Objective To compare the effects of autotransfusion and homologous transfusion on milieu interieurand secretion of erythropoietin (EPO) .Methods Thirty patients aged 8-21 yr undergoing surgical correction of kyphoscoliosis were randomly divided into two groups of fifteen: group A and group B. In group A patients received homologous transfusion during operation, while in group B shed blood was collected from operative field and after filtration RBCs were separated by a differential centrifugation and washed in normal saline and reinfused. Anesthesia was induced with fentanyl 2 ?g? kg-1 , propofol 1 mg ? kg-1 and vecuronium 0.1 mg ? kg-1 and maintained with inhalation of isofiurane and 50% N2O in oxygen and intermittent iv boluses of vecuronium and fentanyl. Blood routine, blood gases, electrolytes, plasma osmotic pressure and activated clotting time (ACT) were measured before operation, 2 h after skin incision and at the end of surgery. Blood EPO concentration was measured before operation, at the end of surgery and 24 h after operation. Results MAP and HCO3- were significantly lower during operation in group A than those in group B. Platelet count was significantly lower at the end of operation in group B than in group A but still within normal range. The EPO level increased at the end of operation and returned to preoperative level 24 h after operation in both groups, and there was no significant difference in EPO levels between the two groups. Conclusion Autotransfusion of the washes RBCs is helpful in maintaining the patients milieu interieur. There is no difference in EPO secretion and erythropoiesis between autotransfusion and homologous transfusion.

Objective To study the mortality and risk factors of death of critical patients treated in emergency department for initial stabilization and life support. Method The clinical data of 1240 critical patients from January 2005 to December 2006 were retrospectively analyzed. The patients were divided into death group and survival group. The differences of demographics, symptoms, physical signs and laboratory findings of patients between two groups were analyzed by using univariate and multivariate logistic regression analysis, sex, age, visiting time after attack, the history of chronic diseases, temperature, respiratory rate, heart rate, mean arterial pressure, respiratory dysfunction, circulatory dysfunction, hepatic dysfunction, gastrointestinal dysfunction, renal dysfunction, coagulation disorders, acid base and electrolyte disturbances, lencocyte count,platelet count, Glasgow coma scale (GCS) score and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ). Results There were higher mortality and morbidities of patients with diseases of respiratory, digestive, circulatory and nervous systems. The mortality of patients with the history of chronic diseases was higher (P < 0.01) ,and there were more patients with chronic obstructive pulmonary disease(COPD), chronic cardiac insufficiency, diabetes mellitus or cirrhosis of liver in death group (P < 0.05). The mortality of patients with 3 dysfunctional organs was 32.81%, and the mortality of lity of those with five dysfunctional organs was 76.67% . Logistic regression analysis indicated that male gender, age between 46 and 65, respiratory dysfunction, circulatory dysfunction, gastrointestinal dysfunction, hepatic dysfunction, low Glasgow coma scale (GCS) score and high APACHE II score were risk factors of the death of critical patients. Conclusions The mortality of patients with the history of critical diseases is higher. The more dysfunctional organs, the higher mortality is. Age between 46 and 65, male gender, and dysfunction of lung, circulation, gastrointestinal tract,and liver,and low CCS score and high APACHE II score are risk factors of the death of emergency and critical disease.

Objective To develop a curriculum system for social communication disorders rehabilitation in children with autism based on humanoid robot. Methods The curriculum was developed through the robot programming and the structure hierarchy of the curriculum. It was applied in three children with autism. Results and Conclusion The curriculum has been developed. All the children concentrated in the class, with few emotive disorders.

Objective: To investigate the epidemiological characteristics of 45 norovirus clusters in Baoshan District, Shanghai Municipality from 2019 to 2021, so as to provide the evidence for improving the management of norovirus clusters. Methods: The epidemiological characteristics and laboratory testing of 45 norovirus clusters were collected in Baoshan District from 2019 to 2021, and the temporal distribution, population distribution, distribution of places of norovirus clusters, clinical manifestations, laboratory testing results, origin of norovirus infection and transmission routes of norovirus clusters were analyzed using a descriptive epidemiological method. Results: A total of 45 norovirus clusters involving 29 379 individuals were reported in Baoshan District from 2019 to 2021, and 435 cases with norovirus infections were identified, with an average attack rate of 1.48%. Norovirus infection most often occurred from November to April of the following year, and the infection predominantly occurred among students (408 cases, 93.79%). There were 25 norovirus clusters in kindergartens (55.56%), 18 clusters in primary and middle schools (40.00%), one cluster in a social care facility and one cluster in a geriatric ward. Vomiting was the predominant clinical symptom (416 cases, 95.63%). The positive rate of norovirus was 37.35% in 597 samples. There were 40 norovirus clusters caused by the norovirus GⅡ genotype (88.89%), and the median duration of the norovirus cluster was 6 days (interquartile range, 1 day). In addition, 82.22% of the norovirus clusters reported to centers for disease control and prevention within 1 day,and 88.89% of the clusters were transmitted through human to human transmission or vomitus of cases. Conclusion The norovirus clusters predominantly occur in winter/spring and among students in Baoshan District from 2019 to 2021. Kindergartens and primary and middle schools are main places of norovirus infections, and the norovirus GⅡ genotype is the main type of pathogens. Human-to-human transmission and exposure to patients' vomitus are the main routes of transmission.

Objective To investigate the impacts of treating stratege for non-infarct related artery on clinical prognosis in elderly patients with acute myocardial infarction (AMI) after urgent percutaneous coronary intervention (PCI). Methods From Augst 2007 to Augst 2010,a total of 75 elderly AMI patients (aged 75 years and over) were treated by urgent PCI and confirmed as multivessel coronary disease in our hospital. Among them,30 patients received medicine combined with PCI once again (PCI group) and 45 patients received only medicine treatemt (medicine group).The major adverse cardiovascular events (MACE) and results ot coronary angiography after treatment for average one year were compared between the two groups. Results There were no significant differences in the rates of in stent restenosis[1 case(2.2 ％)vs.0 case],late loss of in-segment lumen [5 cases(11.1％)vs.3 cases(10.0％)],stent thrombosis[1 case(2.2％)vs.1 case(3.3％)] and larget vessel revascularization [2 cases (4.4 ％ ) vs.1 case ( 3.3 ％) ] between medicine group and PCI group (x2=0.00,0.00.2.03 and 0.00,all P＞0.05).The propertions of angina recurrence and second hospital admission for heart diseases were lower in PCI group than in medicine group [36 cases (80.0％)vs.14 cases(46.7％),18 cases(40.0％)vs.5 cases(16.7％),x2=9.00,4.61,P＜0.01and P＜0.05].However,no differences were found in the secondary heart failure,recurrent nonfatal myocardial infarction,severe arrhythmia,all- cause death and mortality rate of cardiovascular disease between the two groups (x2 =0.09,0.00,0.00,0.00 and 0.00,all P＞ 0.05). Conclusions Compared with single medicine therapy,the medicine combined with PCI for non- infarct-related artery may decrease the rates of angina recurrence and second hospital admission for heart diseases in elderly patients with AMI.

Curriculum integration has become the core content of the current medical education reform.With the rapid development of information technology,how to reflect the teaching and learning effects and to further improve them,is one of the difficulties in the reform of the integrated curriculum.In view of the problems of single form of assessment model,separate classroom teaching and extracurricular teaching evaluation,low utilization of network and electronic teaching resources,we make full use of network methods to carry out reform on the current formative teaching evaluation system.With the purpose of formative assessment and evaluation,the "Blackboard network teaching system" of the curriculum has been built,and the evaluation indexes of classroom teaching and extracurricular teaching have been established.And at the same time,the formative assessment index has been enriched and perfected in a diversified form,and the formative assessment model adapted to the integrated curriculum is preliminarily explored.

OBJECTIVE: To analyze the Z values of true and false positive cases by non-invasive prenatal testing (NIPT) in order to improve its accuracy in clinical practice. METHODS: Results of 24 384 NIPT tests were reviewed. For cases with high risks for trisomies 21, 18 and 13, the range of Z values in true and false positive cases was analyzed and discussed. RESULTS: A total of 335 high-risk cases were identified by NIPT, among which 256 had elected prenatal diagnosis, 153 (59.77%) were verified as true positives, and 103 (40.23%) were false positives, and the area under the curve (AUC) was 0.9994. For NIPT screening, the positive predictive value (PPV) for trisomy 21 was 100% when Z>13, regardless if the pregnant woman was over 35. When 335 and about 41.6% (5/12) for those<35. For trisomy 18, the PPV was 100% when Z>13, and only 14.3% (1/7) when 3CONCLUSION NIPT is a technique similar to prenatal diagnosis and has a high positive predictive value for trisomies 18 and 21. Proper classification and division of the high-risk Z value of NIPT can further improve the positive predictive values for trisomies 21, 18 and 13 in different intervals, and is more helpful to guide clinicians in genetic counseling for high-risk pregnant women. Meanwhile, the compliance of prenatal diagnosis in high risk NIPT pregnant women with Z value between 3~13 was improved.
Female ; Pregnancy ; Humans ; Trisomy 13 Syndrome/genetics* ; Trisomy/genetics* ; Down Syndrome/genetics* ; Chromosome Disorders/genetics* ; Trisomy 18 Syndrome/diagnosis* ; Prenatal Diagnosis/methods*

ObjectiveTo investigate the monitoring status and epidemiological characteristics of foodborne disease pathogens in Baoshan District， Shanghai so as to improve early detection and warning capabilities of foodborne diseases outbreaks， and to provide a scientific basis for the prevention and control of foodborne diseases. MethodsAnal swabs or fecal samples from food-borne diarrhea cases were collected from two sentinel surveillance medical institutions in Baoshan District of Shanghai during 2019 and 2021. Salmonella， diarrheagenic Escherichia coli， Shigella， Vibrio parahaemolyticus， campylobacter and norovirus were tested in anal swabs and fecal samples， and all the testing results were statistically analyzed. ResultsA total of 1 693 cases were reported， among which 1 693 anal swabs and fecal samples were collected， with a male-to-female ratio of 1.04∶1. The largest number of cases was from the age group of 45-64 years （504 cases）. The highest number of reported cases was among retirees （762 cases）. The high-incidence period of the diseases was in summer and autumn， with the highest number of cases associated with meat and meat products （566 cases）. The primary location of exposure was at home （1 260 cases）. The detection rate of pathogenic bacteria and virus was 21.32%， among which campylobacter accounted for the largest proportion （10.28%）. The peak incidence rate was from May to September. The detection rate of norovirus was 13.29%， with a higher incidence in winter and spring. The predominant serotype of Salmonella was Salmonella enteritidis （41.82%）， and the predominant local serotype of diarrheagenic Escherichia coli was EAEC （50.52%）. Campylobacter was mainly represented by jejuni （81.61%）， and the predominant type of norovirus was GⅡ （60.87%）. ConclusionCampylobacter has the highest proportion among foodborne pathogens causing foodborne diseases in Baoshan District， followed by diarrheogenic Escherichia coli. And norovirus GⅡ type is the predominant virus. Appropriate prevention and control measures should be taken based on the characteristics of each pathogen's epidemiology.

Objective To further strengthen the management of radiological health technical service institutions, standardize their technical service behaviors, and explore the supervision countermeasures for radiological health and technical service institutions. Methods The radiological health technical service institutions status questionnaires s were designed to survey the basic situation, professionals and technical personnel, the equipment configuration, testing items and workload of service institutions. Results By the end of 2019, there were 23 radiological health technical service institutions in Hebei province, including 8 disease control and occupational prevention institutions (accounting for 34.8%) and 15 third-party institutions (accounting for 65.2%); The distribution of regional agencies were unbalanced; There were 223 professional and technical personnel, of which 29.6% were senior technical professionals, 29.6% were intermediate technical professionals and 40.8% were other professionals.58.8% had a bachelor's degree or above, and 41.2% had a college degree or below; The majors of professionals were relatively scattered, with only 6.44% of radiological health, 5.15% of physics-related majors, and 51.07% of medical-related majors. Other majors involve chemical pharmacy, environmental engineering, public relations planning, food, English, accounting and other majors.The professional technical responsible person had no part-time job;. The institution were totally equipped with 308 sets of radiation protection detectors and 172 sets of phantoms, basically in line with the configuration requirements; All quality control system documents such as quality management manuals, procedural documents, operating procedures, and work instructions have been established; All test items applied by laboratory measurement certification have passed;Conclusion The CDC institutions were gradually shrinking, the private institutions were gradually increasing and the nature of the institutions was gradually diversified.The allocation of regional resources was unbalanced.It is suggestedto strengthen the training on the theoretical basis and professional skills of professionals in testing and evaluation. Increasing on-site practical training is a more important and effective way.It is recommended to strengthen the training of basic-level health administrative departments and supervisory agencies and improvethe sense of responsibility of supervisors.

Objective: To standardize the occupational health management of radiation workers and raise the management level and technical content for the supervision of occupational health of radiation workers. Methods: The information system for radiation worker passbook was established and applied in Hebei province for practice. Results: Until December 2018, 4 339 passbooks have been issued to radiation workers from 140 medical institutions. Through the establishment and operation of the radiation worker passbook information system, the basic information and distribution characteristics of the provincial registered medical institutions and their radiation workers in Hebei province were obtained. The efficiency of the examination and approval and issuance of radiation worker certificates by the health administrative departments was improved by reducing the intermediate procedure. Conclusions Data are obtained and provided for the discussion of electronic card management of occupational health of radiation workers, real-time query of information such as medical institutions of radiation workers, education and training, individual dose monitoring, occupational health examinations, and diagnosis and identification of occupational radiological diseases. Reference basis is provided for health administrative departments to carry out radiation worker supervision.