Objective To study the seasonal characteristics of cholera, Hepatitis A, bacillary dysentery, kidney syndrome hemorrhagic fever (HFRS), and epidemic encephalitis B and rabies in Nanchang from 1998 to 2007. Methods The seasonal characteristics and the peak morbidity time distribution were analyzed respectively by the Concentration degree analysis and the Circular distribution. Results In terms of seasonal characteristics, cholera was strictly and epidemic encephalitis B stronly distributed, while bacillary dysentery had some indicdtions and Hepatitis A and HFRS were not obvious. All the above diseases had their peaks: cholera on August 3, and epidemic encephalitis B on July 8.95% of credible time zones were from June 12 to August 24 and April 24 to September 21 respectively. Conclusions Hygienic publisizing and disease surveillance should be strengthened, especially during morbidity peak time.

Objective To investigate correlations of hyperuricemia and matrix metalloproteinase -9 level with left ventricular remodeling in patients with type 2 diabetes and the clinical effect of intervention for hyperuricemia.Methods 100 type 2 diabetic patients with hyperuricemia in our hospital from June 2011 to June 2012 were selected as hyperuricemia group,50 type 2 diabetic cases with normal uric acid were considered as DM group.Levels of blood glucose,blood lipids,glycosylated hemoglobin and matrix metalloproteinase-9 were detected.All patients underwent echocardiography.Patients in hyperuricemia group were randomly divided into treatment group (receiving allopurinol and alkaline urine-alkalify therapy added to hypoglycemic treatment,n=50) and control group (receiving hypoglycemic treatment,n=50).After 6 months of treatment,levels of blood glucose,blood lipids,glycosylated hemoglobin,matrix metalloproteinase-9 and echocardiography were rechecked.Results The levels of triglyceride (TG),blood uric acid,MMP-9,left ventricular posterior wall thickness (LVPWT),interventricular septal thickness (IVST) and left ventricular mass index (LVMI) were increased in hyperuricemia group versus DM group[(2.3±0.5) mmol/L vs.(1.6±0.30) mmol/L,(498.9±32.5) μmol/L vs.(322.8±35.6) μmol/L,(765±38) g/L vs.(420±26) pg/L,(11.0±1.1) mm vs.(9.2±0.8) mm,(11.5±1.6) mm vs.(10.1±1.1) mm,(138.7±35.6) g/m2 vs.(115.0±10.4)g/m2,t=4.945,5.124,4.895,3.985,3.965,3.989,respectively,all P＜0.05].Levels of TG,blood uric acid,MMP,LVPWT,IVST were decreased in treatment group after treatment versus before treatment [(1.6±0.5) mmol/L vs.(2.3±0.6) mmol/L,(323.0±30.5) μmol/L vs.(496.6±32.6) μmol/L,(766±34) pg/L vs.(410±25)pg/L,(9.1±0.8) mm vs.(11.0±1.1) mm,(9.2±1.1) mm vs.(11.6±1.5) mm,(116±10.5)g/m2 vs.(138.8±35.2) g/m2,t=3.386,4.525,4.865,3.256,3.895,3.985,all P＜0.05].Correlation analysis showed that LVMI had positive correlations with levels of blood uric acid,TG,MMP-9 (r=0.435,0.348,0.356,respectively).Conclusions Hyperuricemia involves in left ventricular remodeling,and therapeutic intervention on the hyperuricemia can reverse this remodeling.

Objective To evaluate the X-ray diagnosis value of intestinal malrotation in adults.Methods The X-ray findings of 16 cases with intestinal malrotation confirmed by surgery were analyzed retrospectively. All of them were taken X-ray plain films, 11 cases were taken alimentary tract barium meal,and 5 cases were taken barium enema. Results Eight cases were found incomplete obstruction of the duodenum, and 2 cases were found low small intestine obstruction on the X-ray plain films. The alimentary tract barium meal showed 4 cases with dilatation and incomplete obstruction of the duodenal bulb to horizontal segment,and the distal end of narrowing intestine appeared as a rat tail,7 cases showed the abnormal duodenal location and shape,called "strip" sign. Four cases were found abnormal duodenojejunal flexure by barium enema examination. Conclusion The alimentary tract barium meal and barium enema examination has great diagnosis value for intestinal malrotation in adults.

Objective To investigate the effects of Sacubitril/Valsartan on amino terminal probrain natriuretic peptide (NT-proBNP),high sensitivity C-reactive protein (hs-CRP),soluble suppression of tumorigenicity 2(sST2)levels and on left ventricular(LV)structure in NYHA Ⅳ heart failure with reduced ejection fraction(HFrEF) patients.Methods A total of 67 HFrEF patients with NYHA Ⅳ were randomly divided into the control group (n =30)receiving conventional medical treatment,and the observation group(n=32)receiving Sacubitril/Valsartan instead of ACEI(or ARB if ACEI induced cough) in conventional medical treatment.NT-proBNP levels were determined by fluorescer-enhanced chemiluminescence.hs CRP levels were detected by latecx enhanced immunoturbidimetric assay.sST2 levels were determined by enzyme-linked immunosorbent assay (ELISA).The modified Simpson method was used to detect left ventricular end-diastolic diameter (LVEDD),LV posterior wall(LVPW)and LV ejection fraction(LVEF).Two groups of patients were treated and followed-up for 6 months.Results Clinical efficacy was better in the observation group than in the control group(effective rate,20 cases or 61.3％ vs.8 cases or 26.7％,P＜0.05).As compared with the control group,the observation group of patients had an increased LVEF[(46.7±9.2) ％ vs.(41.8±8.0)％,P＜0.05]and a decreased LVEDD[(52.6±6.7)mm vs.(58.8±7.5)mm,P＜0.05].After vs.before treatment,NT-proBNP,hs-CRP and sST2 levels were decreased in both control and observation groups [(1 427 ± 219) μg/L vs.(2 615 ± 273)μg/L,(1.14 ± 1.02) mg/L vs.(1.55±1.38)mg/L,(0.30±0.12)μg/L vs.(0.41±0.10)μg/L,all P＜0.05],and the decrements were much more in the observation group than in the control group (P＜0.05).The annual accumulated frequence and duration of hospitalization were less in the observation group than in the control group[(0.8±0.6)times vs.(1.8±1.0) times,(10.2±5.8)d vs.(16.5±7.2)d,P＜0.05].The maintenance dose of tolasemide was lower in the observation group than in the control group [(15.2±8.4)mg vs.(20.6±10.8)mg,P＜0.05].Conclusions Sacubitril/valsartan therapy is safe and effective and it can reduce hs-CRP and sST2 levels and improve the ventricular remodeling in HFrEF patients of HYHA Ⅳ.

At present medical disputes still happen sometimes though governments at all levels, health departments and hospitals pay more and more attention to correctly guide patient's behavior, regulate doctor's behavior in diagnosis and treatment, purify therapeutic environment, strengthen legislation and protect the legitimate rights and interests of doctors and patients. The causes of medical disputes are great many, and the fundamental reason is that the medical behavior from the beginning to the end is related to the life and health, naturally accompanying medical risk and hiding dispute, therefore what we ought to do is not to absolutely eliminate the risk, but to reduce the risks and disputes. In this report, to explore the causes of medical disputes and risks and look for ways to reduce them, the survey of questionnaires was carried out and practical cases of medical disputes were analyzed in hospitals. Seventy-seven cases of medical disputes from 2013 to 2015 had been completed by arbitration or court decisions, and the final arbitral ideas were as follows: invalid doctor-patient communication, low technology and insufficient management were the main causes of medical disputes; the survey of 483 questionnaires on doctors and nurses in the hospital showed that in addition to the above 3 reasons, there were other deep reasons, namely heavy working intensity, low quality of patients or their family members, and the insufficient management runs through all the links in the way. Therefore, to reduce medical disputes, the following aspects should be commenced: effective communication between doctors and patients; improving doctors' clinical diagnosis and treatment ability; optimizing medical management; correcting medical work attitude;timely medical consultation; attaching importance to medical records; doctor's order leaving some leeway or allowing for unpredictable circumstances; constructing healthy hospital culture; paying attention to the physical and mental health of medical staff; actively improving the medical dispute settlement mechanism and related legal system construction.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.