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 prepare a kind of Gelsolin-targeted ultrasound contrast agent (GSN-PLGA) and to explore its targeting and imaging effection in vitro.Methods The high molecular PLGA-COOH ultrasound contrast agents were prepared by a modified double emulsion technique and then conjugated with Gelsolin monoclonal antibody by carbodiimide technique.The physical property of contrast agent was determined.And the connectivity condition of ultrasound contrast agent with Gelsolin monoclonal antibody was estimated.The targeting ability and the effect of enhancing ultrasound imaging in vitro were explored.Results The average diameter of GSN-PLGA was (575.67 ± 4.71) nm.The potential was (-11.46±1.19) mV.And the binding rate of Gelsolin monoclonal antibody was 96.93％.In vitro experimentshowed more GSN-PLGA could be intaked by Hca-F cells and the ultrasound imaging cloud be enhanced greatly.Conclusion The GSN-PLGA nanoparticle can bind to Hca-F cells specifically and can enhance the ultrasound imaging greatly.

Objeetive: To evaluate the imported risk of COVID-19 cases from aboard to Zhejiang Province,so as to provide reference for control strategies. Methods: The epidemic data of COVID-19 in 9 foreign countries（US,UK,Italy,etc.）and Zhejiang Province were collected,as well as the number of entry persons. The imported risk values of COVID-19 cases to 90 counties（cities or districts）of Zhejiang Province and from the 9 countries during March 7th and 30th were calculated and normalized to the imported risk indexes. The imported risk indexes were classified into five levels from high to low according to percentiles. The imported risk of 90 counties（cities or districts）,the developing trend and the source were analyzed. Results : A total of 39 confirmed cases and 24 asymptomatic cases were imported to Zhejiang Province untill March 30th. There were 10,13,22,21 and 24 counties（cities or districts）with high,medium high,medium,medium low and low imported risk,respectively. Qingtian had the highest imported risk（0.43）,followed by Ruian（0.32）and Wencheng（0.29）. The imported risks in 80（88.89%）counties（cities or districts）showed increased trend. The highest imported risk came from Italy（0.51）,followed by US（0.14）and Spain（0.11）. The imported risk in Wenzhou and Lishui mainly came from Italy and Spain,while that in the other areas mainly came from US,Germany and UK. Conclusions The risk of imported COVID-19 cases from aboard to Zhejiang Province showed an upward trend since March. The areas at high and medium high risk lay in southeast Zhejiang and the downtown of Hangzhou. The source of imported risk were maimly from Italy,US and Spain,but varied in counties.

Objective : To learn the epidemiological characteristics of coronavirus disease 2019 (COVID-19) cases reported from January 21 to February 20,2020 in Zhejiang Province,so as to provide basis for formulating and implementing effective control measures. Methods : The COVID-19 cases reported by Zhejiang Province were extracted from the National Diseases Prevention and Control Information System. A descriptive analysis was adopted for the epidemiological characteristics of COVID-19 cases,including time,spatial and population distribution,severity of symptoms, and exposure history. Results : Totally 1 284 cases were reported,of which 1 176 were confirmed cases (91.59%) and 108 were asymptomatic cases (8.41%). The first confirmed case was reported on January 21. The curve of the disease onset peaked from January 22 to 29, with 87 cases as the biggest number a day. The curve of the disease reported peaked from January 28 to 30, with 130 cases as the biggest number a day. Then the number of the cases showed a declining trend. By February 4, totally 79 counties (cities, districts) had confirmed cases, covering 87.78% of Zhejiang Province, and it has not increase since then. A male to female ratio of 1.02∶1 was reported among 1 284 cases,1 021 were 30-69 years old (79.52%) and 339 (26.40%) were business service providers. There were 11 health workers reported to be infected,but not by occupational exposure. Among the confirmed cases, 1 010 (85.88%) were clinically mild cases. One case died. Before January 23, the cases were mainly imported from Hubei Province, local cases were predominant by the end of January. Conclusions The COVID-19 epidemic has spread widely in Zhejiang Province and people are generally susceptible. Most cases were clinically mild, and were aged 30-69 years. No health workers infected were due to occupational exposure. The incidence of COVID-19 in Zhejiang Province has turned into a lower level,suggesting that the early prevention and control measures have achieved initial results. With people returning from holiday, precise prevention and control should be put into effect.

Objective To investigate the changes of indications, degree of difficulty in procedure, complication and its severity in endoscopic retrograde cholangiopancreatography (ERCP) in Changhai hospital from 2001 to 2007. Methods The clinical data, including demographic data, indications, degree of difficulty in procedure, success rate, complication rate and severity of complication, of 2374 patients who underwent ERCP in 2001 and 2007 (966 in 2001 and 1408 in 2007), were retrospectively reviewed. Results Indications of ERCP changed at an interval of 5 years. Operations due to bile duct stone decreased (59.0% vs. 49.3%, P=0.000), while operations due to pancreas disease, especially chronic pancreatitis (6.6% vs. 18.5%, P=0.000) and recurrent pancreatitis (0.2% vs.1.6%, P=0.001), increased. Patients with biliary duct problems after liver transplantation appeared in 2007. The procedures of ERCP performed in 2007 were more difficult (P=0.000), with an increased percentage of Degree 5 procedure (7.3% vs. 33.3%, P=0.000). The number of diagnostic ERCP significantly decreased (Degree 1 + Degree 3, 30.5% +2.8% vs. 5.9% +3.1%, P=0.000). There was no significant difference in the success rate between the two years (P=0.084). The complication rate of ERCP in 2007 was significantly higher than that in 2001 (3.73% vs. 7.88%, P=0.000), but the severity of complication showed no significant difference (P=0.820). Conclusion Cases of diagnostic ERCP decreased in 2007. Indications of ERCP have changed, with a decrease in bile duct diseases and an increase in pancreatic diseases. The procedures are more complicated, but it does not lead to lower success rate. The increase in complication rate is possibly due to increase of therapeutic ERCP.

BACKGROUNDPrevious studies have demonstrated that acupuncture could modulate various brain systems in the resting brain networks. Graph theoretical analysis offers a novel way to investigate the functional organization of the large-scale cortical networks modulated by acupuncture at whole brain level. In this study, we used wavelets correlation analysis to estimate the pairwise correlations between 90 cortical and subcortical human brain regions in normal human volunteers scanned during the post-stimulus resting state.

METHODSThirty-two college students, all right-handed and acupuncture naïve, participated in this study. Every participant received only one acupoint stimulation, resulting in 16 subjects in one group. Both structural functional magnetic resonance imaging (fMRI) data (3D sequence with a voxel size of 1 mm(3) for anatomical localization) and functional fMRI data (TR = 1500 ms, TE = 30 ms, flip angle = 90°) were collected for each subject. After thresholding the resulting scale-specific wavelet correlation matrices to generate undirected binary graphs, we compared graph metrics of brain organization following verum manual acupuncture (ACU) and sham acupuncture (SHAM) groups.

RESULTSThe topological parameters of the large-scale brain networks in ACU group were different from those of the SHAM group at multiple scales. There existed distinct modularity functional brain networks during the post-stimulus resting state following ACU and SHAM at multiple scales.

CONCLUSIONSThe distinct modulation patterns of the resting brain attributed to the specific effects evoked by acupuncture. In addition, we also identified that there existed frequency-specific modulation in the post-stimulus resting brain following ACU and SHAM. The modulation may be related to the effects of verum acupuncture on modulating special disorder treatment. This preliminary finding may provide a new clue to understand the relatively function-oriented specificity of acupuncture effects.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Analgesia ; Brain ; physiology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Nerve Net

Objective:To investigate the value of real-time shear wave elastography (SWE) in the assessment of splenic congestion in patients with chronic right heart failure.Methods:Sixty patients with chronic right heart failure with cardiac function grade Ⅱ-Ⅳ of New York Heart Association (NYHA) treated in Lianyungang First People′s Hospital from March 2020 to February 2021 were collected as the study group, and 20 healthy subjects in the same period were selected as the control group. Routine echocardiography was performed on all subjects; spleen stiffness measurement (SSM) was detected by SWE, and blood biochemical indicators related to patients with right heart failure were detected and recorded. SSM and other related parameters between the two groups were analyzed; the SSM in patients of different cardiac function classifications and course of disease were compared; 60 patients were divided into low SSM group (SSM≤15.0 kPa), middle SSM group (15.0 kPa

The risk of colorectal cancer is substantially higher in patients with long-term colorectal inflammation than in the general population.Prolonged inflammation is an essential factor that triggers colorectal cancer.The dynamic pathological evolution process of the classic"inflammation-mediated carcinogenesis"in the colorectum is proctocolitis→dysplasia→cancer.Traditional Chinese medicine lacks a systematic consensus on the pathogenesis of colorectal"inflammation-mediated carcinogenesis".This article proposes the theory of"pathogenic factors lurk intestinal collaterals"to explain the development law of pathogenesis in the dynamic evolution of colorectal"inflammation-mediated carcinogenesis".Internal and external factors can trigger the movement of the latent pathogenic factors,thereby damaging the intestinal tissues,when latent pathogenic factors are hidden in the intestinal collaterals,and the healthy qi is unable to expel them.The prolonged course of the disease further weakens the healthy qi,allowing the latent pathogenic factors to accumulate in the intestinal collaterals,intertwine with phlegm-dampness and blood stasis,accelerate accumulation,and lead to cancer."Latent pathogens trapped in the intestinal collaterals"is the core pathogenesis during inflammation-mediated carcinogenesis.Thus,to prevent colorectal inflammation-mediated carcinogenesis,consideration should be given to the principle of driving away pathogenic factors and dredging the collaterals in clinical practice.The theory regarding"latent pathogens trapped in the intestinal collaterals"can provide a theoretical reference for syndrome differentiation and treating colorectal inflammation-mediated carcinogenesis and offer novel ideas for clinical treatment.

Objective:To explore the incidence and risk factors of severe bleeding after percutaneous renal biopsy (PRB) in patients with advanced chronic kidney disease (CKD).Methods:The study was a retrospective cohort analysis. The data were collected from patients with advanced CKD who were hospitalized in the Department of Nephrology, Nanfang Hospital, Southern Medical University and underwent PRB between January 2010 and December 2020. Severe bleeding after PRB was defined by any of the following criteria: a postoperative hemoglobin decrease of ≥20 g/L within 48 hours, a maximum diameter of perirenal hematoma ≥5 cm postoperatively, or the need for posterior pituitary hormone, blood transfusion, or renal vascular intervention post-surgery. The occurrence of severe bleeding following PRB served as the primary endpoint for this study. Logistic regression model was used to analyze the risk factors associated with severe bleeding in patients with advanced CKD undergoing PRB.Results:A total of 895 patients aged (46.1±14.1) years were encompassed in the study. Among them, 60.1%(538/895) were male, 15.9%(142/895) were afflicted with diabetes, and 57.9%(518/895) suffered from hypertension. The estimated glomerular filtration rate (eGFR) was (40.1±13.2) ml?min -1?(1.73 m 2) -1, and the 24-hour urine protein excretion was 2.5(1.1, 4.9) g. After PRB, 22.9%(205/895) of the patients encountered severe bleeding, including 30 patients (14.6%) who received postoperative somatostatin, 10 patients (4.9%) who underwent postoperative blood transfusion, 1 patient (0.5%) who underwent postoperative renal vascular intervention for hemostasis, and no fatalities occurred. Compared to the non-severe bleeding group, patients in the severe bleeding group after PRB exhibited a higher proportion of hypertension [64.4%(132/205) vs. 55.9%(386/690), χ2=4.627, P=0.031]. Additionally, preoperative serum creatinine levels and mean arterial pressure were significantly elevated [(193.9±106.6) μmol/L vs. (180.8±102.6) μmol/L, t=-2.559, P=0.011; (95.8±10.9) mmHg vs. (93.9±11.0) mmHg, t=-2.134, P=0.033]. Furthermore, platelet counts were lower in the severe bleeding group [(227.5±70.3) ×10 9/L vs. (247.5±74.8) ×10 9/L, t=-3.788, P<0.001]. No statistically significant differences were observed between the two groups regarding age, gender distribution, prevalence of diabetes mellitus, as well as preoperative serum albumin level, hemoglobin concentration, other coagulation function indicators and pathological histological type (all P>0.05). Multivariate logistic regression analysis indicated that body mass index ( OR=0.936, 95% CI 0.891–0.984, P=0.010), eGFR ( OR=0.985, 95% CI 0.971–0.999, P=0.034), serum albumin level ( OR=1.041, 95% CI 1.011–1.072, P=0.007), 24 hours urinary protein excretion ( OR=1.092, 95% CI 1.030–1.158, P=0.003), and platelet count ( OR=0.996, 95% CI 0.994–0.999, P=0.002) were independently associated with the severe bleeding following PRB in patients with advanced CKD. In the PRB cohort analyzed, the six most prevalent renal histological types were as follows: IgA nephropathy (46.3%, 414/895), membranous nephropathy (11.1%, 99/895), focal segmental glomerulosclerosis (8.5%, 76/895), diabetic nephropathy (7.6%, 68/895), sclerotic kidney disease (6.9%, 62/895), and vascular sclerosis of the kidneys (4.9%, 44/895). Conclusions:Patients with advanced CKD exhibit a heightened risk of severe bleeding following PRB, estimated at approximately 22.9%. Independent risk factors for the occurrence of severe bleeding complications in these patients include low body mass index, reduced eGFR, decreased platelet count, elevated serum albumin, and increased urinary protein level.

Objectives:To establish a grading model on prognosis of drug-coated balloon (DCB) treatment on femoropopliteal de novo lesions, and assess whether patients at high risk could benefit from combination of directional atherectomy(DA).Methods:The clinical data of 114 patients with femoropopliteal de novo lesions admitted to Department of Vascular Surgery, Peking University People′s Hospital from October 2015 to January 2019 were collected retrospectively. There were 95 patients(108 limbs) underwent DCB treatment, including 66 males and 29 females, aged 71.9 years old(range:48 to 91 years), and 19 patients (21 limbs) underwent DA combined with DCB treatment, including 13 males and 6 females, aged 69.5 years old(range: 62 to 80 years). The demographic data, intraoperative and postoperative conditions of the patients were collected. Cox regression model was performed for modeling and then goodness of fit was tested. Kaplan-Meier estimate was carried out between the two groups for patients at high risk and low risk, respectively.Results:All patients were followed up for more than 24 months. Restenosis occurred on 34 limbs in DCB group and 3 limbs in DA+DCB group. Severe calcification( HR=3.804, 95% CI:2.460 to 5.883), popliteal artery involvement ( HR=2.104, 95% CI:1.368 to 3.236), long lesion ( HR=1.824, 95% CI:1.196 to 2.780), poor runoff( HR=1.736, 95% CI:1.025 to 2.940), chronic kidney disease( HR=1.601, 95% CI:1.040 to 2.463) were independent risk factors of restenosis after DCB treatment, and were defined 3, 2, 1, 1 and 1 points, respectively. Total points≥3 was regarded as high risk group. Kaplan-Meier analysis showed that patients in low risk group did not benefit from DA+DCB comparing with DCB with regard to primary patency at 24 months (77.78% vs. 90.31%, P=0.271) while patients benefited from DA+DCB comparing with DCB in high risk group(88.26% vs. 20.80%, P<0.01). Conclusions:The grading model shows satisfying clinical value. The clinical effect of DA+DCB is better than DCB along in high risk group. Patients at high risk are supposed to receive aggressive vessel preparation like DA.