AIM: To observe platelet activation and fibrinolytic activity and evalute the effects of valsartan and amlodipine in elderly patients with essential hypertension. METHODS: Double antibody sandwich ELISA and spectrophotometric assay were used to examine the levels of platelet alpha granule membrane protein (GMP 140), tissue type plasminogen activator (t PA) and its inhibitor (PAI 1) in 57 elderly patients with essential hypertension and 30 normotensives. Valsartan was given in 29 cases (groupⅠ) and amlodipine in 28 cases (group Ⅱ) for 12 weeks. RESULTS: Elevated GMP 140, decreased t PA activity, and elevated PAI 1 activity were detected in the patients, but not in normotensives (P

Objective: To investigate the level and influencing factors of mental health literacy among middle school students in Taizhou City, Zhejiang Province, so as to provide the basis for the development of mental health education and intervention. Methods: Middle school students were selected from six counties (districts) in Taizhou City using the random cluster sampling method. Demographic information, disease history, learning status, and relationship with parents were collected through questionnaire surveys. The level of mental health literacy was investigated using the Structured Mental Health Literacy Questionnaire for Middle School Students. The influencing factors for mental health literacy was analyzed using a multiple linear regression model. Results: A total of 7 173 middle school students were surveyed, including 4 273 junior high school students (59.57%) and 2 900 high school students (40.43%), and had a mean age of (15.52±1.49) years. There were 3 644 male students (50.80%) and 3 529 female students (49.20%). The median score of mental health literacy was 83.00 (interquartile range, 23.00) points. Multiple linear regression analysis revealed that older age (β'=0.074), female gender (β'=0.038), living in urban areas (β'=0.029), good family economic status (β'=0.061), engaging in sports (β'=0.122), having a good relationship with the father (β'=0.128), and having a good relationship with the mother (β'=0.094) were associated with higher mental health literacy scores among middle school students; while having a history of disease (β'=-0.144) and learning difficulties (β'=-0.178) were associated with lower mental health literacy scores. Conclusion The level of mental health literacy among middle school students in Taizhou City is relatively good, and is influenced by demographic characteristics, disease history, sports participation, learning and relationships with parents.

Objective To investigate and evaluate the pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy. Methods 282 cases of triplets who received multi-fetal pregnancy reduction (MFPR) at Shandong Provincial Hospital affiliated to Shandong University were recruited from Sep 2001 to Mar 2014. According to the remaining fetal number after MFPR, 231 cases were opted to reduce to twins (twins group) while 51 cases were opted to singleton pregnancy (singleton group).The indication of the former group was fetal abnormalities under ultrasound or on patients′ demand; while the indication for the later group included dichorionic triamniotic (DCTA) triplets or patients′ aspiration. Potassium chloride was injected into the targeted fetal heart until cardiac standstill was obtained. The pregnancy outcomes, gestational age at delivery, birth weight of newborns of the two groups were recorded. Successful pregnancy was defined as take-home at least one baby. Results (1)The overall rate of successful pregnancy was 91.5%(258/282).There were 413 neonates in the twins group, including 4 neonatal deaths and 409 live babies, with the successful rate of 90.5%(209/231). There were 49 neonates in the singleton group, including 2 cases of fetal loss. Thus the successful rate was 96.1%(49/51). There was no difference of successful pregnancy rate between the two groups(P>0.05).(2)The mean gestational age at operation for the twins group and singleton group were(16.5±3.5)weeks and (14.2±2.0) weeks, respectively. Each group was divided into three periods,11-13+6 weeks, 14-16+6 weeks and≥17 weeks.In the twins group, the cases in each time period were129(55.8%,129/231), 50(21.6%,50/231)and 52(22.5%,52/231), respectively. While in the singleton group, the cases in each time period were 27(53%,27/51), 16(31%, 16/51)and 8(16%,8/51).There was no difference between the two groups at each time period(P>0.05). (3)The fetal loss rate in the twins group were 7%(9/129), 12%(6/50), 10%(5/52) at each time period, respectively. While for the singleton group they were 4%(1/27), 0(0/16)and 1/8, respectively. There was no significant difference between the two groups at each time period(P>0.05).(4)The mean birth weight of the twins group was lower than the singleton group [(2 555±447) g vs (3 084±550) g, respectively, P<0.05].The rates of low birth weight infants(<2 499 g)in the twins group and the singleton group were 45.5%(188/413)and 8%(4/49), respectively(P<0.05).The rate of very low birth weight infants(≤1 499 g) was 3.9%(16/413)in the twins group compared with 0(0/49)in the singleton group(P>0.05).(5)The gestational age at delivery of the twins group was earlier than the singleton group [(36.2 ± 2.4) weeks vs(38.3 ± 2.2)weeks, respectively,P<0.05]. The labor rate of the two groups was significantly different for both 34-36+6 weeks and≥37 weeks(P<0.05).The full-term delivery rate in the twins group was 47.6%(110/231), and was 88.2%(45/51)in the singleton group(P<0.05). The fetal loss rate before 28 weeks did not differ between the two groups[8.7%(20/231)vs 3.9%(2/51), P>0.05].Conclusions Reduction to one fetus led to significantly better outcome than two fetuses, with no significant difference in fetal loss rate. It is better to advise patients with triplets reduce to singleton pregnancy.

Objective To explore the value of Swansea criteria on diagnosis and severity evaluation of acute fatty liver of pregnancy (AFLP).Methods Fifty-two AFLP patients were admitted to Shandong Provincial Hospital Affiliated to Shandong University between January 1,2000 and December 31,2011.All these cases were retrospectively reassessed by Swansea criteria.According to the severity,prognosis and whether continuous blood purification treatment was needed,these cases were classified as mild and severe cases.Differences between groups were detected by x2 or t test.Bivariate correlation analysis was used for Swansea criteria compliance and postnatal hemorrhage and days in hospital.Results After reassessing by Swansea criteria,31 cases could be diagnosed as AFLP (20 cases met seven or more criteria,11 cases met six criteria)and the other 21 cases could not (16 cases met five criteria,three cases met four,and two cases met three).For the 16 cases that met five Swansea criteria,they were confirmed as AFLP based on postnatal follow-up.The five cases that met four or three criteria were confirmed as AFLP because no other disease could explain their status.Among the patients who met seven or more Swansea criteria,the incidence of intrauterine fetal death was 40％ (8/20),and 65％ (13/20) needed continuous blood purification.These were higher than in patients who met six or fewer Swansea criteria [9％ (3/32) and 28％ (9/32),x2=6.921 and 6.857,P=0.014 and 0.011].Postpartum hemorrhage was positively correlated with Swansea criteria compliance (r2=0.286,P=0.040).Conclusion Patients who meet five Swansea criteria can be diagnosed as AFLP.Swansea criteria can be applied to the severity evaluation of AFLP.

Objective: To investigate the level and timeliness of CD4+T lymphocyte cell (CD4 cell) counts at first measurement among newly reported HIV/AIDS cases in Taizhou City, Zhejiang Province from 2012 to 2021, so as to provide insights into improving the management of HIV/AIDS cases. Methods: Demographic data and first measurement of CD4 cell counts of newly reported HIV/AIDS cases in Taizhou City from 2012 to 2021 were collected from the HIV/AIDS Comprehensive Control System of Chinese Disease Prevention and Control Information System. The level and time of CD4 cell counts at first measurement were descriptively analyzed, and factors affecting CD4 cell counts at first measurement were identified using a multivariable logistic regression model. Results: A total of 4 834 newly reported HIV/AIDS cases were recorded in Taizhou City from 2012 to 2021, including 3 889 men (80.45%), 2 005 cases at ages of 20 to 39 years (41.48%), and 2 130 farmers (44.06%). There were 1 664 cases (34.42%) with CD4 cell counts of <200/mm3 at first detection, 2 576 (53.29%) with CD4 cell counts of 200/mm3 to 499/mm3, and 594 (12.29%) with CD4 cell counts of ≥500/mm3. The proportion of CD4 cell counts of <200/mm3 showed a tendency towards a rise from 2012 to 2021 (χ2trend =4.250, P<0.001). There were 3 465 cases (71.68%) that had an interval of ≤14 days between the first detection of CD4 cell counts and confirmatory HIV test, 740 (15.31%) that had an interval of >14 to 30 days, 315 (6.52%) that had an interval of >30 to 90 days, 135 (2.79%) that had an interval of >90 to 180 days, and 179 (3.70%) that had an interval of >180 days. The proportion of an interval of ≤14 days appeared a tendency towards a rise from 2012 to 2021 (χ2trend=6.874, P<0.001). Multivariable logistic regression analysis identified women (OR=0.630, 95%CI: 0.529-0.751), age of ≥20 years (OR: 1.958 to 3.218, 95%CI: 1.216-5.412), other or unknown routes of HIV infection (OR=1.785, 95%CI: 1.100-2.896), and identification by medical institutions (OR=1.779, 95%CI: 1.497-2.114) as factors affecting CD4 cell counts of <200/mm3 at first measurement. Conclusions The timely detection of CD4 cell counts at first measurement gradually increased with year among newly reported HIV/AIDS cases in Taizhou City from 2012 to 2021; however, there were still 34.42% of cases with CD4 cell counts of <200/mm3. Gender, age, route of HIV infection, and sample source were factors affecting CD4 cell counts of <200/mm3 at first measurement.

Objective To explore the effect of edaravone on serum level of 8-iso-PGF2α and prognosis in patients with severe head injury(SHI).Methods 68 patients with SHI were randomly divided into two groups,which were both given conventional treatment,while the treatment group was also given extra injection of edaravone for 14d.8-iso-PGF2α,GCS score and GOS were observed and compared between the two groups respectively.Results The decrease of serum level of 8-iso-PGF2α in treatment group was significantly higher than that of the control group,the GCS score and good outcomes after 3 months was significantly higher than that of the control group after the treatment(P＜0.05).Conclusion Edaravone could reduce the serum level of 8-iso-PGF2α in SHI patients and improve the prognosis.which was woah clinical application.

Obiective To evaluate the efficacy of health package for the nurse in train evacuation, Methods The self-manufactured new mobile health package for the nurses provides shortcut and completed equipment in various basic nursing care, therapic procedure, condition observation, emergency aid and treatment for nursing staff who performed transportation in train evacuation.Results The potable health package can play an important role in several medical support training and have special mission. Conclusion The health package has mobile applicability and operability, which is an important equipment for successful medical support training.

Objective To establish a kind of medical box for wound debriding and change dressing in sanitary train,which could be used to satisfy the requirements of natural and manmade disasters for medical service.Methods With tri-grade modularization theory,the medical box were divided into four functional sections,including disinfection cleaning solution section,debriding and change dressings common section,contaminated wound change dressings section and infected wound change dressing section.Through the four sections,the medical box could be provided 5 wound debirding and 50 change dressings.Results The medical box can satisfy all requirements for wound treatment with useful and convenient function.Conclusions The invented medical urgent box has so many advantages of modularization,complete functions and expansionary,which could satisfy all requirements for sanitary train.

BACKGROUND:Transfusion guidelines pointed out:whole blood should be stored at (4±2)℃. The bacterial growth or loss of function should occur if the blood leaves the suitable storage conditions. Recipients wil suffer from different degrees of blood transfusion reaction or invalid infusion.
OBJECTIVE:To observe morphology of erythrocytes of autologous blood stored at different temperatures using microscope.
METHODS:Blood was obtained from 40 cases of acute normovolemic hemodilution and stored in ACD citrate bags. Whole blood was respectively stored at 4 ℃ and 23 ℃. Blood smear was taken respectively in the blood storage immediately, 1, 2, 3, 4, 5 and 6 hours after col ecting autologous blood. Changes in morphology of erythrocytes were observed with a microscope. Deformity rate of erythrocytes was calculated. Six blood samples were randomly selected to test pH, K+, and free hemoglobin respectively in 6-hour common temperature group and ACD banked blood within the valid period. Six blood samples were randomly selected for the bacterial culture in each group of two groups at 6 hours.
RESULTS AND CONCLUSION:There were no significant differences in abnormality rates of erythrocytes between 4 ℃ and common temperature groups at each time point. The pH, K+, free hemoglobin at six hours in the common temperature group were better than those of ACD banked blood within the valid period and there was no bacterial growth in culture between the two groups. Therefore, it is feasible to transfuse autologous blood back to the patient within 6 hours of storage at room temperature.

Objective To investigate the effect of different doses of dexmedetomidine on the median effective concentration (EC50) of propofol required to prevent the response to Supreme laryngeal mask airway (LMA) insertion in aged patients.Methods ASA Ⅰ or Ⅱ patients of both sexes,aged ≥ 65 yr,with a body mass index of 20-28 kg/m2,undergoing knee operation under general anesthesia,were randomly divided into 3 groups:control group (group C),small dose dexmedetomidine group (group D1 ) and large dose dexmedetomidine group (group D2 ).Dexmedetomidine 0.4 and 0.8 μg/kg were infused intravenously over 10 min in groups D1 and D2 respectively,while group C received the equal volume of normal saline instead.Anesthesia was induced with target-controlled infusion of propofol.The initial target plasma concentration of propofol was set at 3.5,3.0 and 2.6 μg/ml in groups C,D1 and D2 respectively.Following equilibration between the plasma and effect-site concentration of propofol,LMA was inserted when BIS value was 50-60.EC50 was determined by up-and-down sequential trial.The target plasma concentration of propofol increased/decreased by 10％ in the next patient depending on whether or not the LMA insertion response occurred.Positive LMA insertion response was defined as body movement,comer of the mouth movement,biting LMA,bucking and/or wallowing during insertion.The EC50 and 95％ confidence interval (CI) of propofol required to prevent LMA insertion response were calculated with sequential method.Results EC50(95％ CI) of propofol was 3.57 μg/ml (2.91-3.87 μg/ml),3.09 μg/ml (2.66-3.53 μg/ml) and 2.62 μg/ml (2.30-3.15 μg/ml) in groups C,D1 and D2 respectively.EC50 was significantly lower in groups D1 and D2 than in group C,and in group D2 than in group D1 ( P ＜ 0.05 ).Conclusion Dexmedetomidine 0.4 and 0.8 μg/kg infused intravenously can reduce the EC50 of propofol required to prevent the response to Supreme LMA insertion in aged patients,and the effect of 0.8 μg/kg is more obvious.