Objective To analyze the risk factors associated with acute renal failure (ARF) in critically ill obstetric patients in intensive care unit (ICU).Methods A retrospective analysis of 192 critically ill obstetric patients admitted to the ICU for postpartum complications was conducted. There were 10 patients excluded because 3 died of amniotic embolism with massive hemorrhage in ICU and 7 had incomplete records, therefore, only 182 critically ill obstetric patients were enrolled in this study. According to the occurrence of ARF or not, the patients were divided into ARF group (68 cases) and non-ARF group (114 cases). The indicators of preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, thrombocytopenia), acute fatty pregnancy liver, postpartum hemorrhage, sepsis were collected in the two groups. The main drugs used in the 4 days after delivery were as follows: ① plasma volume expanders: fluids (crystalloids, artificial colloids, hypertonic albumin and 4% serum albumin) and blood products (packed red cells, concentrated platelets, fibrinogen, fresh frozen plasma and activated factor Ⅶ); ② antifibrinolytic drug: tranexamic acid; ③ anti-hypertensive drugs: angiotensin-converting enzyme inhibitors (ACEI), diuretics; ④ nephrotoxic drugs: aminoglycosides, contrast agent. The above indexes were firstly analyzed by the univariate method, and the risk factors with statistical significance were further analyzed by multivariate logistic regression method to screen out the independent risk factors of developing ARF in critically ill obstetric patients in ICU.Results Univariate analysis showed that HELLP syndrome, tranexamic acid and hypertonic albumin infusion used in 4 days after delivery were the risk factors of ARF (χ2 value was 4.92, 4.29, 5.53, respectively, allP < 0.05). The multivariate logistic regression analysis showed: HELLP syndrome [odds ratio (OR) = 10.478, 95% confidence interval (95%CI) was 1.248 - 17.953,P = 0.030] and hypertonic albumin infusion used in 4 days after delivery [OR = 6.632, 95%CI was 1.211 - 16.328,P = 0.029] were the independent risk factors to develop ARF.Conclusions The occurrence of ARF in a critically ill obstetric patient in ICU is a process involving multiple factors, therefore, it is necessary to fully recognize the risk factors influencing the development of this disease; the presence of HELLP syndrome and hypertonic albumin infusion used in 4 days after delivery are the independent risk factors of developing ARF. Thus, particular attention should be paid to those patients with such high risk factors to decrease the incidence of ARF.

Objective To observe the indexes of liver injury and the expression of inflammation-related factor interleukin-10 (IL-10) in rats with severe acute pancreatitis (SAP), and to discuss the correlation between the expression of IL-10 and the related factors of liver injury in SAP rats at different altitudes. Methods 280 male Wistar rats with SPF grade aged 5 to 6 months were divided into four groups according to random number table with 70 rats in each group, and the rats were placed in different altitudes such as Xi'an (at an altitude of 1 027 m), Xining (at an altitude of 2 260 m), Xinghai (at an altitude of 3 300 m) and Wenquan (at an altitude of 3 950 m). The rats in each altitude were randomly divided into sham operation group (Sham group, n = 10) and SAP 1, 6, 12, 24 hours groups (all n = 15). SAP rat model was reproduced by injecting sodium cholate into the posterior membrane of pancreas, and the rats of Sham group were only turned pancreas over several times after opening the abdomen and then closed the abdomen. The rats were sacrificed at the corresponding time points after model reproduction in SAP groups, and rats in Sham group were sacrificed at 6 hours after sham operation. At the same time, the abdominal aorta blood was harvested, and the contents of serum amylase (AMY), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined by automatic biochemical analyzer. Liver tissues were harvested, and the expression level of IL-10 was determined by immunohistochemistry. Pancreatic tissues were harvested, and hematoxylin-eosin (HE) staining was performed to observe the pathological changes under light microscopy. The correlations among the indicators were analyzed by Pearson correlation. Results At different altitudes, no significant abnormality was found in the pancreas of Sham group, but significant pathological changes were found in the pancreas of all SAP groups, mainly manifested as pancreatic acinar swelling, inflammatory cell infiltration, vascular congestion and hemorrhage, acinar cell degeneration and dissolution, changes in glandular lobule structure, peri-pancreatic fat necrosis, and continuous aggravation with the increasing of time and altitude. At the same altitude, the pancreatic pathology score, the serum AMY, ALT and AST levels, and the hepatic IL-10 expression were all significantly increased in all the SAP groups as compared with those in Sham group, and they were continuously increased with time. In Sham group, there was no statistically significant difference in pancreatic pathology score, AMY, ALT, AST, or IL-10 level among different altitudes. At the corresponding time point after model reproduction, the pancreatic pathology score, AMY, ALT, AST and IL-10 levels in the SAP groups were also shown a continuous rising tendency with altitude increase, and the differences in above parameters of SAP 24 hours group in Wenquan area were statistically significant as compared with those of Sham group [pathology score: 11.06±0.94 vs. 0.23±0.15, AMY (mmol/L): 2 706.6±208.3 vs. 336.5±94.3, ALT (U/L): 267.00±5.37 vs. 52.00±4.84, AST (U/L): 465.88±11.02 vs. 139.00±11.61, IL-10 (A value): 0.579±0.006 vs. 0.281±0.006, all P < 0.05]. It was shown by correlation analysis that IL-10 of SAP rats at different altitudes was positively correlated with pancreatic pathology score, AMY, ALT and AST, the correlation coefficient (r value) between IL-10 and the above indicators in the Wenquan area with the highest altitude was 0.959, 0.928, 0.977, 0.983, respectively (all P < 0.01). Conclusions The severity of SAP rats was positively correlated with altitude. IL-10 was involved in the pathological expression process of SAP liver damage, and its expression level was positively correlated with altitude and the degree of SAP liver damage.

Objective To explore the effect of family integrated care (FIC) model on the growth and development in preterm infants. Methods A total of 128 cases of hospitalized preterm infants from January 2016 to June 2016 were selected and divided into intervention group(64 cases)and control group (64 cases) by random number table. Intervention group was received FIC after the condition was stable, control group was adopted current traditional preterm infants care. The weight, body length and head circumference of both group were recorded at 3rd month,Neonatal Behavioral Neurological Assessment (NBNA)was assessed at correction gestational aged 40 weeks,hospital stays were counted while outpatient visits and readmission case were collected within 3 month after discharge. Results The study included 118 cases,56 cases in intervention group and 62 cases in control group.The weight,body length and head circumference in intervention group was (4 315.77 ± 856.48) g,(54.22 ± 2.74)cm, (36.23 ± 1.25) cm at 3rd month,while in control group was(3 886.52±812.94)g,(53.84±2.61)cm,(35.99± 1.58)cm.It showed that the weight,body length and head circumference in intervention group were significantly higher than those in control group(t =2.785, 2.512, 1.785, P<0.01 or 0.05). The score of NBNA was (36.85 ± 2.01) points and hospital stays was(16.96±8.01)d in intervention group,while (35.97±1.86)points and(20.41±7.26)d in control group,there were significant differences(t=2.692,-2.534,all P<0.05).Incidence of outpatient visits and readmission were 14.29%(8/56),3.57%(2/56)in intervention group and 32.26%(20/62),14.51% (9/62) in control group, incidence of outpatient visits and readmission were significantly lower in intervention group as compared with control group (χ2=5.251, 4.170, all P<0.05). Conclusions FIC model is implemented in neonatal progressive care unit for preterm infants, it could promote growth and development in preterm infants,shorten the length of hospital stays,while decrease incidence of outpatient visits and readmission.

Objective:To investigate the apoptosis-inducing effect of Ginkgo biloba extract (Ginaton) on human laryngeal cancer Hep-2 cells and the underlying molecular mechanism.Methods:Human laryngeal cancer Hep-2 cells were cultured in vitro and human laryngeal cancer Hep-2 cells in the log phase were treated with Ginaton in time and concentration gradients. The cell counting kit-8 (CCK-8) assay was performed to investigate the inhibitory effects of Ginaton on Hep-2 cells. Flow cytometry was performed to detect apoptosis and determine the level of reactive oxygen species (ROS). Western blot assay was performed to detect apoptosis and signaling pathway-related protein expression. Results:Ginaton inhibited the proliferation of Hep-2 cells in a time-dependent and concentration-dependent manner. Malondialdehyde level decreased gradually in a time-dependent manner, and decreased to 2.98 μmol/g after 24 hours of Ginaton treatment. Superoxide dismutase level increased gradually in a time-dependent manner and increased to 90.35 U/g after 24 hours of Ginaton treatment. ROS level decreased gradually in a time-dependent manner and deceased to 18.7% of the level before treatment after 24 hours of Ginaton treatment. There was no significant difference in ROS level between before and after 24 hours of Ginaton treatment ( F = 14.98, 19.65, 11.47, all P < 0.001). After 3, 6, 12 and 24 hours of Ginaton treatment, the expression of phosphorylated N-terminal protein kinase increased to 1.98, 2.57, 2.91 and 3.28 in a time-dependent manner. There was significant difference in the expression of phosphorylated N-terminal protein kinase between before treatment and after 3, 6, 12 and 24 hours of Ginaton treatment ( F = 16.37, P < 0.001). Conclusion:Ginaton can effectively inhibit the proliferation and induce apoptosis of human laryngeal cancer Hep-2 cells in vitro, which may be related to regulating ROS level and activating JNK signaling pathway.

Objective To explore the clinical significance of colonoscopy follow-up in Chinese Lynch syndrome mismatch repair (MMR) gene mutation carriers.Methods The results of colonoscopy follow-up was analyzed in 194 MMR gene mutation carriers of 50 Lynch syndrome families.The follow-up period was from April 2001 to November 2016.The detection rates of advanced adenomas and colorectal cancers,five-year survival rate and ten year survival rate were compared between 123 patients of regular follow-up group (colonoscopy interval less than two years) and 71 patients of irregular follow-up group (time colonoscopy interval more than two years).T test,chi-square test and Kaplan-Meier method were performed for statistically analysis.Results The incidence of colorectal cancer of irregular follow up group was significantly higher than that of regular follow-up group (57.7％,41/71 vs 22.8％,28/123);and the difference was statistically significant (x2 =24.00,P＜0.01).The average age at diagnosis for colorectal cancer in irregular follow up group was younger than that of regular follow up group ((45.3 ± 1.9) years vs (48.7±1.8) years);and the difference was statistically significant (t=4.10,P＜0.01).In regular follow-up group,28.6％ (8/28) advanced-stage colorectal cancer (TNM Ⅲ or Ⅳ) was found,while in irregular follow up group,73.2 ％ (30/41) advanced-stage colorectal cancer was found,and there was statistically significant difference in pathological stage between two groups (x2 =4.90,P =0.032).The five year and ten-year survival rates of regular follow-up group were 96.2 ％ and 85.1 ％,respectively,which were both higher than those of irregular follow-up group (46.3 ％ and 28.7 ％);and the differences were statistically significant (x2 =13.20 and 14.80,both P＜0.05).The incidence of advanced adenomas of irregular follow up group was significantly higher than that of regular follow-up group (49.3％,35/71 vs 18.7％,23/123);and the difference was statistically significant (x2 =20.10,P＜0.05).The detection rate of advanced adenomas of MMR gene mutation carriers was higher than those without MMR mutation gene (85.4％,35/41 vs 14.6％,6/41);and the difference was statistically significant (x2 =5.20,P＜ 0.05).Conclusion Regular colonoscopy surveillance may decrease the incidence and mortality of colorectal cancer in MMR mutation carriers of Lynch syndrome families,and increase five-year and tenyear survival rates.

ObjectiveTo design a simple leg-sliding rehabilitation equipment for patients with lower limb dysfunction who need to exercise their leg muscles in bed at the early stage of rehabilitation. MethodsThe mechanism scheme was designed using the crank slider transmission system. The kinematic model was established and the structural dimensions were determined according to the human joint mobility, analysis and verification were then implemented; and the strutural strength of the machanism was verified, and based on the analysis, a protype was built to verify the feasibility of proposed scheme. ResultsThe range of joint activities of the proposed mechanism was in line with the normal human joint activities, the structural strength met the requirements, the prototype operated smoothly, and the actual running speed was basically consistent with the theoretical planning speed. ConclusionThis design could meet the needs of rehabilitation training for bedridden patients with lower limb dysfunction at the early stage of rehabilitation. It has the advantages of small size and light weight, which provides reference value for promoting the development of miniaturized and lightweight lower extremity rehabilitation equipment.

ObjectiveTo explore the mechanism of Gancao Fuzitang （GCFZ）in inhibiting the bone destruction of collagen-induced arthritis （CIA） model in mice. MethodThirty male DBa/1J mice were randomly divided into normal group， CIA group， low-dose GCFZ group （GCFZ-L， 2.4 g·kg^-1）， high-dose GCFZ group （GCFZ-H， 4.8 g·kg^-1）， and methotrexate group （MTX， 1 mg·kg^-1）， with six mice in each group. The CIA model was induced by secondary immunization method. The arthritis index of mice in each group was observed and recorded， and the histopathological changes in ankle joint were observed by hematoxylin-eosin （HE） staining. The damage to ankle cartilage was detected by safranin O-fast green staining. Micro-CT scanning was used to detect the bone destruction of ankle joint， and the expression of nuclear factor-κB p65 （NF-κB p65）， p-NF-κB p65， inhibitory-κB kinase α/β （IKKα/β）， and p-IKKα/β was observed by immunohistochemical staining. ResultCompared with the normal group， the CIA group showed manifest joint swelling and increased arthritis index score （P<0.01）. Compared with the CIA group， the groups with drug intervention could inhibit joint swelling and reduce arthritis index score （P<0.05， P<0.01）. As revealed by HE staining and safranine O-green staining， compared with the CIA group， the groups with drug intervention could inhibit synovial invasion and reduce the destruction of articular cartilage. Micro-CT scanning analysis showed that compared with the CIA group， the GCFZ-H group and the MTX group showed reduced bone destruction scores （P<0.01）. The immunohistochemical results showed that compared with the normal group， the CIA group showed increased optical density values of NF-κB p65， p-NF-κB p65， IKKα/β， and p-IKKα/β（P<0.01）. Compared with the CIA group， the GCFZ-H group and the MTX group showed reduced optical density values of NF-κB p65， p-NF-κB p65， IKKα/β， and p-IKKα/β（P<0.05，P<0.01）. In the GCFZ-L group， only the NF-κB p65 optical density value decreased（P<0.01）. ConclusionGCFZ may inhibit bone destruction in CIA mice by regulating the NF-κB signaling pathway.

Objective To understand the situation and the influencing factors of life quality in diabetic patients in Shanghai， and to develop effective intervention measures. Methods A total of 212 diabetic patients in Baoshan District， Shanghai were selected as the research objects. Diabetes specific quality of life scale （DSQL） was used to investigate the basic situation and quality of life of patients. Combined with biochemical detection indexes and questionnaire survey， data were analyzed by variance analysis and multiple linear stepwise regression analysis. Blood glucose level was assessed according to the 1999 WHO diagnostic criteria for type 2 diabetes. Results The overall quality of life score in the patients was 4.31±7.82， which was higher than the domestic norm. The best quality of life was in the dimension of physiological function with the score of 1.84±6.00， which was lower than the domestic norm. The next was the dimension of social relationship， and the worst was the dimension of treatment. The single factor analysis and multivariate analysis identified the following influence factors of quality of life in the patients： family history， educational level， exercise habit， blood glucose control and diet control. There was a negative correlation with educational level and blood glucose control， and a positive correlation with diet control. Conclusion The quality of life in the middle-aged diabetic patients was affected by the education level， blood glucose control and diet control. We suggest to strengthen the community management， health education， and improve the living habits.

Objective:To study the distribution and antibiotics resistance of the main pathogens of neonatal purulent meningitis in different regions of China.Methods:A retrospective descriptive clinical epidemiological study was conducted in children with neonatal purulent meningitis which admitted to 18 tertiary hospitals in different regions of China between January 2015 to December 2019. The test results of blood and cerebrospinal fluid, and drug sensitivity test results of the main pathogens were collected. The distributions of pathogenic bacteria in children with neonatal purulent meningitis in preterm and term infants, early and late onset infants, in Zhejiang Province and other regions outside Zhejiang Province, and in Wenzhou region and other regions of Zhejiang Province were analyzed. The chi-square test was used for statistical analysis.Results:A total of 210 neonatal purulent meningitis cases were collected. The common pathogens were Escherichia coli ( E. coli)(41.4%(87/210)) and Streptococcus agalactiae ( S. agalactiae)(27.1%(57/210)). The proportion of Gram-negative bacteria in preterm infants (77.6%(45/58)) with neonatal purulent meningitis was higher than that in term infants (47.4%(72/152)), and the difference was statistically significant ( χ2=15.54, P=0.001). There were no significant differences in the constituent ratios of E. coli (36.5%(31/85) vs 44.8%(56/125)) and S. agalactiae (24.7%(21/85) vs 28.8%(36/125)) between early onset and late onset cases (both P>0.05). The most common pathogen was E. coli in different regions, with 46.7%(64/137) in Zhejiang Province and 31.5%(23/73) in other regions outside Zhejiang Province. In Zhejiang Province, S. agalactiae was detected in 49 out of 137 cases (35.8%), which was significantly higher than other regions outside Zhejiang Province (11.0%(8/73)). The proportions of Klebsiella pneumoniae, and coagulase-negative Staphylococcus in other regions outside Zhejiang Province (17.8%(13/73) and 16.4%(12/73)) were both higher than those in Zhejiang Province (2.9%(4/137) and 5.1%(7/137)). The differences were all statistically significant ( χ2=14.82, 12.26 and 7.43, respectively, all P<0.05). The proportion of Gram-positive bacteria in Wenzhou City (60.8%(31/51)) was higher than that in other regions in Zhejiang Province (38.4%(33/86)), and the difference was statistically significant ( χ2=6.46, P=0.011). E. coli was sensitive to meropenem (0/45), and 74.4%(32/43) of them were resistant to ampicillin. E. coli had different degrees of resistance to other common cephalosporins, among which, cefotaxime had the highest resistance rate of 41.8%(23/55), followed by ceftriaxone (32.4%(23/71)). S. agalactiae was sensitive to penicillin, vancomycin and linezolid. Conclusions:The composition ratios of pathogenic bacteria of neonatal purulent meningitis are different in different regions of China. The most common pathogen is E. coli, which is sensitive to meropenem, while it has different degrees of resistance to other common cephalosporins, especially to cefotaxime.

Objective: Using data of health information system (HIS) of medical institutions to study the incidence and hospitalization of herpes zoster in three districts of Beijing. Methods: According to the different level of economic development and geographical features in Beijing, 3 districts of Xicheng, Changping and Miyun were chosen and all 110 medical institutions of the first level and above in the 3 districts are included in the survey. All the outpatient and inpatient herpes zoster cases in 2015 were retrospectively reviewed by HIS system. After distinguishing the reduplicated cases, Using the first outpatient case as a molecule and the resident population as denominator to estimate the annual incidence rate, as well as the annual hospitalization rate was estimated based on primary diagnostic hospitalized cases as molecule and the resident population as denominator. Results: A total of 32 313 primary visit outpatient cases were investigated, of which 18 360 cases (56.8%) were women and 20 923 cases (64.8%) were ≥50 years old. The overall estimated incidence of the 3 districts was 8.8‰ with an increase trends with age and reached to the highest in ≥80 years old (30.5/1 000). The incidence of Xicheng, Changping and Miyun districts are respectively 16.2‰, 4.0‰ and 5.7‰. A total of 701 primary visit inpatient cases were identified, of which 366 cases (52.2%) were women and 651 cases (92.9%) were ≥50 years old. The estimated annual hospitalization rate was 19.4/100 000, with the primary and secondary diagnostic hospitalization rate are respectively 5.9/100 000 (212 cases) and 13.5/100 000 (489 cases). The disease types of secondary diagnostic inpatient herpes zoster cases were as follows: cardiovascular disease (19.0%, 93 cases), stroke (14.5%, 71 cases), pneumonia/chronic obstructive pulmonary disease (14.1%, 69 cases), tumor (12.5%, 61 cases) and diabetes (5.7%, 28 cases). Conclusion Most of the herpes zoster cases in Beijing are over 50 years old, and the incidence of female is slightly higher than male. This disease should become a public health issue of great concern.