Objective To discuss the utility of lean management in the informationalization of health check-up.Methods A total of 2125 matched adults who received health check-up from April to July 2008 (n =1001) or 2012 (n =1124) were enrolled by using random sampling.Time of health check-up registration and laboratory sheet filling,preparation of final report,consumption of labor force,and integrity of data collection were compared before and after the conduction of lean management.Results Since lean management startup,time of registration was decreased from (250.0 ± 7.7) to (7.8 ± 0.9) min/100persons,time of sheet filling was reduced from (137.0 ± 10.6) to (26.0 ± 2.9) min/100 persons,preparation of final report was less time-consuming ((702.0 ± 11.7) vs.(300.0 ± 12.6) min/100persons).The integrity and accuracy of health check-up reports were significantly improved (67.0％ vs.99.2％).Newer health check-up receivers were increased from 17.8％ to 29.4％ (x2 =461.944,P ＜0.05).Conclusion Lean management may be feasible and effective in the informationalization of health check-up.

Objective To investigate the risk factors,clinical prediction and intrapartum management of shoulder dystocia in non-macrosomia.Methods Totally 7 811 cases of vaginal delivery were retrospectively reviewed from Juanary 2009 to December 2013 in Shengjing Hospital.Shoulder dystocia was found in 11 cases (0.14％,11/7 811),including 1 case of macrosomia and l0 cases of non-macrosomia (shoulder dystocia group).Each non-macrosomia shoulder dystocia case was matched with 10 cases of normal delivery in the same week,which were selected randomly as the control group.The tendency and risk factors of shoulder dystocia in macrosomia and non-macrosomia were analyzed,and the following data between the two groups were compared,including the height of uterus fundus,abdominal circumference of the pregnant woman,the increasing of body mass index(BMI),fetal biparietal diameter (BPD),fetal femur length (FL),duration of every stage of labor,birth weight of the newborn,head circumference and chest circumference of the newborn,Apgar score.Results (1) There were 213 macrosomias among the 7 811 vaginal deliveries,with the incidence of 2.73％ (213/7 811).Only 1 shoulder dystocia was macrosomia (0.46％,1/213); while the other 10 cases were non-macrosomia (0.13％,10/7 598).(2) From 2009 to 2013,the macrosomia happened by 24 cases (2.32％,24/1 034),42 cases (3.61％,42/1 164),46 cases (2.60％,46/1 772),62 cases (3.01％,62/2 060),39 cases (2.19％,39/1781),respectively.The incidence of macrosomia had no significant difference among these 5 years (P＞0.05).The shoulder dystosia occurrence without macrosia in these 5 years were 1 case (0.10％,1/1 034),3 cases (0.26％,3/1 164),2 eases (0.11％,2/1 172),2 cases (0.10％,2/2 060),2 cases (0.11％,1/1 781),respectively.The incidence of shoulder dystocia without macrosomia had no significant difference among these 5 years (P＞0.05).(3) In the should dystocia group,5 cases were complicated with premature rupture of membrane (5/10),4 cases were mother≥ 35 years old (4/10),3 cases were multipara(3/10),3 cases had gestational diabetes mellitus(3/10),3 cases were occiput posterior during the first stage of labor(3/10),3 cases had prolonged second stage of labor (3/10) and 6 cases had routine lateral incision (6/10).In the control group,3 cases were complicated with premature rupture of membrane(3/10); 1 case was mother≥35 years old (1/10); 2 cases were multipara(2/10),3 cases had gestational diabetes mellitus (3/10),1 case had prolonged second stage (1/10) and 7 cases had routine lateral incision (7/10).(4) There were no significant difference in the height of uterus fundus,BMI,BPD,FL,and duration of the first stage of labor between the shoulder dystocia group and the control group (P＞0.05).Compared with the control group,the increasing of BMI [(6.8±3.1) vs (4.8± 1.4) kg/m2],the time of the second stage of labor[(86±65) vs (38±28) minutes] and abdominal circumference[(108±8) vs (101±7) cm] were significantly higher in the shoulder dystosia group (P＜0.05).(5)There were significant difference in the chest circumference of the newborn [(34.0±1.6) vs (32.2±1.9) cm] and the ratio of chest circumference to head circumference of the newborn [(0.99±0.03) vs (0.97±0.03)] between the two groups(P＜0.05).The 1-minute Apgar score of the newborn (7.4±2.8) was significantly lower than the control group (10.0±0.0) (P＜0.01).Clavicular fracture occurred in 3 newborns and brachial plexus injury occurred in 4 newborns in the shoulder dystosia group.Conclusion It is difficult to predict shoulder dystocia in non-macrosomia.Shoulder dystocia of non-macrosomia could be predicted by measurement of the head circumference,chest circumference,the ratio of chest circunfference to head circumference by using prenatal ultrasound.The risk factors may complicated with premature rupture of membrane,abnormal occiput position during the first stage of labor and prolonged second stage of labor.

BACKGROUNDTo evaluate the epidemiological trends of lung cancer in Henan, China.

METHODSCancer mortality data were collected from 1974 to 1999. The mortality trends of lung cancer were studied. Secular trend on lung cancer form 1974 to 2010 with regression used for spatial analysis.

RESULTSThe data showed that lung cancer was the dominating cause of all cancer-related deaths in Henan. During the period of 1974 to 1999, marked changes took place in Henan in the mortality rate of lung cancer. Lung cancer mortality rates increased from 4.15 per 100 000 in the early seventies to 12.13 per 100 000 in the late nineties, lung cancer accounted for 5.09% of all cancer related deaths in the early seventies and 14.09% in the late nineties. In general, men had higher mortality rate than women, and urban area had higher mortality rates than rural area. The mortality rate for male and female would be about 25 per 100 000 and 15 per 100 000 respectively in 2010 if no intervention strategy was taken

CONCLUSIONSThe overall age-adjusted mortality rate of lung cancer in Henan has increased during the past two decades, strengthening education for health is very important in cancer control.

Objective To detect the serum microRNA-148b-3p level in patients with diabetes mellitus and diabetic nephropathy,and to analyze its correlation with clinical and pathological indexes.Methods The research crowd was divided into three groups (1) diabetic nephropathy group:biopsy with diabetic nephropathy (n=25,14 males,11 females);(2) type 2 diabetes mellitus group:type 2 diabetes mellitus patients with normal urinary microalbumin/urinary creatinine value (n=10,4 males,6 females);(3) normal control group:healthy subjects (n=9,3 males and 6 females).Clinical indicators included gender,age,24-hour urine protein,systolic blood pressure (SBP),diastolic blood pressure (DBP),serum creatinine (Scr),urea (Urea),cystatin-C (Cys-C),blood albumin (ALB),urine microalbumin (UMA),triacylglycerol (TG),total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),serum uric acid (UA),fasting blood glucose (FBG),glycated hemoglobin (HbA1c),urine microalbuminuria / urinary creatinine (UACR),and estimated glomerular filtration rate (eGFR) calculated by CKD-EPI formula.Real-time quantitative PCR was applied to verify the expression of microRNA-148b-3p in serum samples of the research crowds.The relationships between microRNA-148b-3p level and clinical features was also analyzed.Results The levels of serum microRNA-148b-3p in diabetic nephropathy group and in type 2 diabetes mellitus group were 1.82 times and 1.73 times of that in normal control group (P ＜ 0.05,respectively).The level of serum microRNA-148b-3p was significantly correlated with HDL-C (r=-0.374,P=0.013),UMA (r=0.426,P=0.004),FBG (r=0.330,P=0.046) and TG (r=0.423,P=0.005).Multiple linear regression analysis showed that UMA level was independently associated with serum microRNA-148b-3p level (β=0.338,P=0.044).The area under the receiver operating characteristic curve (ROC) of serum microRNA-148b-3p in diagnosing type 2 diabetes mellitus and diabetic nephropathy was 0.835 and 0.665,respectively.Conclusions The level of serum microRNA-148b-3p of patients with type 2 diabetes mellitus or diabetic nephropathy significantly increases.The level of UMA is independently associated with serum microRNA-148b-3p level.Serum microRNA-148b-3p is expected to be a potential biomarker for the diagnosis of diabetic nephropathy.