Background and Objective Keshan disease is clinically characterized as a dilated eardiomyopathy. We analyze the prevalence trend during last decade of hypertension and Keshan-disease in Yangzhuang village which was a Keshan-disease epidemic area.Method The survey including medical history,blood pressure and ECG were carried out every two years during the follow up 13 years.Results During follow up period,the total detection rate(hypertension:13.4 % vs Keshan-disease:10.7 %,?~2=8.555,P=0.002)and the accumulative rate of hypertension were higher than those of Keshan-disease,which was on the contrary to that before 1993,when increasing rate of Keshan-disease was higher than hypertension.Furthermore,the accumulative increasing rate of hypertension was 240.0%,which was higher than the national average level during corresponding period with no significant differences between female and male.Conclusion The detection rate of hypertension in Keshan disease epidemic area was higher than the average rate nation-wide.Whether the hypertension prevalence was re- lated to Keshan-disease needs further investigation.

Objective To evaluate the effectiveness of intravenous immunoglobulin (IVIG) in critical hand-foot-mouth disease (HFMD).Methods The data from PubMed, MEDLINE, EMBASE, EBSChost, Cochrane Library, Cochrane Central Register of Controlled Trials, Ovid, China Biology Medicine disc, Wanfang Data, China National Knowledge Infrastructure, Chinese Citation Database, and other references and grey literatures were retrieved, screening out all those related to clinical trials on treating critical HFMD by IVIG.Standard methods of the Cochrane Collaboration were employed to evaluate the methodological quality of the trials.Meta analysis was performed with Rev man 5.3 software.Results Eleven trials including 967 cases were investigated.The meta analysis showed that IVIG had significantly clinical efficacy (OR =6.84,95％ CI:3.74-12.52 ,P ＜ 0.05).IVIG could significantly decrease duration of fever (MD =-1.94,95％ CI:-3.07--0.81 ,P ＜0.05) ,hospitalization time (MD =-4.56,95％ CI:-8.95--0.17,P ＜0.05).There was no significant difference in duration of fever (MD =-0.28,95 ％ CI:-0.59-0.03, P ＞ 0.05), duration of herpes (MD =0.18,95％ CI:-0.22-0.59, P ＞ 0.05), hospitalization time (MD =-0.12,95％ CI:-0.47-0.23, P ＞ 0.05) when the dosage of injection was adjusted.Conclusions IVIG is recommended for treating critical HFMD because it is effective in decreasing the duration of fever and hospitalization.Well designed studies with more sample in multi-center are required in further study to explore the efficacy and safety of IVIG on critical HFMD.

Objeetive To explore the situation of cognition related to radio contrast-induced nephropathy in the elderly patients with the interventional thempy.Methods Self-designed questionnaire was applied and analyzed in the 80 eldedy patients with the interventional therapy.Results 96.25％of patients psychological reaction of nervousness when they were told the interventional therapy earl canae radio contrast-induced nephropathy and hoped to acquire the healthy education.81.25％of patients were fond of individualeducation.Condusions The elderly patients with the interveutional therapy are lack of the knowledge related toradio contrast.induced nephropathy and have the psychological reaction of nervousness and anxiety.The nllles should adopt the suitable education style,execute the healthy education on purpose and help the patients to obey the therapy.thus can prevent and decrease the radio contrast-induced nephropathy.

Objective To investigate the psychological effects of different hydration proposal in elderly who received interventional therapy in order to find out the best hydration proposal for the elderly. Methods A total of 80 patients who were plan to receive interventional therapy were enrolled and divided randomly into traditional proposal group and improvement proposal group according to hydration proposal, questionnaire investigation were carried out in all the patients on operation day by SAS and SDS. Results The two proposal showed the same protective effect against radiographic contrast nephropathy (P > 0. 05), but the patients who received the traditional proposal score much higher in SDS and SAS questionnaire investigation (P < 0. 01). Conclusions The oral hydration proposal using n-acetyl-l-cysteine have good effects on radiographic contrast

China ; epidemiology ; Deficiency Diseases ; epidemiology ; Health Status ; Humans ; Iodine ; deficiency

Objective To explore the correlation between serum hepatitis B virus (HBV) X antigen/antibody (HBxAg-wild/HBxAb-wild,and HBxAg-mutant/HBxAb-mutant) and the disease progression in patients with chronic HBV infection.Methods A direct enzyme immunosorbent asssay (ELISA) was performed to detect HBxAb using recombinant antigen,and a double antibody sandwich ELISA assay to detect HBxAg using monoclonal antibody and specific rabbit polyclonal antibody.HBxAg-wild/HBxAb-wild and HBxAg-mutant/HBxAb-mutant were tested in sera from cases at different stages of chronic HBV infection.A chi-square test was employed to examine statistical significance.Results The positive rates of HBxAg-wild and HBxAg-mutant in the chronic asymptomatic HBV carriers,chronic hepatitis,hepatitis B-related cirrhosis and liver cancer were 6.2％ (2/32),10.7％ (3/28),28.6％ (6/21),43.6％ (17/39) and 3.1％ (1/32),10.7％ (3/28),33.3％ (7/21),48.7％ (19/39),respectively.The positive rates of HBxAb-wild and HBxAb-mutant in the above mentioned groups were 6.2％ (2/32),21.4％ (6/28),38.1％ (8/21),53.8％ (21/39)and 6.2％ (2/32),25.0％ (7/28),42.9％ (9/21),61.5％ (24/39) respectively.The positive rates of HBxAg-wild and HBxAg-mutant were not significantly different among the above groups (x2 =0.871,0.780,0.565 and 0.317,respectively; all P＞0.05) ; The positive rates of HBxAb-wild and HBxAb-mutant were also similar among all the groups (x2 =0.780,0.709,0.580 and 0.210,respectively; all P＞0.05).The positive rates of HBxAg-wild,HBxAb-wild,HBxAg-mutant,HBxAb-mutant in patients with low viral loads (HBV DNA＜1 × 104 copy/mL) were 36.5％ (23/63),44.4％ (28/63),42.9％ (27/63) and 54.0％ (34/63),respectively,those in patients with high viral loads (HBVDNA≥1×104 copy/mL) were 8.8％ (5/57),15.8％ (9/57),5.3％ (3/57) and 14.0％ (8/57),respectively.The positive rates of HBxAg and HBxAb were significantly higher in cases with low viral loads than those with high viral loads (x2 =12.869,11.522,22.556 and 20.976,respectively; all P＜0.05).The positive rates of HBxAg-wild,HBxAb-wild,HBxAg-mutant,HBxAb-mutant in the HBeAg positive group were 21.7％ (18/83),30.1％ (25/83),22.9％ (19/83) and 32.5％ (27/83),respectively,while those in the HBeAg negative group were 27.0％ (10/37),32.4％ (12/37),29.7％ (11/37) and 40.5％ (15/37),respectively.No significant difference of HBxAg/HBxAb positive rates between HBeAg positive group and HBeAg negative group was noticed (x2 =0.408,0.064,0.638 and 0.722,respectively; all P＞0.05).Conclusions The antigenicity and specificity of HBV X protein remains similar after the occurrence of A1762T/G1764A double mutant in X gene.It is also found that the positive rates of HBxAg and HBxAb increase with disease progression.HBxAg/HBxAb might be promoting factors for tumorigenesis in chronic HBV infection.HBxAg and HBxAb might have negative influence on HBV replication.

Objective To evaluate the effect of iodine supplementation on improvement of developmental quotient (DQ) at the critical period of infant brain development.Methods Pregnant,lactating women and infants less than 3 years old were supplemented with iodized oil in Linxia Hui Autonomous Prefecture(Linxia Prefecture) Gansu Province in 2006-2010.Before and after the intervention(2006,2007-2010),five townships were randomly selected in the north,the south,the east,the west and the center of eight counties(cities) of Linxia.One village was chosen from each of those townships and 20 infants,20 pregnant women and 20 lactating women were randomly selected in each village(insufficient was made up from the neighboring villages).Urinary iodine(UI) level of the infants,pregnant and lactating women were determined by arsenic cerium catalytic spectrophotometry.DQ value of infants was measured before and after supplementation of iodized oil in 2006 and 2010.UI value of pregnant,lactating women and infants was monitored every year after iodine supplementation.Results Before iodine supplementation(2006),the median UI level of pregnant,lactating women and infants was 89.28,84.85,107.3 μg/L,respectively.After iodine supplementation,the medians UI level in 2007,2008,2009 and 2010 were,respectively,pregnant women:136.0,187.8,118.2,175.8 μg/L; lactating women:135.2,159.8,187.5,163.5 μ g/L; infants:139.6,174.7,190.7,168.4 μg/L.Before iodine supplementation,the DQ value of infants was 92.8 ± 16.3,and the average score of gross motor,fine motor,adaptive capacity,language and social behavior was 93.7 ± 20.0,91.4 ± 20.0,92.4 ± 19.0,90.3 ± 20.0,96.4 ± 22.1,respectively.After iodine supplementation,the DQ value of infants was 104.3 ± 13.8,and the average score of gross motor,fine motor,adaptive capacity,language and social behavior was 104.8 ± 21.5,104.1 ± 17.2,104.8 ± 16.1,99.9 ± 19.1,108.0 ± 22.7,respectively,which were higher than that before iodine supplementation (t =-10.43,-10.77,-13.78,-14.28,-9.96,-15.33,all P ＜ 0.01).Conclusions Iodine deficiency at the critical period of brain development can affect the intellectual development of infants and young children at all functional areas of intelligence.Iodine supplementation at the critical period of brain development can prevent mental retardation caused by iodine deficiency disorders.

Objective:To construct the molecular transmission network of human immunodeficiency virus type 1 (HIV-1) epidemic strains in northern Zhejiang Province (Jiaxing City and Huzhou City) and to explore the HIV-1 transmission characteristics in this region.Methods:A total of 371 newly diagnosed human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in Jiaxing City and Huzhou City in 2017 were included as study subjects, and the blood samples were collected and the basic demographic and epidemiological information were obtained. RNA in plasma was extracted, and the pol region gene sequence was amplified by reverse transcriptase polymerase chain reaction (RT-PCR) and nested polymerase chain reaction (PCR) to construct phylogenetic tree for identifying subtypes. The pairwise genetic distances were calculated, and the optimal threshold of genetic distance was selected, and finally the molecular transmission network was constructed. Chi-square test was used for statistical analysis. Results:The pol region gene sequences of 336 samples were successfully obtained, and 11 subtypes were detected, mainly including circulating recombinant form (CRF)07_BC (40.8%, 137/336) and CRF01_AE (31.2%, 105/336). Based on the 1.0% genetic distance threshold, the molecular transmission network of HIV-1 was plotted. A total of 38 transmission clusters (cluster sizes ranging from two to 28) including 119 patients were found, with males predominantly (82.4%, 98/119) and most of the patients aged over 40 (include 40) years old (52.9%, 63/119), mainly infected with CRF07_BC subtype (57.1%, 68/119) and CRF01_AE (24.4%, 29/119). The clustering rate of CRF07_BC (49.6%, 68/137) was significantly higher than that of CRF01_AE (27.6%, 29/105), the difference was statistically significant ( χ2=5.27, P=0.022). Two large clusters C1 (28 cases) and C2 (11 cases) were identified, the majority of which were men who have sex with men (17 cases and seven cases, respectively). High-risk cases generally sought sexual partners in local or nearby cities through mobile phone dating software, of which the infected sequences mostly had high homology with other economic developed regions (Guangdong Province, Beijing City and Hangzhou City, etc.). Conclusions:The HIV-1 subtypes are diverse in Jiaxing City and Huzhou City, mainly CRF07_BC and CRF01_AE. The HIV-1 transmission networks are complex, among which high-risk cases may be the key factor leading to the HIV-1 epidemic in the region. Therefore, it is urgent to deepen the transmission network monitoring and formulate timely precise intervention and prevention strategies.

Objective To explore the clinical pathway of operable and evaluable psychological nursing for elderly patients so as to improve the psychological nursing competence of duty nurses.Methods Sixty elderly patients were randomly divided into control group( n =30 cases) which received traditional psychological nursing and pathway group( n =30 cases) which received psychological nursing in clinical pathway.Then,patients' satisfaction to psychological nursing service and the effect of psychological nursing pathway on competence of duty nurses were compared.Results The rate of emotional attention in nurses,psychological nursing content,mastery of relax skill,mental support feeling and patients' satisfaction in pathway group was 96.67％,86.67％,93.33％,100％,respectively,which were higher than 63.33％,36.67％,6％,36.67％,80％in control group,and difference was statistically significant (x2 =10.42,15.86,45.06,27.80,4.04,respectively;P ＜0.05 or P ＜0.01 ).The score of health education,assessment and intervention,communication and cooperation of nurses after clinical pathway application of psychological nursing respectively was (94.00 ±0.42),(87.61 ±7.09),(98.40 ±0.69) significantly higher than (92.80 ±0.49),(61.3.0 ±9.50),(93.70 ±1.24) before application (t =11.76,14.04,20.95,respectively; P ＜ 0.05 ).Conclusions Application of psychological nursing pathway is good for improving competence of nurses and promoting psychological nursing service in geriatric internal medicine wards.

OBJECTIVETo study the prediction value of age and congestive heart failure (CHF) for occurrence of multiple organ dysfunction syndrome elderly(MODSE) in old patients with hypertension.

METHODSMedical history of 19,996 cases (aged over 60 year) admitted to PLA General Hospital because of hypertension or developing hypertension during hospital stay from Jan 1993 to Dec 2008 were analyzed retrospectively. According to age the patients were divided into four groups: 60-69 year group; 70-79 year group; 80-89 year group; > or = 90 year older group. The incidence of CHF and the morbidity of MODSE induced by CHF at different ages and different boundary ages were investigated.

RESULTS1. The incidence of MODSE in CHF cases was higher than that in the non-CHF cases (7.43% versus 3.05%, Chi(2) 195.15, P < 0.01), showing CHF were the important factor in happening of MODSE. 2. The incidence of CHF and the morbidity of MODSE were 10.60% versus 18.88% versus 30.11% versus 60.57%, P <0.05, P < 0.05 and 1.6 versus 7.0 versus 17.08 versus 25.47% , in 60-69 year group; 70-79 year group; 80-89 year group; > or =90 year older group, P < 0.05. Occurrence of CHF and that of MODSE were positively correlated with age (r = 0.696 - 0.987, P < 0.01). High risk population of MODSE induced by CHF were old patients with hypertension above 69 year old.

CONCLUSIONThe age is valuable for early prediction of MODSE induced by CHF in old patients with hypertension. The distinctly boundary age for the incidence of MODSE induced by CHF in old patients with hypertension is 69.

Age Factors ; Aged ; Aged, 80 and over ; Female ; Heart Failure ; epidemiology ; Humans ; Hypertension ; complications ; Incidence ; Male ; Middle Aged ; Multiple Organ Failure ; epidemiology ; Retrospective Studies