Objective To evaluate the applicability and effectiveness of the model for managing patients with convulsive epilepsy in rural China.Methods The model is under leadership of the government departments and medical institutions at all levels organized primary physicians for treatment and management.People with convulsive epilepsy in 24 rural areas were screened by local physicians and confirmed by neurologists.Patients diagnosed with convulsive epilepsy and agreed with managing were recruited into study.They were managed at primary care level and provided with phenobarbital monotherapy.Efficacy was assessed from the changes in seizure frequencies from baseline.Results There were 408 town hospitals and 979 trained primary care physicians participating in our study.Five thousand and thirty-eight patients were enrolled in 2 years,and 90％ patients with good compliance.Among the people who were treated with phenobarbital monotherapy,3 170 were managed for 12 months,and 2 005 (63.3％) of whom had a 50％ or greater reduction in seizure frequency and 1 246 (39.3％)patients remained seizure free;651 patients were managed for 24 months,and 491 (75.4％) of whom had a 50％ or greater reduction in seizure frequency and 202(31.0％)patients remained seizure free.Three hundred and forty-three (6.8％) patients withdrew from the study,and only 35 (0.7％) patients discontinued treatment because of side effects.Sixty-nine (1.4％) patients were dead and 8 (11.6％) of them were caused by status epilepticus.Conclusion This study confirms that this model is beneficial to patients with epilepsy and is suitable to the rural areas of China.

Objective To investigate the relationship between body mass index (BMI) and blood pressure in non-stroke population with over 50 years old from Dongcheng District and Shijingshan District of Beijing.Methods A total of 9 524 of non-stroke population with over 50 years old were selected as our subject,which were sampled from Dongcheng District and Shijingshan District of Beijing by using stratified cluster random sampling method.Investigation and physical inventory check were conducted on all subbjects conduct,and the results was statistical analyzed by using SPSS 17.0 software.Results Systolic blood pressure and diastolic blood pressure of all subjects increased with the increasing of BML The prevalence of hypertension of three age groups were significant different between male and female (Z =-50.47,P ＜ 0.001).The prevalence of hypertension in males with 50-59 years old was considerably higher than that of females (x2 =14.74,P ＜0.001).However,the prevalence of hypertension in females with 60-69 years old and ≥70 years old group were higher than that of males (x2 =12.39,P ＜ 0.001 ; x2 =10.36,P =0.001).Overall,the prevalence of hypertension between males and females was no significant (male for 37.9％,female 37.3％,x2 =0.31,P =0.578).BMI increased with the increasing blood pressure levels and prevalence of hypertension,taking the people with BMI ＜ 18.5 kg/m2 as reference,OR values of the risk for male people with BMI 18.5-24.0kg/m2,24.0-28.0 kg/m2,and ≥ 28.0 kg/m2 to get hypertension people were 1.622 (95％ CI:0.653 -4.029),2.405 (95％ CI:0.940-5.940),4.248 (95％ CI:1.709-10.559) respectively,while for female people were 2.212 (95％ CI:1.193-4.104),3.870 (95％ CI:2.092-7.157),6.603 (95％ CI:3.557 -12.258) respectively.Conclusion Overweight and obesity are risk factors of hypertension.Obesity control contributes to the prevention and treatment of hypertension in middle-aged and elderly population.

Objective To analyze the relationship between CT characteristics of chronic subdural hematoma (CSDH) and its recurrence, as well as relevant pathological mechanism. Methods The study involved 178 patients with CSDH who underwent surgery, of whom 38 patients (40 lesions) experienced recurrence of CSDH. Univariate and multivariate logistic analyses were performed to assess the correlation among CT characteristics ( including side, density, width, subtype and midline shift of the hematoma) and CSDH recurrence. Results ( 1 ) The width of hematoma, midline shift, type of hematoma were found to be correlated with the recurrence of CSDH in the univariate analysis. The odds ratio (OR)and 95% confidence interval (CI) value of patients with hematoma width ＞30 mm, midline shift ＞10 mm and the separated type were 18. 400 (2.024-167. 301 ), 4. 643 ( 1. 815-11. 877 ) and 14. 385 (3. 601-57.467 ), respectively. (2) The midline shift and type of hematoma were found to be correlated with the recurrence of CSDH in the multivariate analysis, when the OR and 95% CI value of patients with hematoma midline shift ＞ 10 mm and separated type were 5. 280 ( 1. 339-20. 823) and 19. 125 (4. 175-87.619), the OR and 95% CI value of patients with hematoma width ＞30 mm was 14. 838 ( 1. 353-162.698). Conclusions Type of hematoma and midline shift are found to be independently correlated with the recurrence of CSDH, and the width of hematoma is also related with its recurrence.

Objective To observe the efficacy and the side-effects of sodium valproate (VPA) in patients with epilepsy in rural China. Methods Epilepsy patients were selected from rural areas of Tianmen in Hubei province and Tiandong county in Guangxi province according to the inclusion and exclusion criteria.Efficacy evaluation standard depending on the change of seizure frequency compared with the situation prior to entering the treatment group. Among the treated patients, no seizures, seizure reduced ＞ 75%, seizure reduced 50%-75% sums for the total effective rate. Results All 607 patients with epilepsy were treated and followed up, the male were 395 (65. 1% ) female 212 (34. 9% ), and 579 patients were treated for 12 months. Patients with generalized tonic-clonic seizures were 517 (85.2%), absence seizures 20 (3. 3% )and the other types of seizures 70 (11.5% ) including simple partial seizures, tonic, clonic, myoclonic or atonic seizures etc. The completed control of seizures ( without any seizures) during the period after taking 3 months, 6 months, 12 months were 270 (45.5%), 249 (42. 3% ) and 238 (41.1%) respectively. The total effective rates in the three periods were 65.2% , 75.4% and 85.5% respectively. The 58 patients in the total group showed side-effects during the follow-up period, mainly including drowsiness, lethargy,fatigue, dizziness, headache and tremor. Nineteen patients (3. 1% ) quitted the treatment group.Conclusions The VPA is an effective antiepileptic drug and no more severe side-effects. It is the same as Phenobarbital and suitable to be used in rural areas of China.

Objective To survey the awareness rate of knowledge about vascular cognitive impairment (VCI) in community physicians.Methods A questionnaire survey on the awareness of knowledge about VCI was conducted in 87 community physicians from 4 community hospitals in Beijing Chaoyang District from October to December 2012.Among all participants there were 27 males and 60 females with an average age of (39 ± 11) years,85％ (74/87)had college or university degrees,90％ (78/87) held primary or middle-level professional titles,41％ (36/87),of them were internists.Results All participants completed the questionnaire.The awareness rate about minor and major neurocognitive disorder was 39％ (60/87) ; the rates of various causes of dementia were 51％ (44/87)-100％ (87/87) and various symptoms of cognitive impairment were 79％ (69/87)-99 ％ (86/87),respectively.The awareness rate of cognitive impairment as initial symptom displayed in stroke was 54 ％ (47/87).The awareness rates of knowledge related to diagnosis and treatment of dementia were 57％ (50/87)-97％ (84/87) and 80％ (70/87)-100％ (87/87),respectively.The awareness rates about that Alzheimer's disease and dementia with Lewy bodies were not reversed by early treatment were 46％ (40/87)and 37％ (32/87),respectively.The awareness rates of vascular risk factors were 20％ (17/87)-100％ (87/87)and those about the mode of health education were 52％ (45/87)-95 ％ (83/87).There was 36％ (31/87) community physicians who thought that they possessed VCI-related knowledge.Conclusions The results of survey suggest that community physicians shall upgrade their knowledge of diagnosis and treatment for vascular cognitive impairment.

Objective To analyze efficacy and its influencing factors of phenobarbital treatment for epilepsy management in rural China.Methods Total 3 315 patients with convulsive epilepsy from rural areas of 24 counties were enrolled in this joint epilepsy management program.All patients received phenobarbital monotherapy for 1 year during November 2011 to November 2013.The efficacy and potential influencing factors including sex,age,duration of epilepsy,number of seizures in the 12 months before management(≥2),previous treatment,daily dose of phenobarbital,taking other antiepileptic drugs and compliance of patients were studied with multivariate analysis.Results Among 3 315 patients,38.9％ were seizure-free during the entire management period.The rates of seizure-free in 15 to 39 y age group (35.2％,495/1 405)and in patients receiving irregular treatment previously (34.6％,625/1 808)were lower.The rates of seizure-free were higher in patients taking phenobarbital 60-90 mg everyday (49.4％,988/2 000) and those with good compliance(42.3％,1 160/2 744).Patients taking other antiepileptic drugs in 12 months had lower seizure-free rate (31.0％,45/145).Univariate analysis showed that gender of patients was not related to seizure-free rate (P ＞ 0.1).Multivariate analysis showed that the longer duration of epilepsy(OR =0.015,95％ CI:1.008-1.021,P ＜ 0.001),more seizures in the 12 months (OR =0.005,95％ CI:1.002-1.007,P =0.002) and the irregular treatment before management were the risk factors for low seizure-free rate (P ＜ 0.05).Patients received formal treatment or untreated had a lower risk of seizure compare with the irregular treatment (OR =0.737,95％ CI:0.611-0.889,P =0.001;OR =0.566,95％ CI:0.469-0.683,P ＜0.001).Patients with good compliance and with a daily dose of 60-89 mg phenobarbital(OR =0.107,95％ CI:0.013-0.905,P =0.040) were associated with high seizurefree rate;in contrast the poor compliance was a risk factor for not being seizure-free(OR =2.038,95％ CI:1.634-2.541,P ＜ 0.001).Conclusion Regular medication of phenobarbital with good compliance is effective for convulsive epilepsy management in rural China.

Objective To investigate the awareness rate of knowledge related with vascular cognitive impairment (VCI) in community residents in Shuangjing District,Beijing.Methods 5 communities were randomly selected from 12 communities in Shuangjing District.According to roster,512 residents were selected randomly.Among them,there were 197 males and 315 females with an average age of (64.71±8.22) years.87.9％ of subjects had junior high school culture and over.The awareness rate of knowledge related with VCI was investigated by questionnaires from January 2013 to March 2013.Results Although the awareness rate of knowledge related with vascular dementia was only 36.9％,the awareness rates of symptoms of impairment in memory,orientation,language,execution,calculation,visuospatial and judgement were 43.8％-89.3％.The awareness rates of four outpatient clinics among dementia patients were 21.5％-38.9％,however,the awareness rate of dementia which was not curable was 47.5％.The awareness rates of 5 risk factors for stroke were 54.5％-83.4％,but the awareness rate of cognition impairment caused by hypotension and hypoglycemia was 42.8％ and 43.2％,respectively.About VCI-related preventive knowledge,the awareness rates of VCI population with high risk factors,cognitive abilities screening,and primary prevention were 35.5％-95.5 ％.The main routes taking healthy knowledge were the television and newspapers with the awareness rate of 86.9％ and 60.2％,respectively.85.9％ of subjects agreed that healthy education was helpful to their life qualities.Multiple linear regression analysis showed a significant relationship of accumulated points of VCI-related knowledge with gender and education degree (P＜0.05).Conclusions The awareness rates of risk factors,diagnosis and therapy and primary prevention for VCI are lower in Shuangjing community,and the health education about VCI should be strengthened.

Total 1350 subjects were selected by cluster random sampling from Chongwen District and Shijingshan District in Beijing with a populations of 100 000.Chongwen District represented a typical urban district and Shijingshan represtnted a newly extended urban district.Qualified investigators conducted face-to-face survey using the uniform questionnaire and measurement, dealing with the knowledge, attitude and behavior for risk factors of stroke in two districts.The results showed:in Chongwen District, the awareness rates of "the diagnostic criteria of hypertension", "antihypertensive drugs can lower the risk of cardiocerebral vascular disease", and "criteria for obesity" were 71.3%, 87.3% and 22.9% respectively,which were significantly higher than those in Shijingshan District.The awareness rate of "bad temper may increase the risk of cardiocerebral vascular disease" was lower in the Chongwen District.There were no significant differences in attitude between two districts.In Chongwen District the level of three risk factors (smoking and obesity) was significantly lower than Shijingshan, but action of self-examination was also significantly lower.Generally, there was higher level in health knowledge and lower level of risk factors in Chongwen District.The hypertension-related knowledge and behavior was not entirely consistent.It is necessary to transform knowledge into behavioral changes or intervention of risk factors in population with high awareness like Chongwen District.

Objective To evaluate the efficacy of the traditional Chinese medicine NAOAN capsule in primary prevention of stroke in high?risk populations. Methods A multicenter, randomized controlled study was performed in community setting, involving 1 088 individuals at high risk of stroke, with cerebrovascular function scores<75 and 10?year Framingham stroke risk ≥6%. Subjects were recruited in communities at Beijing, Shanghai, Changsha, and Chengdu communities, through resident committees or the village unit. A total of 559 subjects were randomized into a group treated with the NAOAN capsule, and 529 subjects in an aspirin treatment group. Follow?up was performed every 2 months for 2 years. At the mid?point and end of the intervention, we compared cerebrovascular function differences between the 2 groups. Results During the 2?year community trial, 531 subjects in the NAOAN capsule group and 465 in the aspirin group followed the protocol. Cerebrovascular function scores increased from 45.2±19.7 at baseline to 61.7±26.5 after the 2?year trial (t=－12.931, P<0.001) in the NAOAN capsule group, and from 47.2±18.9 at baseline to 53.7 ± 25.1 (t=－5.058, P<0.001) in the aspirin group; greater increases in cerebrovascular function scores were found in the NAOAN capsule group than that in the aspirin group (t=4.906, P<0.001). Conclusions Cerebrovascular function in individuals at high risk of stroke was improved by taking NAOAN capsule. Cerebrovascular function scores improved more with NAOAN capsules than with aspirin.

Objective: To investigate application and safety of pediatric interfacility-transport with extracorporeal membrane oxygenation (ECMO) in China. Methods: The data of 48 patients transported inter-hospital from February 2016 to May 2018 were collected from the following 4 centers: pediatric intensive care unit (PICU) of Bayi Children′s Hospital Affiliated to the 7th Medical Center of PLA General Hospital, Pediatric Hospital of Fudan University, Henan Provincial People′s Hospital and Children′s Hospital of Zhejiang University School of Medicine. The data of patients′ characteristics, ECMO mode and wean rate, and mortality were reviewed, which was further compared with the data of 57 compatible inner-hospital ECMO cases with t test, Rank sum test or chi-square test. Results: All the 48 interfacility-transports were accomplished by ambulance on land, with an average transfer distance of (435±422) km. The incidence of ECMO complications was 13% (6 case), without death. There were no significant differences in lactic acid, PaO₂ or SaO₂ before and after transport (4.0 (2.0, 7.5) vs. 3.0 (1.5, 6.0) mmol/L, Z=-1.579, P>0.05; 112(47, 405) vs. 166(122, 240) mmHg (1 mmHg=0.133 kPa), Z=-0.104, P>0.05; 0.97±0.02 vs. 0.96±0.03, t=1.570, P>0.05). Instead, PaCO₂ and pH were significantly different ((47±8) vs. (42±5) mmHg, t=2.687, P<0.05; 7.3±0.2 vs. 7.5±0.2, t=3.379, P<0.05). The total ECMO weaned rate was 73% (35/48) and the survival rate was 67% (32/48). No significant differences in demographic characteristics, ECMO mode or duration, transport distance or duration, or complications existed between the survival group and the death group (7/25 vs. 2/14, χ²=0.615, P>0.05; 4/28 vs. 2/14, χ²=0, P>0.05; (405±404) vs. (493±465) km, t=0.525, P>0.05; (5±4) vs. (5±5) h, t=0.388, P>0.05; 166 (128, 239) vs. 187(52, 405) h, Z=-0.104, P>0.05; 3/32 vs. 3/16, χ²=0.734, P>0.05). The lowest lactate value in survival group before ECMO transport was significantly lower than that in the death group ((5±5) vs. (8±6) mmol/L, t=2.151, P<0.05). There were neither significant differences in age, ECMO mode or support pattern (9/39 vs. 15/42, χ²=0.845, P>0.05; 6/42 vs. 7/50, χ²=0.001, P>0.05; 29/19 vs. 38/19, χ²=0.441, P>0.05), nor in ECMO weaned rate, survival rate or complications between interfacility-transport group and inner-hospital group (35/48 vs. 37/57, χ²=0.775, P>0.05; 32/48 vs. 35/57, χ²=0.313, P>0.05; 20/48 vs. 22/57, χ²=0.102, P>0.05). Conclusion With appropriate transport equipment and mature teams who handle problems timely during the transport, critically ill children could be safely transported to the destination with ECMO.