Objective To explore the role of body fat distribution in the pathogenesis of obesity-related asthma.Methods Totally 125 patients with stable asthma were recruited and were divided into non-obese group (n =51),peripheral obesity group (n =34) and central obesity group (n =40) according to body mass index and waist circumference.The FEV1％,FVC,FEV1/FVC ratio,IL-6,and hs-CRP levels in peripheral blood,eosinophil and neutrophil percentage in induced sputum,as well as exhaled NO levels were determined,and asthma control test (ACT) scores were calculated.Both one-way analysis of variance and analysis of covariance were used for statistical analysis.Results The values of FVC in the central obesity group and the non-obese group were [3.98 (3.99) ±0.99] L and [4.51 (4.51) ±1.00] L,while the levels of IL-6 and hs-CRP in peripheral circulation and the percentage of neutrophils in induced sputum were [33.63 (33.28) ± 14.04] ng/L and [21.22 (21.33)±11.23] ng/L,[2.12 (2.15) ±0.73] mg/L and [0.92 (0.91) ±0.61] mg/L,52.58 (52.81) ± 14.14 and 45.41 (45.34) ± 12.84,respectively (all P ＜ 0.05).After adjusting for inhaled corticosteroids (ICS) doses,the ACT scores were also significantly higher in central obesity group (22.10 ± 1.68 vs.23.01 ± 1.62) (P ＜ 0.05).Only the hs-CRP level was found significantly higher in peripheral obesity group than in non-obese group [(1.54±0.68) mg/Lvs.(0.91 ±0.61) mg/L] (P＜0.05).Conclusion Central obesity may play the leading role in the pathogenesis of obesity-related asthma.

Objective To investigate the effect of rehabilitation nursing in perioperative period of elderly patients with femoral neck fractures undergone supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty.Methods A retrospective cohort analysis was made on 30 patients treated by total hip arthroplasty through the SuperPATH approach from January 2016 to July 2016.There were seven males and 23 females,aged 75-91 years (mean,77 years).Nursing methods contained application of pluralistic education before operation,application of body position management,psychologic support joint pain and sleep multidimensional strengthening nursing intervention and dislocation nursing after operation,and recovery training.Self-rating anxiety scale (SAS),self-rating scale of sleep (SRSS),Barthel index and Harris hip score were used to compare clinical manifestations before and after treatment.Results SAS score was 42.5-66.3 points [(50.0 ± 6.2) points] one day before operation,compared to 33.8-53.8 points [(41.5 ± 5.2) points] five day after operation (P ＜ 0.05).SRSS score was 24-37 points [(29.9 ±3.1) points] one day before operation,compared to 14-34 points [(23.2 ± 5.3) points] five day after operation (P ＜ 0.05).Barthel index was 20-40 points [(38.5 ± 4.4) points] one day before operation,was 35-55 points [(49.7 ± 6.3)points] two day after operation and was 55-70 points [(63.5 ± 5.1)] points five day after operation,showing significant differences (P ＜ 0.05).Harris hip score was 4-25 points [(14.8 ±4.2)points] one day after operation,was 59-75 points[(67.3 ± 5.1) points] two day after operation and was 66-85 points [(79.2 ± 4.3) points] two weeks after operation,showing significant differences (P ＜ 0.05).All incision healed primarily.No complications occurred.Conclusion Perioperative rehabilitation nursing of minimally invasive SuperPATH arthroplasty is effective in alleviating patients' anxiety,improving sleep status and self-care ability,enhancing postoperative rehabilitation effect and reducing risk of in-hospital complications.

OBJECTIVETo investigate the clinical effect of Halo-vest head ring in the treatment of replantation of total scalp avulsion.

METHODSWe treated 11 cases of total scalp avulsion with the anastomosis of arteriovenous vessels and Halo-vest head ring from December 2006 to February 2015.

RESULTSOne patient's replanted scalp got necrosis because of serious contusion which was healed without hair growth after free skin graft and dressing. All the scalp flaps in the other 10 patients survived. After 3-96 months follow-up, the wound completely healed, the scalp and hair grew well with satisfactory appearance.

CONCLUSIONSThe use of Halo-vest head ring for replantation of total scalp avulsion can effectively improve the survival rate and survival area.

Anastomosis, Surgical ; methods ; Bandages ; Graft Survival ; Humans ; Lacerations ; surgery ; Necrosis ; etiology ; Prostheses and Implants ; Replantation ; methods ; Scalp ; injuries ; pathology ; surgery ; Skin Transplantation ; methods ; Surgical Flaps

OBJECTIVE:To provide reference for rational use of antibiotics to treat Pseudomonas aeruginosa (PA) infection in the clinic. METHODS:Resistant rate of PA in our hospital during 2011-2015 were analyzed retrospectively. Antibiotics use densi-ty(AUD)of 10 commonly used antibiotics were analyzed statistically,and the correlation of resistant rate with AUD was investi-gated by Spearman correlation analysis. RESULTS:One thousaud and eleven strains of PA were isolated in our hospital during 2011-2014,detection rate of PA always occupied the top 5 place. Top 3 antibiotics in the list of AUD were levofloxacin,ceftazi-dime,cefoperazone sodium and tazobactam sodium. AUD of piperacillin sodium and tazobactam sodium,levofloxacin,ciprofloxa-cin and meropenem were positively correlated with resistant rate of PA(r were 1.000,0.900,1.000,1.000,P<0.05). AUD of ce-foperazone sodium and tazobactam sodium were negatively correlated with resistant rate of PA(r=-0.900,P<0.05). AUD of imi-penem and cilastatin sodium,ceftazidime,gentamicin,aztreonam and amikacin had no correlation with resistant rate of PA(P>0.05). CONCLUSIONS:There is correlation between AUD of antibiotics and resistant rate of PA. It is of important significance to detect resistant rate of PA and the use of antibiotics regularly. Antibiotics should be selected cautiously in accordance with bacterial monitoring data,results of drug sensitivity tests,the amount and resistant rate of antibiotics,etc,in order to reduce resistant PA.

Objective To study the levels of Th1 and Th2 type cytokines in 3-nitrobenzene sulfonate(TNBS) and oxazolone(OXZ) colitis without or with Trichinella spiralis( T. spiralis) infection. Methods Female BALB/c mice were randomly divided into 4 groups: 50% Ethanol, T. spiralis only, TNBS or OXZ,T. spiralis +TNBS or OXZ(at least 6 in each group when mice were killed). The levels of IFN-γ, IL-12,IL-4, IL-10 in colon in mice with colitis induced by TNBS or OXZ without or with T. spiralis infection 3 d and 7 d post-induction were assessed using ELISA method. Results Colonic protein levels of IFN-γand IL-12 were significantly increased 3 d and 7 d after intra-colonic injection of TNBS( P ＜0.05 ). Concurrent infection with T. spiralis prevented this rise in IFN-γand IL-12 secretion and tended to induce a rise in colonic IL-4 and IL-10 content(P ＜0. 05). The levels of IFN-γ, IL-4 and IL-10 protein in colitic mice colon with prior nematode infection on days 3 and 7 post-induction of colitis were significantly higher than that seen in colitic mice without prior nematode infection ( P ＜ 0.05 ). Conclusion T. spiralis infection significantly attenuates TNBS-induced colitis in mice. The local immunologic mechanism is that T. spiralis can down-regulate strongly Th1-type immune response of colitis and up-regulate Th2 response, Tr1-cytokines. According to the change of Th1/Th2 cytokines, prior T. spiralis infection doesn't reduce the severity of OXZ-induced colitis, but without aggravating colitis. The exactly immunologic mechanism deserve to be explored deeply.

Objective To investigate the efficacy and safety of different course duration of rivaroxaban for deep venous thrombosis (DVT) in elderly patients with femoral neck fractures after artificial femoral head replacement.Methods A prospective case control study was conducted on 95 elderly cases of femoral neck fractures treated from February 2015 to July 2017.There were 18 males and 77 females,with average age of 80.8 years (range,70-98 years).There were 85 patients at stage Ⅲ and 10 at stage Ⅳ according to Garden classification.All patients received artificial femoral head replacement and were randomly divided into 3 groups (Group A:34 cases,rivaroxaban treatment for 2 weeks;Group B:31 cases,rivaroxaban treatment for 3 weeks;Group C:30 cases,rivaroxaban treatment for 5 weeks).At 2,3 and 5 weeks after operation,the patients were given 10 mg oral rivaroxaban once daily.General information,blood transfusion rate,hemoglobin volume,platelet count and DVT rate were recorded before and 6 weeks after operation.Results No significant difference among the groups in terms of division,age,body mass index,fracture classification,time interval from injury,intraoperative blood loss,quantity of drainage fluid after operation,and associated underlying diseases was observed (P ＞ 0.05).The blood transfusion rate of Groups A,B and C within 2 weeks after operation was 9％ (3/34),3％ (1/31) and 3％ (1/30) (P ＞ 0.05) respectively.The comparative difference in hemoglobin and platelet count had no statistical significance (P ＞ 0.05).The DTV rate after operation of Groups A,B and C was 21％ (7/34),13％ (4/31) and 0,respectively.There was no significant difference between Groups B and C (P ＞ 0.05),but the difference between Groups A and C was statistically significant (P ＜ 0.05).Conclusions For elderly patients with femoral neck fracture who underwent the artificial femoral head replacement,it is effective to prevent the occurrence of DVT by extending the course of rivaroxaban treatment to 5 weeks.In addition,it does not increase the risk of bleeding.

Objective:To survey the status quo of family doctor work mode in Shanghai Xuhui district.Methods:Semi-structured and structured in-depth interviews were conducted in Shanghai Xuhui district from April to June 2021, 11 directors, 12 deputy directors in charge and 30 family doctors from 12 community health service centers participated in the survey and completed two stages and four sessions of interviews on the development of the integrated and high-quality family doctor work mode and the ways to realize and the challenges to face. The records of interviews were transcribed, sorted and analyzed using the Colaizzi 7-step analysis method.Results:The survey showed that the family doctor contracting was carried out in a large team mode in the whole district, mainly for the elderly, and most of contracted residents were not included in health management and follow-up services. The team was composed of family doctors and assistants, and the routine outpatient service was the main work pattern, and the regular services also included the chronic disease follow-up and health check-up for elderly. On the issue of how to output high-quality integrated services, the majority of doctors (12/13) believed that the contracted individual should be taken as the unit of fine service, carrying out overall health assessment, optimizing medication plan, lifestyle guidance, one-stop service in hospital, etc.; only one doctor suggested that the family should be the management unit. For upgrading the working mode and service quality, insufficient time and energy were the main obstacle. Public health work occupied a lot of working time, but it seemed not be transformed into favorable resources and conveniences in health management and services. The professional assistants should carry out some responsibility to save family doctor′s time. The survey suggests that informatization, service space, and sufficient drug supply are the keys for ensuring high-quality and high-efficiency integrated services.Conclusion:The organizational structure of the family doctor team in Shanghai Xuhui district is relatively mature, but the integrated and high-quality service output has not yet reached. It is necessary to make regional overall planning and increase efforts to achieve the integration of medical treatment and prevention, so as to gain time for family doctors to carry out high-quality services. At the same time, it is also necessary to cultivate effective family doctor assistants, provide an information work platform that matches the work attributes and goals of family doctors, open up an integrated health management service space, and ensure the full range supply of drugs.

Objective:To evaluate the efficacy and safety of discriminative application of Chinese patent medicines in female patients after percutaneous coronary intervention (PCI) due to acute coronary syndrome (ACS).Methods:The study population was from the Chinese Patent Medicine (CPM) trial. CPM trial was a multicenter prospective cohort study, which enrolled patients from 40 centers in mainland China between February 2012 and December 2015, with the discriminative use of Chinese patent medicines as the exposure factor. Female patients with ACS after PCI who completed 36-month follow-up were included in this analysis, and were divided into a conventional treatment group (using conventional western medicine recommended by the guidelines) and a group with the discriminative use of proprietary Chinese medicines (on the basis of conventional western medicine treatment, discriminative use of Qishen Yiqi dropping pills for Qi deficiency and blood stasis syndrome, Guanxin Danshen dropping pills for blood stasis syndrome, and Danlou tablets for phlegm and blood stasis syndrome combined with the conventional western medicine). The primary endpoint event was a composite endpoint event including cardiovascular death, nonfatal myocardial infarction, and emergency revascularization surgery. Secondary endpoint events were composite endpoint events including readmission for ACS, heart failure, stroke, and other thrombotic events. Adverse events were collected. Cox proportional risk model was used to assess the effect of discriminatory application of Chinese patent medicine on endpoint events, and sensitivity analysis was performed by comparing the results with propensity score matching analysis.Results:A total of 748 female ACS post-PCI patients were included in the analysis, aged (63.2±8.3) years. There were 370 patients in the group of discriminative application of Chinese patent medicines and 378 patients in the conventional treatment group. There were 37 cases (10.0%) and 58 cases (15.3%) of primary endpoint events in the discriminatory application of Chinese patent medicines group and the conventional treatment group, respectively. Cox analysis showed that the risk of primary endpoint in the discriminatory application of Chinese patent medicines group was lower than that in the conventional treatment group after adjusting for confounding factors (adjusted HR=0.62, 95% CI 0.40-0.96, P=0.031). There were 38 (10.3%) and 57 (15.1%) cases of secondary endpoint events in the two groups, respectively. Cox regression analysis showed that the risk of secondary endpoint events in the discriminatory application of Chinese patent medicine group was lower than that in the conventional treatment group after adjusting for confounders (adjusted HR=0.56, 95% CI 0.37-0.87, P=0.001). The results of propensity score matching analysis also showed that Chinese patent medicines based on discriminatory application could reduce the risk of primary endpoint ( HR=0.62,95% CI 0.40-0.97 ,P=0.033) and second endpoint ( HR=0.56, 95% CI 0.37-0.87, P=0.009) significantly. There was no significant difference in adverse events between the two groups (12.4% (46/370) vs. 10.3% (39/378), P=0.362). Conclusion:On the basis of conventional western medicine treatment, discriminatory application of Chinese patent medicines can reduce the risk of endpoints in female patients after PCI due to ACS without significant adverse effects.

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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