Objective To study the disease trend of Keshan in Hubei Province and provide a basis for scientifically making control and prevention strategy.Methods According to Chinese Surveillance Plan of Keshan Disease,physical examination and electrocardiogram were done for surveillance subjects and suspected patients were filmed chest X-ray in Keshan disease areas.Results Totally 4 822 people were monitored from 2007-2014.The numbers of females (2 589,53.69％) were more than those of the males (2 233,46.31％).The group of people under the age of 15 accounted for 52.47％ (2 530/4 822) which was higher than that of the group over the age of 55 (19.14％,923/4 822).The rate of electrocardiographic abnormality was the highest in 2011 (61.33％,268/ 437) and the lowest in 2014 (5.61％,23/410).In the eight years,only potential type of Keshan disease patients were detected,and the incidences from 2007 to 2014 were all lower than 3％ and had a decreasing trend yearly.No Keshan patient was detected in 2012-2014.Ninety-one suspected cases were taken chest X-ray.Most of the suspected cases (63.74％,58/91) had normal cardiothoracic ratio.The cardiothoracic ratio increased,excepting one,other 32 were all potential type Keshan disease patients.Conclusions The disease trend of Keshan disease in Hubei Province is weak.Nevertheless,surveillance and health education are indispensable,in case the disease relapses.

Objective To explore three nutritional support mode in early stage on curative effect and outcome in the severe patients with mechanical ventilation and provide references for the clinic.Methods A total of 90 patients with mechanical ventilation from February 2009 to December 2011 were randomly divided into group A,B and C with 30 cases in every group,and were recevied parenteral nutrition(PN),enteral nutrition(EN)and combined enteral and parenteral nutrition(CEPN),respectively.The nutrition indexes,the immune indexes and the level of plasma endotoxin were mensurated in the 1st day and the 7th day after mechanical ventilation.The complications and the condition changes were carefully observed.Results Among 90 cases,57 cases were successfully detached from the respirator,at early stage,25 cases died,32 cases had complicatinns.All the observation indexes including nitrogen balance,albumin,IgA,IgG,the level of plasma endotoxi,the cases with complication,and the cases detached from respirator were recorded in the 7th day after mechanical ventilation,group A(PN):(2.3±1.2)g/d,(30.6±2.7),(1.4±0.5),(7.8±2.1) g/L,(37.1 ±6.3) pg/ml,17 cases,13 cases; group B(EN):(4.2 ±0.5) g/d,(33.5 ±1.8),(2.5 ±0.3),(13.6 ±1.5) g/L,(49.7 ±7.3) pg/ml,9 cases,21 cases,group C(CEPN):(5.8 ±0.8) g/d,(35.8 ±1.7),(2.5 ± 0.2),(13.9±1.7) g/L,(50.3 ±7.1) pg/ml,23 cases,6 cases.The differences between all the observation indexes in group B and C were superior to group A,which showed statistically significant difference(P ＜0.05).The difference of nutrition indexes and the incidence of complication was statistically significant between group C and group B (P ＜ 0.05 ).Conclusions EN combined with PN is an reasonable and effective nutrition support mode for patients with mechanical ventilation. It can improve the curative effects,and reduce the incidence of complication.

Objective To analyze the prevalence rate of diabetic nephropathy (DN) and the related factors on DN among type 2 diabetic patients.Methods A total number of 1758 type 2 diabetic patients who were hospitalized in the Beijing Hospital from 2003 to 2010 were analyzed retrospectively.Three groups were divided according to the rate of urinary albumin excretion (UAER).Patients whose UAER＜20 μg/min belonged to normal albuminuria (NA) group.The ones whose UAER from 20 to 200 μ g/min belonged to microalbuminuria (MA) group,and the others whose UAER≥200 μg/min belonged to large albuminuia (LA) group.The clinical characteristics were then compared.The related factors of DN were analyzed.Results (1)There were 1246 patients in NA group,408 patients in MA group,and 104 patients in LA group.The constituent ratio of nephropathy was 29.1％ (2) The ages of NA group,MA group and LA group were (59.87± 12.77,62.52± 12.74,64.44 ± 12.74) years old,respectively,with body mass index ( BMI ) as (24.90 ± 3.42,25.53 ± 4.00,25.53 ± 3.91 )kg/m2 respectively; duration of diabetes as (8.39 ± 7.12,10.77 ± 8.02,12.84 ± 7.97)years; systolic blood pressure (SBP) as (133.42 ± 18.19,142.72 ± 20.21,151.12 ± 21.91 )mm Hg;diastolic blood pressure as (78.75 ± 10.66,80.79 ±12.21,83.33 ±13.61 )mm Hg; fasting blood suger (FBS) as (8.25±3.43,9.02±3.72,9.22±4.62)mmol/L; glycated hemoglobin(HbAlc) as (8.88±2.10,9.34 ± 2.36,9.10 ± 2.36)％ ; uric acid (UA) as (288.04 ± 90.41,307.23 ± 96.96,374.28 ±105.47) mmol/L; triglyceride as (1.72 ± 1.51,2.06 ± 1.88,1.94 ± 1.42) mmol/L,high density lipoprotein cholesterol as ( 1.08 ± 0.30,1.02 ± 0.29,1.07 ± 0.28) mmol/L; fasting insulin as (9.24 ±9.02,11.24 ± 9.74,11.06 ± 9.29) μU/ml; fasting C peptide as (462.31 ± 289.94,510.02 ± 350.08,595.93 ± 445.86) pmol/L.There were significant differences between NA,MA and LA groups in all above items ( P ＜ 0.01 or P＜ 0.05 ).( 3 ) Logistic regression analysis showed that DN were related with duration of diabetes,BMI,SBP,HbAlc,FBS,UA (OR values were 1.041,1.055,1.028,1.116,1.100,1.004 respectively,P＜0.05 or P＜0.01 ).Conclusion It would be helpful to prevent and retard progression of DN that comprehensively controlling high blood glucose,hypertension,hyperuricemia and body weight of type 2 diabetic patients.

BACKGROUNDThe decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS). But the gap between artery stenosis and the glomerular filtration ability is still unclear.

METHODSPatients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate (eGFR), respectively. The different levels of eGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them.

RESULTSA total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50%) and no RAS group (RAS < 50%) or did not change correspondingly to RAS severity. The value of eGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR, with strong (r = -0.713, P < 0.001) and moderate (r = -0.580, P < 0.001) correlations. In the subgroup analysis of severe RAS (RAS ≥ 80%), the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, (r = -0.827, P < 0.001) and (r = -0.672, P < 0.001) correlations, respectively.

CONCLUSIONSSeverity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.

Aged ; Female ; Glomerular Filtration Rate ; physiology ; Humans ; Male ; Microcirculation ; physiology ; Middle Aged ; Prospective Studies ; Renal Artery Obstruction ; physiopathology ; Retrospective Studies

Objective To investigate the immunoregulatory effect of sirolimus on the xenotransplantation with arterial patch. Methods The xenotransplantation of arterial grafts was taken from the wild-type Bama pigs to cynomolgus monkeys. The peripheral blood mononuclear cells of recipient monkeys at 14 days after xenotransplantation (POD14) were selected as subjects. Dimethyl sulphoxide (DMSO) was used in the control group (volume ratio of 1:1 000) and sirolimus was administered in the sirolimus experimental group (final concentration of 0.1 μmol/L and 0.5 μmol/L). The cells were cultured for 1.0 and 5.5 d, respectively. The activity of POD14 cells was evaluated. The DMSO control and sirolimus experimental groups (final concentration of 0.1 μmol/L) were established and cultured for 5.5 d. The quantity of T and B cells in POD14 cells was counted and the expression levels of cytokines and messenger RNA (mRNA) were quantitatively measured. Results Compared with the DMSO control group, the activity of POD14 cells was significantly decreased after sirolimus treatment at a final concentration of 0.1 and 0.5 μmol/L for 1.0 d (P<0.01-0.001). After sirolimus treatment at a final concentration of 0.1 and 0.5 μmol/L for 5.5 d, the activity of POD14 cells was significantly decreased (both P<0.001). Compared with the DMSO control group, the quantity of CD3+CD4+T cells and CD3+CD8+T cells in POD14 cells was significantly reduced after sirolimus treatment at a final concentration 0.1 μmol/L (P<0.05-0.01), whereas the quantity of CD3-CD20+B cells was considerably elevated (P<0.01). Compared with DMSO control group, the levels of interferon(IFN)-γ, interleukin(IL)-2, IL-4, IL-5 and IL-6 in the sirolimus experimental group were significantly down-regulated (P<0.05-0.001). The expression levels of IFN-γ, tumor necrosis factor(TNF)-α, IL-2, IL-4, IL-5 and IL-6 mRNA were significantly down-regulated (P<0.05-0.001). Conclusions Sirolimus inhibits the proliferation of POD14 cells in the recipient monkeys after xenotransplantation with arterial patch. The underlying mechanism is that the sirolimus can reduce the quantity of T cells and suppress the expression and secretion of immune rejection-related cytokines.

AIMTo explore whether hypoxic response and breath holding at sea level could predict acute mountain sickness (AMS).

METHODS113 men aged (19 +/- 1) years took part in this study. Blood oxygen saturation (SaO2), heart rate and blood pressure were measured during the course of breathing 10% O2 for 10 minutes and breath holding. Two days later after reaching Lasa (3 658 m altitude) by air, the symptomatic scores of AMS were evaluated. Then the relations between them were analyzed.

RESULTSThe SaO2 reduced progressively and the heart rate speeded up, while the blood pressure represented increase at first and then decrease within 10 min during the short-term hypoxia. The heart rate was lower during short-term hypoxia in subjects who developed AMS than in subjects doing well. But significant reverse correlation existed only between AMS scores and heart rate at 7th min after hypoxic breathing (r = -0.176).

CONCLUSIONLimited information can be gained on AMS score by assessing physiological responses to short-term hypoxia and breath holding at sea level.

Acute Disease ; Adolescent ; Altitude Sickness ; diagnosis ; physiopathology ; Breath Holding ; Humans ; Hypoxia ; diagnosis ; physiopathology ; Inhalation ; Male ; Pulmonary Gas Exchange ; Young Adult

Objective To investigate the clinical distribution and antimicrobial resistance of carbapenem-resistant Enterobacteriaceae (CRE) in Dongguan.Methods CRE isolated from hospitalized patients in 22 secondary and above medical institutions which participated in bacterial monitoring in Dongguan between January 2015 and June 2016 were retrospectively analyzed,antimicrobial resistance was analyzed by WHONET 5.6 software.Results A total of 71 CRE isolates were detected,with a isolation rate of 0.34％ (71/20 713).53 strains(74.65％) of CRE were isolated from patients aged 15-60 years old;46 (64.79 ％) were from male patients;CRE were mainly isolated from patients in intensive care unit(36 strains,50.70 ％);the main specimen was sputum(34 strains,47.89 ％),followed by urine (11 strians,15.49 ％) and wound secretion(6 strains,8.45 ％);the main infection type was healthcare associated infection (64 strains,90.14 ％);CRE were mainly distributed in tertiary hospitals(56 strains,78.87 ％),the isolation rate of CRE in tertiary and secondary hospitals were 0.41 ％(56/13 677)and 0.21％(15/7 036) respectively.71 strains of CRE were all resistant to imipenem,resistance rate to meropenem was 81.12％,only amikacin and tobramycin had drug resistance rates of ＜40％ (21.38％ and 38.79％ respectively),resistance rate to trime thoprim/sulfamethoxazole was 48.23 ％,while resistance rates to fluoroquinolones,third-generation cephalosporins,and enzyme inhibitors were all＞60.Conclusion The isolation rate of CRE in Dongguan is lower than that of the whole nation and the other provinces,effective prevention and control measures should be taken according to the key population and departments that isolated CRE,antimicrobial use should be rational.

OBJECTIVETo investigate the polymorphisms of myeloid differentiation-2 (MD-2) gene promoters, and to explore whether such polymorphisms are associated with the susceptibility to multiple organ dysfunction syndrome (MODS) and sepsis in Chinese Han population.

METHODSUsing polymerase chain reaction-restriction fragment length polymorphism method, the authors detected the single nucleotide polymorphisms of the promoter region of MD-2 gene at position - 1625C/G in 105 severe trauma patients (42 with sepsis). The organ function was scored.

RESULTSThe frequency of CC genotype in MD-2 gene promoter region at position - 1625 was 0.5 (21/42) in septic patients and 0.7 (44/63) in non-septic patients. The frequency of CG genotype was 0.38 (16/42) in septic patients and 0.27 (17/63) in non-septic patients. The frequency of GG genotype was 0.12 (5/42) in septic patients and 0.03 (2/63) in non-septic patients. The MODS scores in trauma patients carrying G allele at position - 1625 were significantly higher than those carrying C allele (P<0.001 for dominant effect, and P>0.05 for recessive effect). Moreover, trauma patients carrying G allele appeared to have higher risk of sepsis comparing to those carrying C allele (OR 0.477, 95% CI 0.266-0.855, P<0.05). Sepsis morbidity was significantly different between subjects with C and G alleles (P<0.05 for dominant effect, P>0.05 for recessive effect).

CONCLUSIONSThe polymorphisms of the promoter region of MD-2 gene at position - 1625 C/G is correlated with MODS and sepsis after severe trauma in Chinese Han population. The people with - 1625 G allele in the promoter region of MD-2 gene may be a risk factor of severe complications.

Asian Continental Ancestry Group ; China ; Genetic Predisposition to Disease ; Humans ; Lymphocyte Antigen 96 ; genetics ; Multiple Organ Failure ; etiology ; genetics ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Sepsis ; etiology ; genetics ; Wounds and Injuries ; complications ; genetics

Objective Through the unified and standardized management of the rescue vehicle,to ensure rescue items complete integrity, fast and effective.Methods Standard configuration in emergency medicine,placement,storage,registration of all aspects evaluate were unified Results The time for rescuing and counting stuffs,satisfied degree of doctors and valid time of medicine were significantly improved after quality control(P<0.01).Conclusions Standard management of the rescue vehicles could ensure medicines fast.safe and effective.It is worthy of clinical application widely.

BACKGROUNDA multi-center large scale study is needed to confirm the efficacy and safety of domestic peritoneal dialysis (PD) solutions. Some researchers believe that 6 L/d is enough for adequate dialysis, but there is no multi-center prospective study on Chinese population to confirm this. In this study, we evaluated the efficacy and safety of domestic PD solution (Changfu) and its difference between 6 L and 8 L dosage.

METHODSAdult PD patients who had taken PD therapy for at least one month were selected and divided into four groups according to two dialysis solution brands and two dialysis dosages, i.e., 6 L dose with Changfu dialysis solution, 6 L dose with Baxter dialysis solution, 8 L dose with Changfu dialysis solution, and 8 L dose with Baxter dialysis solution. After 48 weeks, the changes of primary and secondary efficacy indices were compared between different types and different dosages. We also analyzed the changes of safety indices.

RESULTSChanges of Kt/V from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of creatinine clearance rate (Ccr). Normalized protein catabolic rate (nPCR) from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of net ultrafiltration volume (nUF) and estimated glomerular filtration rate (eGFR). Changes of nPCR from baseline to 48 weeks between 6 L and 8 L showed no statistical differences; so did those of nUF and eGFR. The decline of Kt/V from baseline to 48 weeks in 6 L group was more than that in 8 L group. Change of Ccr was similar. During the 48-week period, the mean Kt/V was above 1.7/w, and mean Ccr was above 50 L×1.73 m(-2)×w(-1). More adverse events were found in Changfu group before Changfu Corporation commenced technology optimization, and the statistical differences disappeared after that.

CONCLUSIONSThe domestic PD solution (Changfu) was proven to be as effective as Baxter dialysis solution. During 48-week period, a dosage of 6 L/d was enough for these patients to reach adequate PD. Clinical study promotes technological optimization, further helps to improve the safety indices of the medical products.

Adolescent ; Adult ; Aged ; Dialysis Solutions ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis ; methods ; Young Adult