Objective To compare the artery function of male and female of all age groups in healthy Shenyang population . Methods By using CVProfilor DO 2020,we measured non-invasively the large artery elasticity index (C1) and small artery elasticity index (C2) of male and female of all age groups in healthy Shenyang population. Results CVProfilor DO-2020 showed C1 was obviously higher than C2 in healthy Shenyang population(P0 05);The results of a second DO-2020 measurement had no significant difference in short term. Conclusion The large artery elasticity was obviously higher than that of small artery.The elasticity of both large and small artery decreased with increasing age .The large artery elasticity of females is a little lower than that of males .There is no difference in small artery elasticity between the male and female.DO-2020 measuring repeated stably.

Objective To observe the clinical therapeutic effect of Astragalus injection combined with sub-hibernation therapy for treatment of patients with severe craniocerebral injury.Methods A retrospective research method was conducted, and 89 cases with severe craniocerebral injury admitted to the Department of Critical Care Medicine of the First People Hospital of Baiyin in Gansu Province from January 2010 to December 2016 were enrolled. Astragalus injection combined with sub-hibernation was applied for treatment of 45 patients in the observation group, and for another 44 cases assigned in the control group, simply conventional treatment was used. The Glasgow coma score (GCS), coma time, ratio of cripple, mortality, incidences of pulmonary infection and urinary tract infection were compared between the two groups.Results After treatment, GCS scores were significantly higher than those before treatment in both groups, but the degree of increase was more marked on the 30 days after treatment in the observation group than that in the control group (13.15±2.53 vs. 8.79±1.59,P < 0.05). Compared with the control group, coma time was obviously shorter (days: 5.79±1.89 vs. 13.65±2.73), ratio of cripple [13.33% (6/45) vs. 22.73% (10/44)] and mortality [17.78% (8/45) vs.31.82% (14/44)] were significantly lower in observation group (allP < 0.05); the incidences of pulmonary infection [22.44% (11/45) vs. 31.82% (14/44)] and urinary tract infection [28.89% (13/45) vs. 36.36% (16/44)] were lower in the observation group, but the differences between the two groups were not statistically significant (bothP > 0.05).Conclusions The treatment of Astragalus injection combined with sub-hibernation treatment can significantly improve the coma degree, shorten the time of coma, reduce the mortality and disability rate of patients with severe craniocerebral injury.

Objective To explore the effects of multidisciplinary comprehensive pulmonary rehabilitation on aged patients with pneumo-coniosis. Methods From January, 2012 to January, 2015, 85 old stable inpatients with pneumoconiosis were divided into control group (n=40) and rehabilitation group (n=45). Both groups accepted routine medicine, while the rehabilitation group received multidisciplinary com-prehensive pulmonary rehabilitation for twelve weeks. They were assessed with cardiopulmonary exercise test, BODE index and quality of life before and after treatment. Results The maximum work, maximal oxygen uptake, 6-minute walk distance, scores of modified Version of the British Medical Researsh Council Respiratory Questionnaire, BODE index, activities of daily living, social activities, depression and anx-iety improved in the rehabilitation group after treatment (t>3.379, P<0.01), and were better than those in the control group (t>2.201, P<0.05). No imporvement was found in all the indices in the control group after treatment (t<2.339, P>0.05). Conclusion Multidisciplinary comprehensive pulmonary rehabilitation can effectively improve exercise tolerance and quality of life in aged patients with pneumoconiosis.

Objective:To explore the effect of self-made protective clothing in tracheal intubation for the patients with respiratory infectious diseases.Methods:Self-made protective clothing were made by adult model plastic raincoat with sleeve lets and goggles. A prospective randomized controlled study was conducted. Patients with severe respiratory infectious diseases who needed tracheal intubation admitted to the department of intensive medicine of the Third Affiliated Hospital of Gansu University of Chinese Medicine from January 1st 2018 to March 31st 2020 were enrolled. According to the random number table method, they were divided into two groups. The control group was wearing standard protective clothing, while the test group was wearing self-made protective clothing for endotracheal intubation. The wearing time, infection rate of operators and costs of protective clothing were compared between the two groups. The patients were sprayed with trypanosome blue diluent before tracheal intubation, and the whole body of the operator was photographed with fluorescence before wearing self-made protective clothing and after doing tracheal intubation to take off the self-made protective clothing, in order to evaluate the permeability resistance of self-made protective clothing.Results:A total of 86 patients were enrolled. There were 46 cases in the test group, included 28 cases of influenza A (H1N1) virus infection, 11 cases of influenza B virus infection and 7 cases of adenovirus infection. There were 40 cases in the control group, included 15 cases of H1N1 virus infection, 10 cases of influenza B virus infection, 10 cases of adenovirus infection and 5 cases of unknown pathogen. There was no significant difference in respiratory etiology between the two groups ( χ2 = 3.789, P = 0.435). The wearing protective clothing time of the control group was 11.6 times than that of the test group (minutes: 22.23±1.45 vs. 1.86±0.24, χ2 = 19.023, P < 0.001). The cost of standard protective clothing was 12.5 times than that of self-made protective clothing (Yuan/set: 500 vs. 40). Fluorescent photography showed that the whole body of the operator was not stained after tracheal intubation, indicating that the protective clothing had good anti permeability and achieved the protective effect. There was no operator infection in the test group and the control group. Conclusion:Self-made protective clothing has short wearing time, low cost and equivalent isolation effect compared with standard protective clothing, which is worthy of clinical promotion.

Multistage sampling is a frequently-used method in random sampling survey in public health.Clustering or independence between observations often exists in the sampling,often called complex sample,generated by multistage sampling.Sampling error may be underestimated and the probability of type Ⅰ error may be increased if the multistage sample design was not taken into considerationin analysis.As variance (error) estimator in complex sample is often complicated,statistical software usually adopt ultimate cluster variance estimate (UCVE) to approximate the estimation,which simply assume that the sample comes from one-stage sampling.However,with increased sampling fraction of primary sampling unit,contribution from subsequent sampling stages is no more trivial,and the ultimate cluster variance estimate may,therefore,lead to invalid variance estimation.This paper summarize a method of variance estimation considering multistage sampling design.The performances are compared with UCVE and the method considering multistage sampling design by simulating random sampling under different sampling schemes using real world data.Simulation showed that as primary sampling unit (PSU) sampling fraction increased,UCVE tended to generate increasingly biased estimation,whereas accurate estimates were obtained by using the method considering multistage sampling design.

Objective To observe the role of Zhenqi Fuzheng granules in the treatment of patients with severe pneumonia respiratory failure. Methods A retrospective research was conducted, 96 patients with severe pneumonia admitted to the Department of Critical Care Medicine of the First People Hospital of Baiyin were enrolled, and they were divided into a western medical conventional treatment group (47 cases) and a combined traditional Chinese and western medicine treatment group (49 cases) according to the different treatment methods. A variety of conventional rescue treatments were carried out in the western medicine routine treatment group (conventional group); while in the combined traditional Chinese and western medicine conventional treatment group (combined group), based on the western medical therapies in the conventional group, at the same time, additionally Zhenqi Fuzheng granules 5 g dissolved in 20 mL warm boiled water were given by nasal feeding to the patients, 2 times daily, 7-10 days constituting a therapeutic course, and after 3 courses, the clinical therapeutic effects were evaluated. The mortality and changes of pre- and post-treatment levels of immunoglobulin, procalcitonin (PCT), C-reactive protein (CRP), course of disease, times of using antibacterial drug and ventilator, and changes in lung exudation before and after treatment, and incidence of pulmonary fibrosis were observed in the two groups. Results The mortality of combined group was significantly lower than that of the conventional group [14.29% (7/49) vs. 36.17% (17/47), P < 0.05]. After treatment, the levels of immunoglobulins were significantly higher than those before treatment, while the levels of PCT and CRP were significantly lower than those before treatment in both groups, and the changes after treatment in the combined group were more obvious than those in conventional group [IgG (g/L): 12.48±2.36 vs. 10.35±3.01, IgA (g/L): 4.16±1.08 vs. 3.18±1.13, IgM (g/L): 5.01±1.15 vs. 3.62±1.02, PCT (mg/L): 1.48±1.36 vs. 2.35±1.01, CRP (mg/L): 8.48±2.36 vs. 10.35±2.01, all P <0.05]. Compared with those in conventional group, the patient's disease course, times of using antibacterial drug and ventilator were significantly shorter in combined group [the course of disease (days): 10.86±2.64 vs. 14.38±3.02, time of using antibacterial drug (days): 11.29±3.54 vs. 13.96±4.21, time of using ventilator (days): 8.26±2.64 vs. 10.25±3.08, all P <0.05]; Compared with those in the conventional group, the cases with significant reduction of pulmonary exudation and the cases with complete absorption of pulmonary exudation were markedly increased, while the cases of pulmonary fibrosis were obviously decreased in the combined group (cases of reduction of pulmonary exudation:15 cases vs. 10 cases, complete absorption of pulmonary exudation: 16 cases vs. 9 cases; cases of pulmonary fibrosis:8 cases vs. 10 cases, all P < 0.05). Conclusion Zhenqi Fuzheng granules can significantly reduce the mortality and inflammatory factor levels, raise immunoglobulin, shorten the course of disease and times of using antimicrobial drugs and ventilator, reduce pulmonary exudation and incidence of pulmonary fibrosis obviously in patients with severe pneumonia.

Objective: To explore the effects of different mild hypothermia therapy time on the efficacy and complications of patients with severe traumatic brain injury (STBI). Methods: A retrospective research method was used. 132 patients with STBI given mild hypothermia therapy admitted to the Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine from January 2010 to December 2018 were enrolled. According to the days of mild hypothermia therapy, the patients were divided into 2-day mild hypothermia treatment group, 5-day mild hypothermia treatment group and 14-day mild hypothermia treatment group. Glasgow coma score (GCS) after treatment of 10 days and 30 days, 30-day disability rate and mortality, coma time, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer, and the incidence of complications such as decreased blood pressure, decreased gastrointestinal motility, infection, nonunion of scalp, cerebrospinal fluid leakage, etc. were compared among three groups. Results: Among the 132 patients with STBI, there were 44 cases in the 2-day mild hypothermia treatment group, 45 cases in 5-day mild hypothermia treatment group, and 43 cases in 14-day mild hypothermia treatment group. There was no significant difference in gender, age, GCS score before treatment or time from injury to admission among three groups. Compared with 2-day mild hypothermia treatment group, the GCS score 10 days and 30 days after treatment in 5-day mild hypothermia treatment group and 14-day mild hypothermia treatment group were significantly higher (11.61±2.23, 10.17±2.03 vs. 6.79±1.49; 13.15±2.53, 11.24±2.24 vs. 8.79±1.59), the coma time were shorten (days: 5.79±1.89, 5.45±1.72 vs. 13.65±2.73), and 30-day disability rate and mortality were significantly decreased [13.33% (6/45), 11.63% (5/43) vs. 22.73% (10/44); 17.78% (8/45), 16.28% (7/43) vs. 31.82% (14/44)], PT and APTT were reduced obviously (s: 20.14±4.12, 22.54±3.56 vs. 30.67±5.19; 35.14±12.41, 38.59±13.54 vs. 56.67±10.62), Fib rose obviously (g/L: 1.84±0.25, 1.98±0.27 vs. 0.67±0.12), and D-dimer reduced obviously (mg/L: 53.10±19.84, 49.20±20.13 vs. 102.60±20.13), with statistically significant differences (all P < 0.05). But there was no significant difference in above indicators between the 5-day mild hypothermia treatment group and 14-day mild hypothermia treatment group (all P > 0.05). The incidence of complications in 14-day mild hypothermia group was significantly higher than those in 2-day mild hypothermia group and 5-day mild hypothermia group [decrease of blood pressure: 55.56% (20/36) vs. 36.67% (11/30), 35.14% (13/37); weakening of stomach intestinemotive power: 72.22% (26/36) vs. 46.67% (14/30), 45.95% (17/37); urethral infection: 52.78% (19/36) vs. 36.67% (11/30), 35.14% (13/37); lungs infection: 47.22% (17/36) vs. 36.67% (11/30), 37.84% (14/37); disunion of scalp: 5.56% (2/36) vs. 0% (0/30), 0% (0/37); leak of cerebrospinal fluid: 5.56% (2/36) vs. 0% (0/30), 0% (0/37), all P < 0.05], but there was no significant difference between the 2-day mild hypothermia treatment group and 5-day mild hypothermia treatment group (all P > 0.05). Conclusions The optimal time frame for mild hypothermia treatment in patients with STBI is 5-day, which shortens the coma time, and reduces the mortality and the disability rate. The shorter mild temperature time cannot effectively prevent secondary brain injury. However, the prolonged period of mild temperature will affect the repair of the patient's injury tissue, which is not conducive to the recovery of patient's mechanical function and is prone to complications.

To investigate the research status and trends of application of objective structured clinical examination (OSCE) in medical education in China and globally, and to provide a reference for clinical teaching and medical education research. CNKI and Web of Science Core Collection were searched to identify journal articles related to OSCE published up to the present day. CtieSpace V software was used to visually analyze the research institutions, authors, highly cited literature, and keyword changes of the articles based on scientific knowledge maps. The overall number of publications on OSCE published in China and globally showed an increasing trend, but foreign publications were significantly more than Chinese publications. The institutions and authors were widely distributed. Comprehensive universities were the main institutions in foreign publications, with relatively little cooperation between each other. Domestic research primarily focused on medical education in the early stage, SP training and standardization in the middle stage, and clinical competence for resident physicians, nurses, and other clinical professionals in the late stage. Early foreign research focused mainly on medical education and clinical competence, while later research focused primarily on communication with patients and ability assessment. It is expected that future domestic research will focus on building clinical competence evaluation systems based on the OSCE model, while future foreign research will focus on patient communication and humanistic care assessment.

OBJECTIVETo compare design-based and model-based methods in descriptive analysis of complex sample.

METHODSA total of 1 000 samples were selected and a multistage random sampling design was used in the analysis of the 2010 China chronic disease and risk factors surveillance. For each simulated sample, cases with probability proportional age were randomly deleted so that sample age structure was deviated systematically from that of the target population. Mean systolic blood pressure (SBP) and prevalence of raised blood pressure, as well as their 95% confidence intervals (95%CI) were determined using design-based and model-based methods (routine method and multi-level model). For estimators generated from those 3 methods, mean squared error(MSE) was computed to evaluate their validity. To compare performance of statistical inference of these methods, the probability of 95%CI covering the true parameter(mean SBP and raised blood pressure prevalence of the population) was used.

RESULTSMSE of mean estimator for routine method, design-based analysis and multilevel model was 6.41, 1.38, and 5.86, respectively; and the probability of 95%CI covering the true parameter was 24.7%, 97.5% and 84.3%, respectively. The routine method and multi-level model probably led to an increased probability of type I error in statistical inference. MSE of prevalence estimator was 4.80 for design-based method, which was far lower than those for routine method (20.9) and multilevel model (17.2). Probability of 95%CI covering the true prevalence for routine method was only 29.4%, and 86.4% for multilevel model, both of which were lower than that for design-based method (97.3%).

CONCLUSIONCompared to routine method and multi-level model, design-based method had the best performance both in point estimation and confidence interval construction. Design-based method should be the first choice when doing statistical description of complex samples with a systematically biased sample structure.

Objective:To investigate the efficacy of Hebert screw internal fixation of osteoporotic distal humeral coronary fractures in the elderly.Methods:A retrospective case series study was conducted to analyze the data of 26 elderly patients with osteoporotic distal humeral coronary fractures treated in Changhai Hospital from December 2011 to December 2018, including 3 males and 23 females aged 56-84 years (mean, 67.8 years). According to Bryan-Morrey classification, there were 7 patients with type I, 11 with type III, and 8 with type IV. All patients received open reduction and internal fixation. Among the 26 patients, 10 patients with simple humeral head fractures were treated with Hebert screw internal fixation, and 16 patients with humeral head fractures combined with humeral epicondyle fracture were treated with Hebert screw combined with humeral condyle miniplate. Operation time and intraoperative bleeding volume were recorded. At last follow-up, elbow range of motion were measured, and Mayo elbow performance score and visual analog scale (VAS) score were assessed. Meantime, complications were observed.Results:A total of 22 patients were followed up for 6-57 months (mean, 31.8 months). Intraoperative bleeding volume was 100 to 245 ml (mean, 126 ml) and operation time was 60 to 195 minutes (mean, 85 minutes). At last follow-up, the elbow joint flexion was (117.3±4.2)° and extension was (8.2±2.1)°. Mayo elbow performance score improved from preoperative 16.5 (12.8, 24.0)points to postoperative 85.0 (82.5, 92.3)points ( P<0.05). VAS was increased from preoperative (9.6±0.5)points to (2.3±0.2)points at latest follow-up( P<0.05). Two patients had elbow joint stiffness after operation and recovered after functional exercise. One patient had bone displacement when receiving rehabilitation care, which did not affect the function, and hence no further treatment was given. All patients had no infection or skin and soft tissue complications after surgery. Conclusions:For osteoporotic distal humeral coronary fractures in the elderly, Hebert screw internal fixation is effective in facilitating function recovery and relieving pain. When the fracture is combined with lateral humeral condyle fracture, additional plate fixation can be used for rigid stabilization.