Objective To investigate the utilization of antibacterials in perioperation for obstetrics and gynecology after the issuing of the notice by the general office of the Ministry of Health "further strengthen in the management of clinical application of antibacterials". Methods According to the survey on the use of antibacterials, 272 cases of surgical patients from April to December 2007 (treatment group) and 270 cases ofsurgical patients from April to December 2008 (control group) in obstetrics and gynecology department were selected,the utilization after the application of antibacterials were investigated and compared. Results The utilization rate of prophylactic use of antibacterials in treatment group and control group were 83.09% (226/272), 84.44%(228/270) respectively (P>0.05). Preoperative use were 77.94%(212/272), 85.19% (230/270) respectively (P< 0.05). The time of medication were (5.8 ± 2.8) d and (4.5 ± 3.8) d respectively (P<0.0l). Drug sensitivity rates were 2.94%(8/272), 2.22%(6/270) respectively (P>0.05). Both used intravenous as the main administration route, double therapy used as the major drug combination. Conclusions Comparison of utilization of antibacterials in perioperation for obstetrics and gynecology before and after the enforcement of "the guiding principle of clinical use of antibacterials" and "further strengthen in the management of clinical application of antibacterials" issued by the general office of the Ministry of Health. The utilization of antibacterials exist some defects:remains high starting point for administration;without an additional if operative time exceed three hours;longer administration time and double therapy as the major drug combination. In summary,there still are some deficiencies that needs co-management and improvement

Objective To investigate the impact of subclinical hypothyroidism (SCH) on macrovascular complications in elderly type 2 diabetic patients.Methods A total of 1170 hospitalized elderly patients with type 2 diabetes mellitus were enrolled in the study through systematic sampling and underwent testing for blood biochemical indicators, thyroid function and C peptide.Parameters for macro-vascular complications, including the ankle/brachial index (ABI), transcranial Doppler vascular ultrasound (TCD), electrocardiogram (ECG), ejection fraction (EF), history of coronary heart disease, and hypertension grading were also monitored.Results All the subjects were divided into two groups based on the thyroid stimulating hormone (TSH) level: the euthyroid group (4 mU/L≥TSH＞0.4 mU/L) and the SCH group (TSH＞4 mU/L), and the latter was further sub-grouped into the mild SCH group (10 mU/L≥TSH＞4 mU/L) and the severe SCH group (TSH＞10 mU/L).ABI was significantly decreased in SCH (R/L: 0.86/0.92, P＜0.01).Levels of basal C-peptide (CP0) and post glucose-challenge C-peptide (CP1-3) were higher in the SCH group than in the euthyroid group [(2.16±0.93)pg/L vs.(1.56±1.05)pg/L, (0.53±0.25)pg/L v, (0.38±0.37),(0.72±0.23) pg/L vs.(0.56 ±0.32) pg/L, (6.21± 2.69) pg/L vs.(4.46 ± 2.62) pg/L,respectively, P＜0.01 for all].EF was higher in the SCH group than in the euthyroid group[(70.87± 6.66)％ vs.(65.10 ± 8.08％), P＜ 0.01].There were no significant differences in other biochemical indicators, ECG, TCD, history of coronary heart disease, hypertension grading and intervention treatment (P＞0.05 for all).Conclusions Lower extremity atherosclerotic disease has a higher incidence in elderly type 2 diabetic patients with SCH and occurs earlier than other macrovascular complications.Elevated TSH levels and insulin resistance may be the major causes.

Objective To evaluate the correlation of sub-foveal chomidal thickness (SFCT) variation in type 2 diabetic patients with clinically significant diabetic macular edema (CSME) and the related factors using enhanced depth imaging optical coherence tomography technique (EDI-OCT).Methods A total of 40 normal volunteers (group A), 49 type 2 diabetic patients without CSME(group B) and 37 type 2 diabetic patients with CSME (group C) were recruited, including 67 male and 59 female.All study subjects received EDI-OCT examination.The SFCT in A, B and C groups were compared using one-way ANOVA analysis.The correlations between SFCT and duration of diabetes, fasting blood glucose (FBG), glycoseylated hemoglobin HbAlc, low density lipopmtein (LDL), triglyceride (TG), total cholesterol (TC), high density lipopmtein (HDL), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed using logistic regression analysis.Results Average SFCT in group A was (271.49±36.18) μm.Average SFCT in group B was (260.48±35.27) μm, and compared with group A, the difference was not statistically significant (P＞ 0.05).Average SFCT in group C was (227.90±34.73) μm, and compared with group A, the difference was statistically significant (P＜0.01).There was a significant difference of SFCT between groups B and C (P＜0.01).There was no statistically correlation between average SFCT and duration of diabetes, FBG, HbA1c, TG, TC, HDL, creatinine, SBP and DBP (P＞0.05), while a statistically correlation between SFCT and LDL or urinary albumin excretion rate (UAER) was observed in the study (r=-0.609,-0.681, P＜0.01).Conclusions Compared with groups A and B, SFCT in type 2 diabetic patients with CSME was significantly thinner.UAER and LDL levels in type 2 diabetic patients with CSME were negatively correlated with SFCT, that is to say, with the increasing of UAER and LDL levels, SFCT in type 2 diabetic patients with CSME decreased.

Objective To investigate the relationship between subclinical hypothyroidism (SCH) and diabetic retinopathy (DR) in elderly type 2 diabetic patients.Methods 1170 hospitalized patients with type 2 diabetes mellitus were enrolled in our study.After identified by systematic sampling,all the elderly patients received examinations of thyroid function,biochemical indexes,steamed bread meal test and C-peptide releasing test.The serious degree of DR was observed through digital fundus photography and ophthalmofundoscope.The relationship between SCH and DR was analyzed.Results All the subjects were divided into two subgroups:euthyroid group(TSH≤4mU/L)and subclinical hypothyroidism (SCH) group (mild SCH group,TSH ＞4～10 mU/L; serious SCH group,TSH＞10 mU/L).Free thyroxine (FT4) was significantly lower in SCH group than in euthyroid group[(13.91±2.17) pmol/L vs.(16.55±2.81)pmol/L,P＜0.001].The levels of basal (CP0) and post glucose-challenge (CP1-3) C-peptide were significantly higher in SCH group than in euthyroid group (P0-3 value:0.001,0.012,0.004,0.001).There were significant differences in the progress of diabetic retinopathy between SCH and euthyroid groups (retinopathy-L,P=0.018; retinopathy-R P=0.013).Conclusions Elderly type 2 diabetic patients with SCH have a higher incidence of diabetic retinopathy (DR).The elevated FT4 level and decreased basal C-peptide level are probably the main reasons.

Objective: To explore the relationship between family structure with adolescents physical and mental health, and to provide a reference for promoting healthy development of adolescents in the family with particular structure. Methods: The stratified random sampling method was used to select 3 941 middle school students aged 13 to 18 years in Shangrao City of Jiangxi Province. Self designed questionnaire, Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Scale (GAD-7) were used to assess family structure, depressive symptoms and anxiety symptoms, participants were divided into underweight or overweight and obesity according to screening for underweight of school age children and screening for overweight and obesity of school age children. Results: The proportion of adolescents with special family structure was 7.0%. Univariate analysis showed that underweight rate of adolescents with divorced parents (31.2%) was higher than that of adolescents whose parents were still married (25.3%) ( χ 2= 3.55 , P <0.05), the detection rate of depressive symptoms in adolescents with special family structure(40.9%) was higher than that in adolescents with typical family structure(34.5%) ( χ 2=4.60, P <0.05). Multivariate analysis showed that the risk of depressive symptoms in adolescents with special family structure was 1.41 times higher than that in adolescents with typical family structure( 95% CI= 1.02-1.79, P <0.05). Conclusion No significant relationships between special family structure with underweight, overweight and obesity, and anxiety symptoms of adolescents are observed,however,special family structures are associated with increased risk of depressive symptoms in adolescents.

BACKGROUNDThe various risk factors for retinal hard exudates are still poorly understood in type 2 diabetic patients. The aim of this study was to determine the association between urinary albumin excretion rate (UAER) and hard exudates in macular region in north Chinese patients.

METHODSA total of 272 patients (272 eyes) were enrolled for this study, including 154 subjects from group 1 (mild hard exudates), 91 subjects from group 2 (moderate hard exudates) and 27 subjects from group 3 (severe hard exudates) confirmed using colour fundus photography, optical coherence tomography (OCT) as well as slit-lamp biomicroscopy with 78 diopter (D) lens. Each participant underwent a comprehensive assessment that included biochemical, clinical characteristics test and detailed ophthalmic evaluation. One-way analysis of variance (ANOVA) test and chi-square test were performed to analyze the fasting blood glucose (FBG), glycated hemoglobin (HbA1c), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), full blood counts, urinary albumin excretion rate (UAER), blood creatinine (CREA), duration of diabetes, body mass index (BMI), systolic blood pressures (SBP) and diastolic blood pressures (DBP) between groups. Ordinal logistic regression analysis was further performed in order to eliminating the possible confounding factors.

RESULTSThree groups were matched in terms of age and gender. Risk factors which showed significant difference between groups include FBG (P < 0.001), HbA1c (P < 0.001), LDL (P < 0.001), UAER (P < 0.001), duration of diabetes (P = 0.001), TC (P = 0.005), SBP (P = 0.026), CREA (P = 0.004) and haemoglobin (Hb) (P = 0.012). There was no significant difference between groups for the TG, HDL, DBP, platelet, total white blood cells and BMI. Using ordinal Logistic regression analyses, of all the variables, HbA1c, LDL and UAER which were independent risk factor for hard exudates showed a significantly odds ratio of 1.25, 3.07, and 1.39, respectively. There were also significant differences in UAER level between patients with mild, moderate, severe hard exudates groups (P < 0.001).

CONCLUSIONSUAER was an independent risk factor associated with retinal hard exudates in macular region in type 2 diabetic patients. This study highlights the need for close monitoring and fundus examination for hard exudates in patients with elevated UAER to prevent irreversible visual loss.

Aged ; Albuminuria ; physiopathology ; Diabetes Mellitus, Type 2 ; physiopathology ; urine ; Female ; Humans ; Macular Edema ; physiopathology ; urine ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors