Objective To explore the effect of online health education by family physician using the wearable devices, and provide the basis in theory and practice to improve the level of primary health care in community. Methods A total of 132 community residents (78 for male and 36 for female, all of them are WeChat user) with hypertension in one residential area who had regularly participated in the activity of volunteer blood pressure measurement organized by community health service center in wujiaochang street from November 2015 to February were chosen as the participants. The residents who wore the wearable device given by the community hospital uniformly were set as the study group (60 people), while the remaining 72 residents were set as the control group. Both groups received the daily online health education provided by the family physicians through their smartphone. We compared the diversity of health cognition, controlling behavior and controlling results to blood pressure of both groups before and after the studyrelatively, then we comprehensively analyzed the effect of use of wearable devices in family physicians ' online health education. SPSS 18.0 was used for data analysis. The categorical data of two groups were compared with chi-square test and the comparison of continuous data was performed with t test. Results Totally 114 community residents were qualified in the study, and the initial backgrounds of study group and control group had no significant difference. After receiving the online health education information for three months, both groups achieved improvement on the cognition and related self-control behavior of hypertension except for several items, and the study group did better than control group in most items. The physical examination showed that the systolic blood pressure of the study group after the intervention [(131.46 ± 12.89) mmHg] (1 mmHg=0.133 kPa) was lower than before [(137.24 ± 12.27) mmHg] and the difference was significant (t=9.2, P<0.01); the diastolic blood pressure of the study group after the intervention [(78.29±8.91) mmHg] was lower than that of before intervention [(80.75±10.25) mmHg] and the difference was significant (t=2.3, P<0.05). Meanwhile, after intervention the systolic blood pressure of study group [(131.46 ± 12.89) mmHg] was lower than that of control group [(133.27 ± 12.7) mmHg] and the intervention was significant (t=2.1, P<0.05). Conclusion Long-term use of wearable devices help family physicians improve the effect of health education, consequently the community hospitals are responsible to enhance the input and management of the informatization of family physicians' service, and assist them to broaden the form and content of health education.

Objective To explore the correlation of mimecan/osteoglycin withnuclear factor koppa B(NF-κB) and P53 in peripheral arterial disease (PAD) and PAD combined with type 2 diabetes in the elderly.Methods 120 patients with PAD and 60 healthy controls were enrolled in this study.PAD patients were divided into PAD group (n=60) and PAD combined with type 2 diabetes group (n =60) according to clinical diagnostic criteria.Patients in PAD group were divided into class Ⅰ (n=15),class Ⅱ (n=15),class Ⅲ (n=15) and class Ⅳ (n=15),and patients in PAD combined with type 2 diabetes group were divided to class Ⅰ (n=14),class Ⅱ (n=15),class Ⅲ (n=16) and class Ⅳ (n=15) according to Fontaine's classification.The levels of NF-κB,P53 and mimecan in peripheral blood were measured by enzyme-linked immunosorbent assay (ELISA).Results The levels of NF-κB,P53 and mimecan were significantly increased in PAD combined with type 2 diabetes group as compared with PAD and control groups [NF-κB..(32.8±5.3) mg/L vs.(19.8±4.2) mg/L,(26.3 ±4.8) mg/L; P53:(3.4±1.3) mg/Lvs.(2.5±1.1) mg/L,(1.4±0.8) mg/L; mimecan:(16.4 ±0.8) mg/L vs.(10.3±0.8) mg/L,(4.8±0.6) mg/L; all P＜0.05].There were significant differences in the levels of NF-κB,P53 and mimecan in class Ⅰ,class Ⅱ,class Ⅲ and class Ⅳ in PAD group [NF-κB:(20.3±3.1) mg/L,(24.5±3.4) mg/L,(28.2±4.6) mg/L and (34.2±5.3) mg/L; P53:(2.2 ±1.8) mg/L,(2.6±1.8) mg/L,(3.3±1.9) mg/L and (3.7±2.7) mg/L;mimecan (8.9±2.6) mg/L,(12.4±1.8) mg/L,(15.6±1.5) mg/L and (17.7±1.6) mg/L; all P ＜0.05].There were significant differences in the levels of NF-κB,P53 and mimecan in class Ⅰ,class Ⅱ,class Ⅲ and class Ⅳ in PAD group combined with type 2 diabetes group [NF-κB:(25.5±4.2) mg/L,(28.8±3.7) mg/L,(33.4±5.6) mg/L and (38.5±4.7) mg/L; P53:(2.5±1.1)mg/L,(2.9±1.0)mg/L,(3.7±1.2)mg/L and(4.6±1.3)mg/L; mimecan:(11.7±2.4)mg/L,(14.9± 1.8)mg/L,(17.4±2.5)mg/L and(20.7±2.8)mg/L; all P＜0.05].The levels of NF-κB,P53 and mimecan was increased with the aggravation of PAD (all P＜0.05).Conclusions The increased levels of NF-κB and P53 are correlated with the increase in mimecan level and Fontaine's classification.

Objective To study the changes in expression of high-sensitivity C-reactive protein (hsCRP),glutathione S-transferase Pi(GSTPi)and annexin A5 (AnxA5)in elderly patients with old myocardial infarction and the clinical significance.Methods Serum levels of GSTPi and AnxA5 were measured by ELISA and the level of hs-CRP was measured by immunoturbidimetry in elderly patients with old myocardial infarction (n =185)from December 2012 to November 2015.Results Along with the increasing coronary artery stenosis,GSTPi level was decreased and AnxA5/hs-CRP levels were increased in elderly patients with old myocardial infarction.In comparison between coronary artery stenosis ＞ 95％ group versus stenosis of 55％-65％ group,GSTPi was(190.0±37.0)μg/L vs.(289.0 ±86.0)μg/L,AnxA5 was(33.9±4.0)μg/L vs.(8.1 ± 2.9) μg/L,and hs-CRP was (15.3 ± 1.3) mg/L vs.(5.9 ± 0.8) mg/L with statistically significant differences(all P＜0.01).There were significant differences between LVEF 30％ group[GSTPi(198.0±39.0) μg/L,AnxA5(38.9±5.1)μg/L and hs-CRP(17.9± 1.9)mg/L]and LVEF 40％-54％ group[GSTPi(219.0± 61.0)μg/L,AnxA5 (12.9±3.9)μg/L and hs-CRP(10.1 ± 1.0) mg/L] (all P＜0.01).There were significant differences between NYHA Ⅳ group [GSTPi (171.0 ± 43.0) μg/L,AnxA5 (18.1 ± 5.0) μg/L and hs-CRP (16.9±2.1)mg/L]and NYHAⅠgroup[GSTPi(295.0±91.0)μg/L,AnxA5(7.3±3.1)μg/L and hs-CRP (7.8± 1.3)mg/L](all P＜0.01).Conclusions The expression of GSTPi,AnxA5 and hs-CRP in elderly patients with old myocardial infarction may become the new indicators to forecast the degrees of coronary artery stenosis and heart failure.

Objectives To study the predictive value of Toll-like receptors 3,4(TLR3,TLR4),fructosamine(FMN)and glycated hemoglobin A1c(HbA1c)in the in-stent restenosis and re-occlusion after primary percutaneous coronary intervention(PCI)in patients aged 70-85 years with old myocardial infarction.Methods 51 patients aged 70-85 years with in-stent restenosis after primary PCI from Jan 2007 to Sep 2016 were selected.Serum level changes in TLR3,TLR4 were detected by flow cytometry.The levels of FMN and HbA1c were tested by colorimetric endpoint reaction and high-pressure liquid chromatography respectively.Results The levels of TLR3,TLR4,FMN and HbA1c were gradually elevated along with the increases of artery numbers(0,1,2,>2)and percentage(0%,70-89%,90-99%,100%)of in-stent restenosis,LVEF(%)decrease and NYHA(Ⅰ,Ⅱ,Ⅲ,Ⅳ)increase(all P<0.01).The examples of data were selected in the following groups of artery numbers(0,1,2,>2)of in-stent restenosis in TLR3,and group of percentage(0%,70-89%,90-99%,100%)in the in-stent restenosis in TLR4,group of LVEF(%)in FMN,and group of NYHAⅠ,Ⅱ,Ⅲ,Ⅳ in HbA1c(%)(all P<0.01).The levels of TLR3(%)in artery numbers of restenosis(0,1,2,>2)groups were(7.6±0.5),(18.9±0.6),(32.0±0.9),(51.3±0.8),respectively(all P<0.01).The levels of TLR4(%)in the in-stent restenosis percentage(0%,70-89%,90-99%,100%)groups were(10.5±7.0),(20.1±7.2),(33.3±9.7),(69.0±11.3%)respectively(all P<0.01).The levels of FMN(mmol/L)in LVEF[(49~59%),(37~48%),(25~36%)]groups were(0.6±0.4),(9.4±0.6),(18.1±0.8),respectively(all P<0.01).And the level of HbA1c(%)in groups of NYHA Ⅰ,NYHA Ⅱ,NYHA Ⅲ,NYHA Ⅳ were(6.1±0.4),(5.9±0.6),(8.9±0.9),(12.0±0.8),respectively(all P<0.01).Conclusions Serum level changes in TLR3,TLR4,FMN and HbA1c may become the new indicators to forecast the degree of in-stent restenosis in very old patients with old myocardial infarction after primary coronary intervention.

Objective To compare the intestinal microbiota of septic shock patients and healthy subjects,and study the composition of the intestinal microbiota and its effect on septic shock patients in the intensive care unit (ICU).Methods A total of 15 stool samples were prospectively collected from septic shock patients admitted to the ICU in the First Affiliated Hospital of Zhengzhou University between June 2015 and February 2016,while 15 samples from healthy subjects served as controls.Bacterial DNA was submitted for 16S rDNA gene sequencing.The association between gut microbiota composition and clinical parameters was evaluated.Shannon index was used to assess the bacterial diversity.Results Compared with the healthy subjects,the composition of intestinal microbiota in septic shock patients changed significantly.The abundance of Proteobacteria and Fusobacteria were significantly higher in septic shock patients than in healthy subjects (23.71％ vs 3.53％,P=0.000 6;1.27％ vs 0.12％,P=0.059,respectively).In this study,29 species were identified,and the composition of intestinal microbiota in each patient was highly individualized.There was no significant difference in Shannon index between septic shock patients and healthy subjects (P=0.12).Conclusions The composition of intestinal microbiota in septic shock patients was characterized by high diversity and individualization,but there was the phenomenon of overproduction of single bacteria genus.The relationship between the composition of intestinal microbiota and clinical outcomes requires further exploration by large sample studies.

Objective:To analyze the risk factors of renal function recovery in patients with severe acute pancreatitis (SAP) combined with acute kidney injury (AKI).Methods:A retrospective study was conducted in 105 SAP patients with AKI who were admitted to ICU or EICU of the Affiliated Hospital of Qingdao University from January 2013 to October 2019. According to the recovery of renal function at 28 days, the patients were divided into the renal function recovery group and the poor recovery group. Multivariate logistic regression analysis was used to analyze the clinical data of the two groups and to determine the risk factors related to renal function recovery.Results:According to the recovery of renal function, 105 patients were divided into the renal function recovery group ( n=73) and the poor recovery group ( n=32). Compared with the renal function recovery group, patients in the poor recovery group were older, had a higher prevalence of diabetes and coronary heart disease and a higher score on the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ); More patients had abdominal necrosis infection and abdominal hemorrhage. The proportion of patients who applied mechanical ventilation was higher in the poor recovery group. Multivariate logistic regression analysis showed that abdominal necrosis infection ( OR=5.088, 95% CI:1.041-24.871, P=0.044) and mechanical ventilation ( OR=4.615, 95% CI:1.126-18.904, P=0.034) were the independent risk factors of renal function recovery in SAP patients with AKI. Conclusions:Abdominal necrosis infection and mechanical ventilation are the independent risk factors for renal function recovery in patients with SAP and AKI.

Objective To analyze the efficacy and safety of nalbuphine in patients with sedative analgesia in intensive care unit (ICU). Methods A prospective observation was conducted. The adult patients with mild and moderate analgesia in general ICU of the First Affiliated Hospital of Zhengzhou University from January to November in 2017 were enrolled, and they were divided into nalbuphine group and sufentanil group in proper order. The nabobrown group was given 40 mg nabobrown, the sufentanil group was given 0.1 mg sufentanil, both of which were injected with 50 mL normal saline for continuous intravenous infusion in micro-pump. Infusion speed was checked according to pain level. The analgesic target was critical-care pain observation tool (CPOT) score < 2. The change in hemodynamics of patients in both groups were observed, and CPOT score and Richmond agitation-sedation scale (RASS) score were recorded before and l, 3, 5, 12, 24 hours after administration. The analgesic and sedative effects of two drugs were evaluated. Results A total of 141 patients were enrolled, including 71 patients in nalbuphine group and 70 in sufentanil group. There was no significant difference in general data including gender, age, body weight, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) or pain source, as well as baseline hemodynamics parameter between the two groups. At 1 hour and 3 hours after administration, nalbuphine had no effect on blood pressure, but the heart rate was decreased slightly, while the heart rate and blood pressure of the sufentanil group were decreased obviously. The two drugs could make the heart rate and blood pressure fluctuate obviously with the time of medication, but there was no statistical difference between the two drugs. The two drugs had no significant effect on pulse oxygen saturation (SpO2) during analgesia. The average dosage of nalbuphine was 0.03 (0.02, 0.05) mg·kg-1·h-1in the nalbuphine group, and the patient was satisfied with the analgesic effect until 3 hours after the use of the drug, and CPOT score was significantly decreased as compared with that before administration [1.0 (1.0, 2.0) vs. 3.0 (2.0, 4.0), P < 0.01], and the sedative effect was increased, RASS score was significantly lower than that before administration [0 (0, 1.0) vs. 1.0 (1.0, 2.0), P < 0.01]. No patients in naporphine group were treated with sufentanil due to unsatisfactory analgesia. The average dosage was 0.11 (0.06, 0.14) μg·kg-1·h-1in the sufentanil group, the patient was satisfied with the analgesic effect until 5 hours after administration, and the CPOT score was significantly lower than that before administration [1.0 (1.0, 2.0) vs. 4.0 (3.0, 6.0), P < 0.01], and the sedative effect was significantly increased, RASS score was significantly lower than that before administration [0 (-1.0, 0) vs. 2.0 (1.0, 2.0), P < 0.01]. The scores of CPOT and RASS in the sufentanil group were significantly higher than those of the naporphine group before use, so the decrease in the CPOT and RASS scores of the two drugs was further analyzed, which indicated the decrease in CPOT score of naporphine group was significantly lower than that in sufentanil group from 3 hours on [1.0 (0, 2.0) vs. 2.0 (1.0, 3.0), P < 0.05], and the decrease in RASS score of naporphine group was significantly lower than that in sufentanil group from 1 hour on [0 (0, 1.0) vs. 1.0 (0, 2.0), P < 0.01]. It suggested that naporphine could achieve sustained and stable analgesic effect and avoid excessive sedation caused by sufentanil. Conclusions Naporphine had a sustained and stable analgesic effect on patients with mild and moderate ICU analgesia. The onset time of naporphine was equivalent to sufentanil, and it had a certain sedative effect and less influence on hemodynamics.