Objective To stratify the risks of patients with acute pulmonary embolism (APE) and pulmonary hypertension (PH) by dynamic pulmonary perfusion imaging (DPPI) and pulmonary perfusion imaging (PPI). Methods From October 2007 to February 2009, 20 healthy volunteers ( 12 males, 8 females; mean age =48.47 ±13.47 years) and 31 APE patients (21 males, 10 females; mean age =47.68 ±18.06 years; from October 2007 to July 2009) were included in the study. DPPI and PPI were performed in all subjects. Percentage of perfusion defect scores ( PPDs% ) were calculated by semi-quantitative analysis of PPI. Risk levels were defined according to PPDs% calculated from PPI: normal (PPDs% =0); very low risk (0 ＜ PPDs% ≤10% ); low risk (10% ＜ PPDs% ≤20% ); moderate risk (20% ＜ PPDs% ≤40% );high risk (40% ＜ PPDs% ≤60% ) and very high risk ( PPDs% ＞ 60% ). Lung equilibrium time (LET)was calculated on region of interest (ROI) drawn over DPPI. Clinical risk was scored by Aujesky method.The t-test, ANOVA and correlation analysis were used with SPSS 13.0 software. Results ( 1 ) LET in healthy volunteers and APE patients was ( 12.18 ± 3.28) and (32.90 ± 14.29) s respectively (t = 6. 81,P ＜ 0. 01 ). (2) The correlation coefficient, coefficient of determination between LET and PPDs% in APE patients were 0.93 and 0. 87, respectively. The correlation coefficient between LET and clinical risk score was 0.86. (3)The mean LET of APE patients in very low risk (n =5), low risk (n = 12), moderate risk (n=9), high risk (n=4) and very high risk groups (n=1) were (19.59 ±0.04), (25.03 ±0.08),(36.07 ±0. 10), (57.15 ±0.06) and (70 ±0.00) s, respectively. There was significant difference among APE patients with different risk levels (F =16. 78, P ＜0.01). Conclusions ( 1 ) DPPI was a reliable, convenient and non-invasive method for the evaluation of PH in APE. (2) Combined LET of DPPI and PPDs% of PPI was valuable for risk stratification and prognosis estimation in APE patients.

BACKGROUNDDelirium is a common and deleterious complication in critically ill patients after surgery. The purpose of this study was to determine the incidence and risk factors of delirium in critically ill patients after non-cardiac surgery, and to investigate the relationship between the serum cortisol level and the occurrence of postoperative delirium.

METHODSIn a prospective cohort study, 164 consecutive patients who were admitted to the surgical intensive care unit after non-cardiac surgery were enrolled. Baseline characteristics and perioperative variables were collected. Blood samples were obtained on the first postoperative day and serum cortisol concentrations were measured. Delirium was assessed using the Nursing Delirium Screening Scale until the seventh postoperative day or the disappearance of delirious symptoms.

RESULTSPostoperative delirium occurred in 44.5% of patients (73 of 164). The median time to first onset of delirium is 0 (range 0 to 5 days) and the median duration of delirium is 3 (1 to 13) days. Independent risk factors of postoperative delirium included increasing age (odds ratio (OR) 2.646, 95% confidence interval (CI) 1.431 to 4.890, P = 0.002), a history of previous stroke (OR 4.499, 95%CI 1.228 to 16.481, P = 0.023), high Acute Physiology and Chronic Health Evaluation II score on surgical intensive care unite admission (OR 1.391, 95%CI 1.201 to 1.612, P < 0.001), and high serum cortisol level on the 1st postoperative day (OR 3.381, 95%CI 1.690 to 6.765, P = 0.001). The development of delirium was linked to higher incidence of postoperative complications (28.8% vs. 7.7%, P < 0.001), and longer duration of hospitalization (18 (7 to 74) days vs. 13 (3 to 48) days, P < 0.001).

CONCLUSIONSDelirium was a frequent complication in critically ill patients after non-cardiac surgery. High serum cortisol level was associated with increased incidence of postoperative delirium.

Aged ; Critical Illness ; Delirium ; epidemiology ; etiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Risk Factors

To develop a Huntington’s disease(HD) cell model in vitro to screen drugs targeting the aggregation of polyQ,different length of CAG repeat fragments were amplified by random primer PCR, identified by DNA sequencing and were fused to the N-terminus of CAT in the pCAR system respectively which had been constructed and identified before. Recombinant plasmids were transformed into and induced to express in the host E.coli. SDS-PAGE and chloramphenicol resistance test were done to determine the solubility of the polyQ and chloramphenicol resistance levels of the fusions. With different length of CAG repeat fragments cloned and expressed in the CAT-fusion protein reporting system, it is found that when the length of the fragments increased over 40, their encoding polyQ expressed as insoluble protein and chloramphenicol resistance levels are lower, while under 40, the polyQ expressed as soluble ones and chloramphenicol resistance levels are higher. A in vitro HD model that could minimize the pathological process of the HD thus has been developed. With which by measure the recombinant bacteria’s resistance to chloramphenicol, the polyQ’ solubility and folding state in vitro by quality and quantity could be determined. Thus this model can be used to screen drugs or bioactivity materials that can inhibit aggregation of the polyQ, which thereby shedding new light on the prevent, diagnosis and therapy of HD.

[Objective]To ascertain the status and related factors of antiretroviral therapy adherence and analyze the influence of management mode on adherence in HIV infected patients in Jing' an District, Shanghai. [Methods]We recruited 150 HIV infected patients who participated in the "peer group care"activities (target group) and those from another 150 patients who did not (control group) but received antiviral treatment during the period from 2015 to 2016 (221 cases in total) into the study. We collected data on general conditions, behavioral way, antiretroviral therapy adherence, life quality, social support, mental status and medical coping modes, and analyzed the related factors of antiretroviral therapy adherence by linear regression model. [Results]The 221 HIV infected patients were included, with 124 in target group and 97 in control group. The proportion of good antiretroviral therapy adherence was 86.0％, with 91.9％ in target group and 78.4％ in control group. Multiple analysis showed that the related factors of antiretroviral therapy adherence were management mode (β = 1.871, P < 0.001) , disposable income per month (β = 0.600, P = 0.001) , social support utilization (β = 0.174, P = 0.044) and yield attitude of medical coping modes (β =-0.153, P = 0.003). [Conclusion]Antiretroviral therapy adherence of HIV infected patients in Jing'an District should be further improved. "Peer group level care and management mode"could effectively promote the increase of antiretroviral therapy adherence; however, it should be improved and perfected in the aspects of its coverage and content.

Objective To introduce and conduct effectiveness evaluation of peer-group level care and management mode in people living with HIV and AIDS(PLHAs)in Jing'an District, Shanghai. Methods We recruited PLHAs who were managed by Jing'an District and participated in the peer-group care activities from 2015 to 2016, and collected their data of general conditions, behavior, antiretroviral therapy, life quality, social support, mental status and medical modes, and then conducted effectiveness evaluation of the mode by multivariate logistic regression model and linear regression model. Results A total of 300 PLHAs were included with 150 cases in each group. PLHAs in target group had higher proportion of antiretroviral therapy[82.7%(124/150)and 64.7%(97/150)]. In addition, they got higher scores in mental health(48.5±9.2 and 43.9±10.6)and social support(28.7±8.2 and 24.8±6.6), and lower scores in depressive severity index(0.5±0.1)and avoidance of medical modes(16.1±3.0 and 17.0±2.5). Multivariate analysis showed that PLHAs in target group had less sex partners(zero partner, OR = 2.1, 95%CI:1.1-3.9;one partner, OR = 3.6, 95%CI:1.9-6.8)and increased condom use(no sex, OR = 5.3, 95%CI:2.4-11.7;complete use, OR = 10.6, 95%CI:4.7-24.1;random miss, OR = 5.1, 95%CI:1.8-14.8)in the last 12 months. Conclusion The effect of peer-group level care and management mode is significantly good in promoting behavior change, enhancing health concern and increasing antiretroviral therapy.

Physician payment system (PPS) is a principal incentive system to motivate doctors to provide excellent care for patients. During the past decade, physician remuneration in China has not been in proportional to physician's average work load and massive responsibilities. This paper reviewed the constitution of the PPS in China, and further discussed the problems and issues to be addressed with respect to pay for performance. Our study indicated that the lower basic salary and bonus distribution tied to "profits" was the major contributor to the physician's profit-driven incentive and the potential cause for the speedy growth of health expenditures. We recommend that government funding to hospitals should be increased to fully cover physicians' basic salary, a flexible human resource and talent management mechanism needs to be established that severs personal interest between physicians and hospitals, and modern performance assessment and multiplexed payment systems should be piloted to encourage physicians to get the more legitimate compensation.
China ; Models, Economic ; National Health Programs ; economics ; Physician Incentive Plans ; economics ; Physicians ; economics ; Salaries and Fringe Benefits ; economics

OBJECTIVETo study the changes of serum total calcium (Ca) and inorganic phosphate (P) levels during children growth and related factors.

METHODSUsing a stratified-multi-steps-cluster sampling method, we selected 2,342 healthy children aged 10-18 years from urban and suburban areas of Beijing from September 2001 to December 2001 to test the levels of serum Ca and P. Their meal status was also surveyed to analyse the correlation of the leves of serum Ca and P with sex, age, height, weight, and diet on statistic basis.

RESULTSThe Ca levels of Beijing children were (2.39 +/- 0.12) mmol/L, which had a positive correlation with age, height, and weight (P < 0.01). The Ca levels of female children were somewhat higher than those of male [male, (2.38 +/- 0.12) mmol/L; female, (2.39 +/- 0.12) mmol/L; P < 0.05]. The Ca levels of urban children were significantly higher than those of suburban children [urban, (2.40 +/- 0.13) mmol/L; suburban, (2.37 +/- 0.10) mmol/L; P < 0.001]. The P levels of Beijing children were (1.39 +/- 0.18) mmol/L, which had a negative correlation with age, height, and weight (P < 0.01). The P levels of male children were significantly higher than those of female [male, (1.43 +/- 0.18) mmol/L; female, (1.36 +/- 0.17) mmol/L; P < 0.001]. The P levels of urban children were significant higher than those of suburban children [urban, (1.41 +/- 0.19) mmol/L; suburban, (1.38 +/- 0.16) mmol/L; P < 0.001]. The Ca levels of Beijing children had a negative correlation with P levels (r=-0.141, P < 0.01). [Ca] x [P] (mmol/L) of Beijing children were 3.32 +/- 0.44. The value of [Ca] x [P] reached peak by 3.45 +/- 0.46 when Beijing children were of 13-14 years old, and then the value declined with increasing age.

CONCLUSIONThe levels of serum Ca and P correlates with sex, age, growth, and diet. The level of serum Ca goes up while P goes down during the children growth.

Adolescent ; Age Factors ; Body Height ; Body Mass Index ; Body Weight ; Calcium ; blood ; Child ; Child Development ; Female ; Humans ; Male ; Phosphorus ; blood ; Reference Values ; Sampling Studies ; Sex Factors ; Urban Health

OBJECTIVETo identify the HBV genotype-specific tag sequence.

METHODSThe large S region sequences from 930 HBV genomes were aligned to identify the genotype-specific tag sequences. PCR was used to check the genotyping effect of these tags.

RESULTSTwo tag sequences, sequence between 149-169 and sequence between 461-483, were identified in the large S region. Using primers specific to these tag sequences, the genotype of HBV can be specifically identified.

CONCLUSIONThese tag sequences can be used for HBV genotyping.

Base Sequence ; DNA Primers ; Gene Library ; Genes, Viral ; Genotype ; Hepatitis B virus ; classification ; genetics ; Hepatitis B, Chronic ; virology ; Humans ; Molecular Sequence Data ; Polymerase Chain Reaction ; methods ; Protein Precursors ; genetics ; Sequence Analysis, DNA

OBJECTIVETo study the expression of targeting protein for Xklp2 (TPX2) and its significance in squamous cell carcinoma (SCC) of the lung.

METHODTwo SCC cell lines and 4 immortalized bronchial epithelial cell lines (as a precancerous model) were examined by Western blot for TPX2 expression. Reverse transcription-polymerase chain reaction analysis for TPX2 was also performed using tumor tissues from 21 patients with SCC of the lung. The expression of TPX2 was studied by immunohistochemistry (using tissue microarray) on paraffin-embedded sections of pulmonary SCC and corresponding precancerous lesions from a group of 319 patients.

RESULTSTPX2 was variably expressed in all the cell lines studied. Compared with matched controls using normal lung tissue, high level of TPX2 mRNA was detected in 16 of the 21 SCC tumor tissue samples analyzed. Immunohistochemical study showed that TPX2 was mainly present in tumor tissues but not in normal controls. The expression of TPX2 correlated with tumor grade, stage and nodal status. As for precancerous lesions, the level of TPX2 was also increased, in accordance with the degree of dysplasia.

CONCLUSIONSExpression of TPX2 may play a role in carcinogenesis of bronchial epithelium and tumor progression of pulmonary SCC. It may also represent a potential biomarker for surveillance of SCC of lung.

Blotting, Western ; Carcinoma, Squamous Cell ; genetics ; metabolism ; pathology ; Cell Cycle Proteins ; biosynthesis ; genetics ; Cell Line, Tumor ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Lung ; metabolism ; pathology ; Lung Neoplasms ; genetics ; metabolism ; pathology ; Microtubule-Associated Proteins ; biosynthesis ; genetics ; Nuclear Proteins ; biosynthesis ; genetics ; Precancerous Conditions ; genetics ; metabolism ; pathology ; RNA, Messenger ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Tissue Array Analysis

OBJECTIVETo evaluate the efficacy and toxicity of the combined chemotherapy with docetaxel, capecitabine and cisplatin (TXP) in the treatment of metastatic nasopharyngeal carcinoma (NPC).

METHODSThis retrospective analysis involved 22 patients with metastatic NPC receiving treatment with the TXP regimen. The patients were given docetaxel at 60 mg/m² on day 1, cisplatin at 20 mg/m² on days 1-3, and capecitabine at 1 250 mg/m² on days 1-14, and the treatment cycle was repeated ever 3 weeks.

RESULTSOf the 22 patients, 14 (63%) achieved partial remission, 2 (9%) had complete remission, and 5 (23%) showed stable disease. The overall clinical response rate of the patients was 72% with a 1-year survival rate of 68%, median progression-free survival of 8 months, and overall survival of 14 months. The main toxicity was myelosuppression; 7 (32%) patients experienced grade 3/4 neutropenia, and 5 (23%) had grade 3/4 anemia. All the other adverse effects were tolerable and reversible.

CONCLUSIONThe TXP regimen is safe and effective for treatment of metastatic NPC, and the results are comparable with those of the reports in recent literatures.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bone Neoplasms ; drug therapy ; secondary ; Capecitabine ; Carcinoma, Squamous Cell ; drug therapy ; pathology ; Cisplatin ; administration & dosage ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Female ; Fluorouracil ; administration & dosage ; analogs & derivatives ; Humans ; Lung Neoplasms ; drug therapy ; secondary ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; Retrospective Studies ; Taxoids ; administration & dosage