An investigation of the special policies for chronic diseases in medical insurance for urban employees and residents has been conducted in 333 prefecture-level cities in China,and the results showed that 78％ of all cities included chronic hepatitis B (CHB) in medical reimbursement for urban employees and 57％ included CHB in medical reimbursement for urban residents.However,there are still some issues to be resolved,such as inconsistent descriptions of the diagnosis of CHB-related diseases,inconsistent diagnostic criteria,lack of standardization of reimbursement process,infringement of patient privacy,and inadequate dose prescribed for CHB patients in the outpatient service.Therefore,we suggested that the Ministry of Human Resources and Social Security should introduce unified policies to include CHB in medical reimbursement,unify disease name and diagnostic criteria,standardize the reimbursement process for CHB,and increase the prescribed dose.

Objective To observe the incidence of severe acute pancreatitis (SAP) in obese acute pancreatitis (AP) patients with medical treatment, and evaluate the impact of obesity in AP progression.Methods A multicenter prospective controlled study was conducted. APACHE Ⅱ scoring system was used to evaluate the severity of AP. Results 161 patients with mild AP(MAP) were enrolled, according to the cut-off point of 25 kg/m2, these patient were divided into obese group (79 patients) and non-obese group (82patients). The levels of CRP, hypertriacylglycerolemia, complication rate, incidence of SAP and mortality were observed under the circumstance of identical medical treatment. The levels of CRP in obese group and non-obese group were (117±109 ) mg/L and (35±36 ) mg/L(P<0.01). The number of obese patients with hypertriacylglycerolemia was two times as many as that in non-obese patients, but there was no significantly difference. There was no local complication in both groups, but the incidence of systematic complication in obese patients (20.3%) was significantly higher than that in non-obese group (6.1%, P<0.01). 16patients (20.3%) in obese group progressed into SAP, which was significantly higher than that in non-obese group (5 patients, 6.1%, P<0.01). One patient(1.3%) died in obese group, but no one died in non-obese group. In MAP patients with APACHE Ⅱ 4～7 points, the incidence of SAP (43.3%) in obese group was significantly higher than that in non-obese group (18.5%, P<0.05). Conclusions Obese MAP patients with APACHE Ⅱ 4～7 points were prone to develop into SAP. More aggressive interventions are needed.

As a new type of medical service mode, day surgery significantly alleviates the contradiction between supply and demand of medical resources. Since 2009, day surgery center in West China Hospital of Sichuan University has gradually carried out endoscopic gastrointestinal(GI) polypectomy, continuously explored and practiced the centralized management mode of GI polyps. The integrated management process included pre-hospital management, clinical pathway during hospitalization, and extended service after discharge. The overall-management database for day surgery patients was established, guiding the clinical practice and standardizing clinical behavior based on various clinical studies, which help day surgery managers make clinical decisions, and achieve the management objectives of fine management, quality and safety normalization for day surgery.

Objective:To explore the risk factors of occurrence of colorectal adenoma after endoscopic polypectomy.Methods:From January 2014 to December 2019, at the Department of Day Surgery Centre in West China Hospital, Sichuan University, 6 430 patients with 20 351 polyps who underwent endoscopic colorectal polypectomy were retrospectively analyzed. Patients were divided into adenomas group (4 573 patients) and non-adenomas group (1 857 patients) according to whether they had at least one adenomatous polyp. According to the results of postoperative histopathology, colorectal polyps were divided into adenomatous polyp group (10 656 polyps) and non-adenomatous polyp group (9 695 polyps). The propensity score matching (PSM) method was applied, with 1∶1 matching, in the patients with adenoma group and the patients with non-adenoma group, as well as in adenomatous polyps group and non-adenomatous polyps group. A total of 1 824 pairs of patients and 7 362 pairs of colorectal polyps were successfully matched. After PSM, patients-related factors as gender (male), age (<40 and 40 to 60 years old), number of polyps (>2), obesity (body mass index ≥28 kg/m 2), melanosis, family history of colorectal cancer in first-degree relatives, polyps-related factors as the maximum diameter (6 to 10 and >10 mm), distribution (distal colon), and morphological classification (sessile and flat polyps) were included in the analysis of risk factors of colorectal adenoma. Univariate analysis and multivariate logistic regression were used for statistical analysis. Results:Among 6 430 patients with colorectal polyps, the detection rate of adenoma was 71.12% (4 573/6 430). After PSM, the results of univariate analysis showed that obesity, family history of colorectal cancer in first-degree relatives, the maximum diameter of polyps >10 mm were all correlated with the occurrence of adenoma (odds ratio ( OR)=1.483, 1.426 and 1.503, 95% confidence interval ( CI)1.063 to 2.067, 1.015 to 2.004, 1.198 to 1.887, all P<0.05). The results of multivariate logistic regression analysis indicated that obesity, family history of colorectal cancer in first-degree relatives, the maximum diameter of polyps >10 mm, sessile or flat polyps in morphological classification were independent risk factors of the occurence of colorectal adenomas ( OR=1.425, 1.411, 1.629, 1.165 and 1.151, 95% CI1.019 to 1.994, 1.001 to 1.988, 1.290 to 2.058, 1.030 to 1.316 and 1.012 to 1.310, all P < 0.05). Conclusions:Obesity, family history of colorectal cancer in first-degree relatives, maximum diameter of polyps >10 mm, sessile polyps or flat polyps were the independent risk factors of the occurrence of colorectal adenomas.

Mirror image visual feedback, a rehabilitation technique, has been used in the rehabilitation for complex regional pain syndrome type I. Some researches showed that it is effective for pain and motor function, which may relate to exciting the motor cortex and activating the mirror neurons, etc.

Objective:To study the iodine nutrition status and influencing factors of thyroid volume of children aged 8 - 10 years in Shiyan City, Hubei Province.Methods:From June 2019 to October 2020, in 8 counties (cities, districts) under the jurisdiction of Shiyan City, Hubei Province, each county (city, district) was divided into 5 districts according to the east, west, south, north, and center. One township (street) was selected in each district, and 40 children aged 8 to 10 years from one primary school (age balanced, half male and half female), were selected in each township (street), and their home salt samples and once random urine sample were taken to detect salt iodine and urinary iodine levels. At the same time, thyroid volume measurements and physical examination were performed.Results:A total of 3 172 salt samples were collected from children's homes, with a salt iodine content of 23.68 mg/kg. The iodine salt coverage rate was 99.81% (3 166/3 172), and the qualified iodine salt consumption rate was 96.72% (3 068/3 172). A total of 3 172 urine samples were collected from children, with a median urinary iodine level of 241.87 μg/L, indicating that iodine nutrition was at a super optimal level. There were statistically significant differences in the median urinary iodine among children of different genders and regions ( Z = - 3.63, H = 160.83, P < 0.001). The thyroid of 1 191 children was examined, and the goiter rate was 0.67% (8/1 191), and there were statistically significant differences in the goiter rate of children of different ages and regions (χ 2 = 6.41, 11.91, P = 0.040, 0.002). The correlation analysis results showed that there was a negative correlation between urinary iodine and thyroid volume in children ( r = - 0.08, P = 0.025); according to age stratification, there were positive correlation between height, weight, body surface area, and thyroid volume in children aged 8, 9 and 10 years ( P < 0.05). Conclusions:The iodine nutrition of 8 - 10 years old children in Shiyan City is in an over appropriate level, and the goiter rate is low. Urinary iodine, height, weight, and body surface area of children are all factors influencing thyroid volume.

Objective:To investigate the iodine nutrition level and thyroid function status of pregnant women in Hubei Province.Methods:According to the requirements of "the National Iodine Deficiency Disorders Monitoring Program (2016 Edition)", in 2020, using a cross-sectional survey method, two mountainous counties and two plain areas in Hubei Province were divided into five districts: east, west, south, north, and central. One township (street) was selected from each district, and 20 pregnant women were selected from each township (street) as survey subjects. Urine iodine content and thyroid function indicators [serum free triiodothyronine (FT 3), free thyroxine (FT 4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb)] were tested. Abnormal thyroid function rate and antibody positive rate were analyzed, and correlation analysis of thyroid function indicators was conducted (Spearman method). Results:A total of 321 pregnant women were included, including 43, 114, and 164 in early, middle, and late pregnancy, respectively; The median urinary iodine was 164.80 μg/L. The median serum FT 3, FT 4, TSH, TPOAb, TgAb levels were 4.10, 12.83 pmol/L, 1.85 mU/L, 15.84 and 13.35 U/ml, respectively. There were statistically significant differences in FT 3, FT 4, and TSH levels among different trimesters ( P < 0.05). According to Spearman's correlation analysis, FT 3 in early stage of pregnancy was negatively correlated with TSH and TPOAb levels ( r = - 0.46, - 0.33, P < 0.05), while TSH was positively correlated with TPOAb level ( r = 0.33, P = 0.032); there was a positive correlation between FT 4 and TgAb levels in middle stage of pregnancy ( r = 0.21, P = 0.032); there was a negative correlation between FT 3 and TPOAb levels in late stage of pregnancy ( r = - 0.19, P = 0.017); FT 3 and FT 4, TPOAb and TgAb levels were positively correlated throughout pregnancy ( P < 0.05). There was no correlation between urinary iodine content and thyroid function indicators ( P > 0.05). The total abnormal rate of thyroid function was 7.79% (25/321), with 16.28% (7/43), 5.26% (6/114), and 7.32% (12/164) in early, middle, and late pregnancy, respectively. There was no statistically significant difference in the abnormal rate of thyroid function among different pregnancy periods (χ 2 = 4.83, P = 0.097). The detection rates of hypothyroxinemia, hypothyroidism, subclinical hypothyroidism, hyperthyroidism, and subclinical hyperthyroidism were 4.36% (14/321), 0.31% (1/321), 2.49% (8/321), 0.31% (1/321), and 0.31% (1/321), respectively. The positive detection rate of autospecific antibodies was 10.28% (33/321), with a TPOAb positive detection rate of 9.97% (32/321) and a TgAb positive detection rate of 5.30% (17/321). Conclusions:The iodine nutrition level of pregnant women in Hubei Province is at a suitable level, and the rates of abnormal thyroid function and thyroid autospecific antibody positive are relatively low. It is necessary to continuously monitor the iodine nutrition and thyroid function indexes of pregnant women, strengthen health education on the hazards of iodine deficiency during pregnancy, and minimize the harm to maternal and infant health caused by iodine deficiency.

Objective: To establish a set of rules for autoverification of blood analysis, in order to provide a way to validate autoverification rules for different analytical systems, which can ensure the accuracy of test results as well as shorten turnaround time (TAT) of test reports. Methods: A total of 34 629 EDTA-K2 anticoagulated blood samples were collected from multicenter cooperative units including the First Hospital of Jinlin University during January 2017 to November 2017. These samples included: 3 478 cases in Autoverification Establishment Group, including 288 cases for Delta check rules; 5 362 cases in Autoverification Validation Group, including 2 494 cases for Delta check; 25 789 cases in Clinical Application Trial Group. All these samples were analyzed for blood routine tests using Sysmex XN series automatic blood analyzers.Blood smears, staining and microscopic examination were done for each sample; then the clinical information, instrument parameters, test results and microscopic results were summarized; screening and determination of autoverification conditions including parameters and cutoff values were done using statistical analysis. The autoverification rules were input into Sysmex Laboman software and undergone stage Ⅰ validation using simulated data, and stage Ⅱ validation for post-analytical samples successively. True negative, false negative, true positive, false positive, autoverification pass rate and passing accuracy were calculated. Autoverification rules were applied to autoverification blood routine results and missed detection rates were validated, and also data of autoverification pass rate and TAT were obtained. Results: (1)The selected autoverification conditions and cutoff values included 43 rules involving WBC, RBC, PLT, Delta check and abnormal characteristics. (2)Validation of 3 190 cases in Autoverification Establishment Group showed the false negative rate was 1.94%(62/3 190)(P<0.001), autoverification pass rate was 76.74%, passing accuracy was 97.47%; Validation of 2 868 cases in Autoverification Validation Group, the false negative rate was 3.38%(97/2 868)(P=0.002), autoverification pass rate was 42.26%, passing accuracy was 92.00%; Validation of Delta check on 288 cases in Autoverification Establishment Group and 2 494 cases in Autoverification Validation Group showed the false negative rates were respectively 1.39% and 2.61%(P<0.001). (3)Three hospitals adopted these rules of autoverification for 25 789 blood routine samples, and found that the average TAT of blood routine test reports were shortened by 24min, 32min and 7min respectively, the rate of samples reported within 30min were elevated by 33%, 53% and 7%. The autoverification pass rates were 72%-74%. Conclusions The application of this set of 43 autoverification rules in blood sample analysis can ensure test quality while shortenTAT and improve work efficiency. It is worth pointing out that for the same analytical systems in this research, validation is necessary before application of this set of rules, and periodic validation is required during application to make necessary adjustment; for different analytical systems, as this research provide a way to establish autoverification rules for blood routine tests.Clinical labs may establish their own suitable autoverification rules on the basis of technological parameters. (Chin J Lab Med, 2018, 41: 601-607)

Objective: The relationship between serum uric acid (SUA) levels and glycemic indices, including plasma glucose (FPG), 2-hour postload glucose (2h-PG), and glycated hemoglobin (HbA1c), remains inconclusive. We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population. Methods: The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study. A total of 105,922 community-dwelling adults aged ≥ 40 years underwent the oral glucose tolerance test and uric acid assessment. The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models. Results: A total of 30,941 men and 62,361 women were eligible for the current analysis. Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels, but with different inflection points in men and women. The thresholds for FPG, 2h-PG, and HbA1c for men and women were 6.5/8.0 mmol/L, 11.0/14.0 mmol/L, and 6.1/6.5, respectively (SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices). Conclusion An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes, while the inflection points were reached earlier in men than in women.
Aged ; Asian Continental Ancestry Group ; Blood Glucose/analysis* ; China/epidemiology* ; Cohort Studies ; Diabetes Mellitus/blood* ; Female ; Glucose Tolerance Test ; Glycated Hemoglobin A/analysis* ; Glycemic Index ; Humans ; Male ; Middle Aged ; Uric Acid/blood*