Objective To seek out the factors that influenced the mortality of population due to heat wave in Shanghai in summer(15 June-15 September). Methods Daily data of mortality of all causes, meteorological and air pollution in Shanghai in 1998 and 2003 were collected. Multivariate analysis was employed to investigate the relationship between mortality and heat wave intensity, duration, and timing within the summer season and air pollution concentrations. Results The heat wave in 1998 was more severe and caused a higher mortality than that in 2003. In 1998 heat wave, the heat wave duration,timing within the summer season were significantly associated with the daily number of deaths,while in 2003, besides the above two factors the daily maximum temperature also played an important role. Air pollution level slightly increased in heat wave and some factors such as air conditioner number, living space and urban greenbelt area could be used to explain the distinctive difference of heat related mortality between 1998 and 2003. Conclusion High temperature is the crucial factor for the high mortality of population due to heat wave in Shanghai in summer(15 June-15 September) in 1998 and 2003. Using air condition and enlarging living space will help to decrease the mortality.

Objective To investigate the clinical effect of maternal pat with Chinese medicine in episiotomy wound care. Methods One thousand one hundred cases of maternal with full-term,vaginal delivery, episiotomy in the Beijing Tongren Hospital Affiliated to Capital Medical University from Jun. 2013 to Jun. 2014 were randomly divided into test group and control group. Patients in test group were given routine nursing care combined with Chinese medicine maternal pat to nurse perineal wound,while in the control group were given routine nursing combined with common maternal pat. The data of perineal wound swelling,pain and healing were recorded and compared in two groups. Results The incidences of mild,moderated swelling within 24 h,48 h in test group were 35. 5%( 195/550 )and 6. 0%( 33/550 ),13. 4%( 74/550 )and 1. 6%( 9/550 ),significantly lower than that of the control group( 24 h:51. 5%( 283/550 ),24. 5%( 135/550 );48 h:34. 2%( 188/550 ), 2. 7%(15/550);Z=12. 555,8. 144;P﹤0. 01). The incidences of moderate,severe pain within 24 h,48 h in test group were 12. 5%(69/550)and 2. 9%(16/550),8. 4%(46/550)and 1. 3%(7/550),significantly lower than that of the control group( 24 h:37. 3%( 205/550 ),7. 5%( 41/550 );48 h:20. 6%( 113/550 ),3. 5%(19/550);Z=10. 429,11. 886;P ﹤0. 01). The wound healing rate in test group was 92. 36%,significantly higher than that of control group( 80. 73%,P ﹤0. 01 ). The wound infection rate in test group was 1. 82%, significant lower than that of control group(3. 82%,P﹤0. 01). The incidence of comfort and satisfaction in test group was 90. 18%,significantly higher than that of control group(73. 09%;Z= -5. 614,-7. 345;P ﹤0. 05). Conclusion Nursing lateral episiotomy wound using Chinese medicine maternal pat can reduce the swelling, pain and promote wound healing with convenient and comfortable. Therefore,it is worth of the clinical popularization and application.

Objective To explore the effect of acupuncture combined with facilitated technique on lower limb function and activities of daily living of stroke patients.Methods 120 stroke patients with lower limb palsy were divided into the group Ⅰ (treated with acupuncture combined with facilitated technique), group Ⅱ (treated with acupuncture), third group Ⅲ (treated with facilitated technique) and the group Ⅳ (treated with medicine). The lower limb function and ADL of four groups were evaluated with Functional Ambulation Classification (FAC), Fugl-Meyer Assessment (FMA), Modified Barthel Index (MBI) before and 10 weeks after treatment.Results The scores of FAC, FMA and MBI of all the groups improved significantly, but it was more significantly in the first group than the in other groups (P<0.01), in group Ⅰ, Ⅱ, Ⅲ than in group Ⅳ (P<0.01). The difference between the group Ⅱ and Ⅲ was insignificantly(P>0.05).Conclusion Acupuncture combined with facilitated technique can improve the lower limb function and activities of daily living of stroke patients more effectively.

Objective To explore the MSCT findings of occipital condyle fracture (OCF) and improve its diagnostic accuracy. Methods Nineteen patients with OCF, selected from 110 patients suffering high energy injuries at the craniocervical junction, were enrolled into the study. The MSCT appearances of OCFs were retrospectively analyzed by two experienced radiologists. OCF had four types: type Ⅰ was a comminuted fracture, type Ⅱ was a extension of basilar skull fracture, type Ⅲ was an avulsion fracture at the attachment site of alar ligament on occipital condyle, type Ⅳ was a fracture of mixed pattern consisting of two or more above fracture types. Results In 19 patients, the left, right and bilateral OCFs were seen in 7,11 cases, and 1 case, respectively. Type Ⅰ was found in one case, which was a comminution of the left occipital condyle. Type Ⅱ was found in 5 cases, which involved the middle and posterior parts of occipital condyles with 2 on the left and 3 on the right, Type Ⅲ was found in 12 cases which showed various degree of fragment displacement with 3 occuring on the left, 8 on the right, 1 involving bilateral sides, 6 involving articular surfaces and 7 accompaning by enlargment of alar ligaments. Type Ⅳ was found in one case, with coexistence of Type Ⅱ and type Ⅲ. In addition, OCFs were accompanied by head and (or) cervical spine injuries in 14 cases, which included cranial fracture in 8 cases, epidural hematoma in 4 cases, subarachnoid hemorrhage in one case, cerebral contusion and laceration in one case, subfalcial hernia in one case, cervical spine fracture and dislocation in 9 cases, and so on. Conclusion OCFs can be accurately diagnosed by MSCT, which is important for selection of treatment protocols.

Objective To analyse the routes and MRI characteristics of disseminated intracranial gliomas after operation. Methods 10 patients of intracranial gliomas confirmed by pathology and intracranial dissemination after operation underwent MRI examina-tions including T_1 WI, FSE T_2 WI, FLAIR and fat-suppressed T_1 WI after intravenous injection of Gd-DTPA. In addition, 4 cases were also examinated with DWI, 1 case with SWI and DTI. Results In 10 cases,there were glioblastoma in 7 cases,grade Ⅱ astro-cytoma in 2 and grade Ⅲ astrocytoma in one. The disseminated tumors were found by MRI in 4 to 56 months after operation. The le-sions in all patients were confirmed with the comparison of contrast-enhanced MRI positive signs between preoperation and post-operation. Plain MR scanning showed line-like thicking with isointensity in 1/7 case/time (C/T)and multiple noduli in 5/7 (C/T) on T_1 WI respectively;shallowed cortical sulci and cistern in 2/7(C/T) and nodular in 5/7(C/T) on T_2 WI;shaUowed cortical aulci and cistern in 2/7 (C/T) and nodular in 6/7(C/T) on FLAIR. The signal intensity of noduli of disseminated tumors in 7 cases were in complete consistency with that of primary neoplasm , however, in 3 cases, it was inconsistent. Enhanced scanning showed 7 ca-ses with the signs of line-like thicking, 7 cases with noduli , 6 cases with :cast-like shape" sign and 6 cases with different extent of hydrocephalus. Conclusion Enhanced MRI can be used as a most useful and reliable monitoring tools for detecting dissemination of brain glioma.

Objective To compare the efficacy of add-on adefovir dipivoxil (ADV) therapy and switch-to entecavir (ETV) monotherapy in chronic hepatitis B (CHB) patients with suboptimal response to lamivudine (LAM).Methods A prospective study was performed in 120 CHB patients from Zhuji People' s Hospital and the First Affiliated Hospital of Zhejiang University School of Medicine during June 2010 and June 2011.All patients previously received more than 24 weeks LAM treatment,but HBV DNA was still positive.Patients were randomized assigned to two groups:60 patients received add-on ADV therapy and another 60 switched to ETV monotherapy.Both groups were treated for 48 weeks.Liver and kidney function,alpha-fetal protein (AFP),HBV serum markers,HBV DNA and prothrombin time (PT) were examined,and ultrasonography or CT scan of liver was performed every 1-3 months.x2 test was used to compare the HBV DNA negative rates,HBeAg seroconversion rates,resistance rates and adverse reaction at week 48 between two groups.Results Thirty-three out of 38 patients (86.8％) with baseline HBV DNA 103-105 copies/mL became HBV DNA negative after add-on ADV treatment for 48 weeks,twenty-seven out of 39 patients (69.2％) with baseline HBV DNA 103-105 copies/ml became HBV DNA negative after switch-to ETV treatment.There was a statistical difference between two groups (x2 =4.578,P ＜ 0.05).Sixteen out of 22 patients (72.7％) with baseline HBV DNA ＞ 105 copies/mL became HBV DNA negative after add-on ADV treatment for 48 weeks,while only 52.4％ (11/21) patients achieved HBV DNA negative in the switch-to ETV group.There was also a statistical difference between two groups (x2 =4.865,P ＜0.05).None of patients in add-on group developed virological breakthrough and resistance,while 5 patients in switch-to ETV group developed virogical breakthrough and 3 patients developed genetic mutation.Among them,rtM204V + rtL180M + rtS202G mutation was detected in 2 patients,and rtM204V + rtL180M +rtT184A mutation was detected in 1 patient; all mutations happened in the baseline HBV DNA ＞ 105 copies/mL group.Conclusion The add-on ADV therapy is better in viral inhibition than switch-to ETV therapy for CHB patients with suboptimal response to LAM,and it can reduce the occurrence of drug resistance.

OBJECTIVE Aim to evaluate the mental level in 4-6 years old children with obstructive sleep apnea hypopnea syndrome(OSAHS). METHODS Children who were diagnosed as OSAHS with a whole night PSG monitor in the sleep center between January 2015 and August 2016, and 30 healthy children were included in the study. Intelligent levels were evaluated at the enrollment day. The following intelligent levels evaluation questionnaires were used: Wechsler Intelligence Scale for children and infants. Intelligent levels were compared between the patient and healthy control groups. RESULTS The 60 children, including 30 children with OSAHS(patient group) and 30 healthy children(control group) were enrolled. Comparison of the patient versus the control groups revealed that total intelligence quotient(FIQ) was 96.59±12.60 vs 102.53±8.44; language capability(VIQ) was 94.00±13.24 vs 101.03±9.41; comprehension test was 5.96±2.5 vs 7.57±2.14; visual analysis was 8.85±2.32 vs 10.3±1.93. All the 4 values in the patient group were significantly lower than those in the control group(all P ＜0.05). The accumulated time of SO2＜90％ correlated with PIQ negatively and significantly. CONCLUSION The intelligent level of children with OSAHS was in the normal range, but lower than that of healthy group. Snoring affects the IQ level of 4-6 years old children, and the influence on PIQ is closely related to the accumulated time of SO2＜90％ in total sleep time.

Objective: To investigate the snoring status of school-aged children in Beijing and explore the association of snoring and academic performance. Methods: A total of 7 925 children aged from 6 to 14 were selected from 15 primary and middle schools at 7 districts (Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou) in Beijing in 2015, using multi-stage stratified cluster random sampling method. The recruited children were asked to complete the Pediatric Sleep Questionnaire (PSQ) and a questionnaire related to sleep behavior. The multiplelogistic regression was used to analyze the association of snoring and academic performance. Results: A total of 794 (12.44%) children showed a decline in academic performance among 6 383 eligible respondentsfor data analysis. 580 (9.08%) children with snoring was identified, of which 333 and 247 were in frequency of 1-2 times per week and frequency of ≥3 times per week, respectively; 357, 170 and 53 were in snoring grade Ⅰ, grade Ⅱ and grade Ⅲ, respectively. Compared with the children without snoring, the OR (95%CI) for children with 1-2 times per week and ≥3 times per week was 1.363 (1.000-1.857) and 1.605 (1.135-2.269), respectively; and the OR (95%CI) for children with grade Ⅰ, grade Ⅱ and grade Ⅲ of snoring was 1.226 (0.893-1.683), 1.595 (1.062-2.397) and 2.31 (1.17-4.565), respectively. Conclusion There is a statistical relationship between snoring and the decline of academic performance. The decline of academic performance positively associated with increased frequency and grade of snoring.

【Objective】 To evaluate the efficacy and safety of plasma-derived human coagulation factor Ⅷ (FⅧ) in the treatment of patients with hemophilia A. 【Methods】 A multi-center and open, SAT(single-arm trials) clinical study was conducted. A total of 54 subjects with hemophilia A were enrolled in 5 research centers. FⅧ was injected according to the subjects' weight, severity of disease and other factors, and the transfusion efficiency of FⅧ activity at 10 min after the first infusion of the first bleeding event was taken as the main efficacy indexes. The improvement scores of bleeding symptoms and signs within 24 h after the first infusion of the first bleeding event were the secondary efficacy indexes. The pathogenic microbial indexes and FⅧ inhibitors were detected on 90(th) and 180(th) day after treatment. 【Results】 The transfusion efficiency of FⅧ activity of 54 subjects at 10 min after the first infusion was 171.9% on average, with median of 169.5%, both higher than the target value of 100%. Within 24 h after the first infusion, the improvement of bleeding symptoms and signs of the subjects were scored, among which 19 cases (35.2%) were "obvious", 35 cases (64.8%) were "good", and the total clinical effective rate reached 100%. Five subjects (9.3%) had six drug-related adverse events. On 90(th) and 180(th) day after treatment, hepatitis B surface antigen, hepatitis C antibody, HIV antibody, treponema pallidum antibody and FⅧ inhibitors were detected, and no negative to positive cases were found. 【Conclusion】 After infusion, the FⅧ preparation can significantly improve the FⅧ activity level in hemophilia A patients in a short period of time, which has high infusion efficiency and can achieve better treatment efficacy, and can also effectively control and relieve bleeding symptoms and signs, with good overall safety.

Objective To investigate high risk human papillomavirus(HR-HPV)prevalence among married women in Beijing and to study the high risk flactors.nethods During March 2007 to September 2008.a total of 6185 married women sampled from 137 communities in 12 districts were screened bv HR-HPV DNA test and cytogical test.The interview was carried out with unified questionnaires.The databage was set up and twice entered in EpiDam 3.0.After checked up,the data were analyzed in SPSS 15.0.Results (1) The HR-HPV infection rate was 9.89%.The HR-HPV infection rate of the city zone,the suburb and the exurb were 9.34%,10.51% and 9.51% (P>0.05).The HR-HPV infection rate of the native and the oudander were 9.53%,11.30% (P<0.05).(2) The age distribution of HR-HPV infection was that the rate was around 10% among 25 to 44 age groups,which was the highest(11.21%) in 30 to 34 age group;then the rate was descended as the age raising,the rate of 50 to 54 age group was the lowest(7.78%).(3) Multiple logistic regression showed that the related risk factors of HR-HPV infection mainly included 1000 RMB and above of family income per person per month.possessing more than 1 sexual partner of her husband,outlander and hish levels of education.(4) The prevalence of cervical intraepithelial neoplasia(CIN)in HR-HPV positive group wag significantly higher than that in HR-HPV negative group(29.76% vs 3.32%,P<0.01).Conclusions(1)The HR-HPV infection rate among aged 25 to 54 years was 9.9% and there was no significant difference in area distribution.(2)The hish risk population which should strengthen screening was the married bearing-age women with high level of family income,outlander,high levels of education and her husband possessing more than 1 sexual partner.(3)HR-HPV infection is the main risk factor for CIN and cervical cancer.while does not provide a causal relationship with them.The high risk population should be checked regularly to understand the development of HR-HPV infection and CIN incidence.