knowledge on domestic violence and 75.2 % of the women did not even know what domestic violence was referring to and some women suffered from DV themselves but knowing nothing about its implication. In general, physical violence was better understood among interviewed women while the knowledge about psychological violence was relatively poor. Conclusion Domestic violence, psychological violence in particular, was very common in rural China, while the knowledge of DV among married women was poor, effective actions should be taken to stop DV at no time.

Adult ; China ; epidemiology ; Data Collection ; Domestic Violence ; psychology ; statistics & numerical data ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Marriage ; Prevalence ; Rural Population

OBJECTIVETo present data from a baseline investigation on stroke-related cohort population in rural area of Shanghai.

METHODSA cross-sectional study was carried out in a cluster sampling population aged 40 years and over. General information and data on common risk factors in the population were gathered and cerebral vascular hemodynamic indexes were checked. Hemodynamic score was estimated according to single indexes by unified methods. 5335 persons who had met the inclusion criteria were enlisted in the study. Exposure level of risk factors, prevalence of stroke, and hemodynamic indexes were analyzed and distributional characteristics were described.

RESULTSExposure rate of hypertension, heart disease, diabetes, family history of hypertension, overweight or obesity in males were 31.74%, 6.09%, 1.16%, 3.22%, 17.64%, 29.68% and were 32.76%, 9.22%, 1.55%, 3.84%, 19.22%, 29.44% in female respectively. Standard prevalence of stroke was 1167.3/100000, which in male was significantly higher than that in female (P < 0.05). The change of cerebral vascular hemodynamic indexes was significantly associated with age. Hemodynamic score in 21.3% of the subjects was below 75 points.

CONCLUSIONSAmong population of 40 years old and over in rural areas, hypertension was the principal risk factor regarding the rate of stroke. Prevalence of stroke in males was significantly higher than that in females. Abnormal rate of hemodynamic score was about 20% in this population.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Brain ; blood supply ; China ; epidemiology ; Cohort Studies ; Cross-Sectional Studies ; Female ; Hemodynamics ; Humans ; Hypertension ; complications ; epidemiology ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Rural Health ; Sampling Studies ; Sex Factors ; Stroke ; epidemiology ; physiopathology

OBJECTIVETo establish a predicting model for stroke according to cerebral vascular hemodynamic indexes and major risk factors of stroke.

METHODSParticipants selected from a stroke cohort with 25,355 population in China. The first step was to carry out principal component analysis using CVHI. Logistic regression with principal component and main risk factors of stroke were then served as independent variables and stroke come on as dependent variables. The predictive model was established according to coefficient of regression and probability of each participant was also estimated. Finally, ROC curve was protracted and predictive efficacy was measured.

RESULTSThe accumulative contribution rates of four principal components were 58.1%, 79.4%, 88.4% and 94.6% respectively. Seven variables were being selected into the equation with the first to fourth principal component as history of hypertension, age and sex. Area under ROC curve was 0.855 and optimal cut-off point was probability over 0.05. Sensitivity, specificity and accuracy of stroke prediction were 80.7%, 78.5% and 78.5% respectively.

CONCLUSIONThe model established by principal component and regression could effectively predict the incidence of stroke coming on.

Brain ; blood supply ; Hemodynamics ; physiology ; Humans ; Logistic Models ; Models, Biological ; Principal Component Analysis ; Risk Factors ; Stroke ; etiology

OBJECTIVETo understand the perception on roles of gender and decision-making regarding family affairs among married women and its impact on the utilization of perinatal care.

METHODSClustering sampling was conducted to select 1227 married women with at least a child aged from 0 to 7 years old, from Hebei, Hubei and Sichuan provinces. All women were interviewed using a uniform questionnaire during Nov.-Dec. 2004.

RESULTSThe overall proportion of women who had relatively poor perception of gender role was 65.1%. 59.3% of the women agreed that "husband's health is more important than wife's in the family" versus 39.7% of interviewed women agreed that "man is more suitable for leadership than woman". In 46.2% of the families, wife and husband shared the responsibility of decision making on family affairs. In 16.2% of the families women played a decisive role, while 67.1% of interviewed women had to get the approval of her husband when spending money on daily necessities. When there were different opinions between the couples, husband usually made the final decision in 20.5% of all the families versus 17.4% of families where wife made the final decision. In total,the proportion of women who had somehow rights on family affairs was 64.1%. The coverage rate of antenatal care was 91.0%, and 65.3% women who received antenatal care got the first antenatal visit during the first trimester and the proportion of women who had at least five antenatal visits was 39.7%. The institutional delivery was 59.3% among all the women. Perception of gender role was not a predictor for antenatal care utilization, but it was predictive of institutional delivery. Education was quite a significant predictor on perinatal care utilization.

CONCLUSIONEfforts should be strengthened to improve women's awareness and to increase their perception on gender role in the families so that more women could achieve quality perinatal care.

Adult ; Child, Preschool ; China ; Decision Making ; Family Health ; Female ; Gender Identity ; Humans ; Infant ; Infant, Newborn ; Male ; Marriage ; Perinatal Care ; utilization

OBJECTIVETo explore the exposed level of stroke risk factors in Fengxian county of Shanghai and the relationships between risk factors and stroke.

METHODSCommunity based populations including 10,565 individuals aged 40 years old and over were cluster sampled from Fengxian county in 2003 or 2004. Status of exposure on common risk factors such as hypertension, cardiovascular disease, diabetes, family history of stroke, cigarette smoking, alcohol intake were gathered while cerebral vascular hemodynamic index (CVHI) was examined, with CVHI score below 75 points as abnormal. During 2003 to 2006, 78 stroke cases occurred. The relationships between risk factors and stroke were analyzed by univariate and Cox proportional hazards regression models.

RESULTSRates of exposure regarding hypertension, cardiovascular disease, diabetes, family history of stroke, obesity (BMI > or = 28 kg/m2), smoking, drinking and CVHI score abnormal were 21.14%, 6.72%, 1.88%, 5.63%, 4.17%, 34.96%, 17.81% and 29.43%, respectively. Data from Univariate analysis indicated that relative risk (95% CI) of above-mentioned risk factors were 2.76 (1.76-4.32), 2.19 (1.16-4.14), 1.52 (0.38-6.19), 1.58 (0.69-3.62), 1.24 (0.45-3.38), 1.75 (1.12-2.73), 2.10 (1.30-3.39) and 12.72 (7.02-23.06), respectively. Results from Cox proportional hazards regression models analysis showed that cigarette smoking, CVHI score abnormal were screened into equation.

CONCLUSIONAmong all the risk factors, rate of hypertension was the highest while hypertension, cardiovascular disease, cigarette smoking, alcohol intake and abnomal CVHI score had remarkable etiological correlations to stroke. Abnormal CVHI score, cigarette smoking seemed to be the independent forecasting factors related to stroke.

Adult ; Aged ; Alcohol Drinking ; adverse effects ; Cardiovascular Diseases ; complications ; China ; epidemiology ; Diabetes Complications ; Female ; Hemodynamics ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Obesity ; complications ; Proportional Hazards Models ; Risk Factors ; Smoking ; adverse effects ; Stroke ; epidemiology ; etiology

Objective To describe the distribution of over weight and obesity to discover the level of exposure on risk factors of stroke among people aged 40 and over, in a community-based population.Methods From 2003 to 2004, people aged t≥40 years in a community of Fengxian district in Shanghai were selected by cluster sampling. Out of 11 791 individuals who were selected, 10 565 met the inclusion criteria and responded to the investigation. By face to face interview, a cross-sectional survey was carried out, using a questionnaire for risk factors of stroke. Height, weight and blood pressures were measured and cerebrovascular hemodynamic parameters (CVHP) were checked. Age and gender distribution of over weight and obesity in the population were described. Using 60 year as cut-off point, participants were grouped into three: normal, over weight and obesity by body mass index. Level of stroke risk factor exposure between groups was compared and logistic regression model was used for multiple analyses. Results Proportions of over weight and obesity were 28.5 percent and 4.1 percent in male and 26.3 percent and 4.2 percent in female (P=0.045 ). Systolic and diastolic blood pressure in over weight group were (132.5±19.4)ram Hg and (83.9±10.5)mm Hg(1 mm Hg= 0.133 kPa),which were higher than that in normal weight group and lower than that in obese group (P<0.05). Exposure rate of heart disease,family history of stroke in < 60 year old group and diabetes in ≥60 year group increased along with the increase of weight. Exposure rate of hypertension, abnormality of CVHP score in both age groups were also increased with the increase of weight. Data from multiple logistic regression indicated that hypertension,family history of stroke and heart disease, CVHP score below 75 points, sex and age were independent factors of over weight and obese. Conclusion The prevalence of over weight or obesity in a community-based population among aged 40 years or over was around 30 percent. The overall exposure rate of stroke risk factors were increasing along with the increase of weight, especially for those in the middle age.

OBJECTIVE: To reconstruct a car-pedestrian crash accident using numerical simulation technology and explore the injury biomechanism as forensic evidence for injury identification. METHODS: An integration of multi-body dynamic, finite element (FE), and classical method was applied to a car-pedestrian crash accident. The location of the collision and the details of the traffic accident were determined by vehicle trace verification and autopsy. The accident reconstruction was performed by coupling the three-dimensional car behavior from PC-CRASH with a MADYMO dummy model. The collision FE models of head and leg, developed from CT scans of human remains, were loaded with calculated dummy collision parameters. The data of the impact biomechanical responses were extracted in terms of von Mises stress, relative displacement, strain and stress fringes. RESULTS: The accident reconstruction results were identical with the examined ones and the biomechanism of head and leg injuries, illustrated through the FE methods, were consistent with the classical injury theories. CONCLUSION The numerical simulation technology is proved to be effective in identifying traffic accidents and exploring of injury biomechanism.
Accidents, Traffic ; Adult ; Automobiles ; Autopsy ; Biomechanical Phenomena ; Computer Simulation ; Craniocerebral Trauma/pathology* ; Finite Element Analysis ; Forensic Medicine/methods* ; Humans ; Image Processing, Computer-Assisted/methods* ; Leg Injuries/pathology* ; Male ; Models, Theoretical ; Walking/injuries*