Objective On the basis of internet of things technology,to initially establish a management model of chronic obstructive pulmonary disease (COPD) patients in Gumei community,so as to provide experience for the comprehensive management of community COPD patients.Methods According to the characteristics of the Internet of things technology,we formulated a scheme as a technical route to manage the COPD patients.A homogenous COPD management team of doctors was established under the training of experts from the Department of Respiration of Zhongshan Hospital,Fudan University.Results We drew a COPD patient management model chart,and initially formed a qualified and homogeneous COPD management team of general practitioner.Conclusions Through the Internet of things technology management,we initially formed a set of manual quality control model in the process of data automatic transmission,and initially formed a management model of community COPD patients,based on the internet of things.

Background and purpose: Currently, intraoperative radiation therapy (IORT) has become the adjuvant therapy of cancer. The study was to establish the daily quality assurance (QA) program and analyze dosimetric characteristics’ long-term stability for mobile IORT accelerator. Methods:The QA program of this study included two parts:safety and functionality and energy and output. The two years’ QA datasets were acquired and analyzed to investigate the stability of energy and output. Results:All safety and functionality tests passed on a daily basis. The energy index was (0.666±0.015)mm, (0.839±0.009)mm, (0.781±0.010)mm, (0.724±0.009)mm and the output dose error was (0.511 ± 0.671)%, (0.278 ± 0.516)%, (0.368 ± 0.532)%, (0.382 ± 0.912)%for all energy, respectively. There was no signiifcant time trend in the dosimetric characteristics. Conclusion:The daily QA program is suitable for mobile IORT accelerator. The long-term stability is acceptable for IORT in clinical use.

Objective To compare various risk factors of bipolar disorders with and without suicidal behavior. Methods A total of 5452 inpatients were divided into 2 groups; with (n=1739)and without (n=3713) suicidal behavior within 1 week. Socio-demographic and clinical data were compared between two groups. Multiple logistic regression models were used to assess risk factors of bipolar disorders with suicidal behavior. Results Compared to without suicidal behavior group, the suicidal behavior group had significantly higher rate of the following characteristics:older age [34.8±13.6 vs. 33.3±12.8, t=-3.46, P<0.01], female (58.3％vs. 52.7％,χ2=14.83, P<0.01), history of mental trauma (10.6％vs.7.8％,χ2=10.72, P<0.01), history of suicide (4.1％vs. 0.1％,χ2=140.11, P<0.01), family history of suicide (6.7％vs. 3.9％,χ2=20.22, P<0.01), family history of mental illness (33.8％vs. 29.6％,χ2=9.33, P<0.01) and history of suicide (4.1％ vs. 0.1％, χ2=140.11, P<0.01). Logistic regression analysis showed that female (OR: 1.192, 95％CI:1.043-1.363), older age (OR: 1.008, 95％CI: 1.003-1.013), history of mental trauma (OR: 1.355, 95％CI:1.083-1.696), history of suicide (OR:39.139, 95％CI:12.230-125.256) and family history of suicide (OR:1.648, 95％CI: 1.223-2.221) were significantly correlated with suicidal behavior in bipolar disorders. Conclusions The study indicates that female, older age, history of mental trauma, history of suicide and family history of suicide may be the key independent risk factors to suicidal behavior in bipolar disorders.

Objective:To investigate the damaging traits of cognitive function in late-onset depression.Methods:In this cross-sectional study,30 elderly out-and in-patients whose first onset of major depression occurred at 60 years of age and older were included as the case group,and 30 age-and gender-matched normal elderly people were included as the controls.The diagnoses of moderate to severe depressive episode or recurrent depression were made according to the International Statistical Classification of Diseases and Related Health Problems,Tenth Revision (ICD-10) diagnostic criteria.The Wisconsin Card Sorting Test (WCST),Stroop Test and Verbal Fluency Test (VFT) were used to assess attentional set shifting,attentional inhibition and working memory.The severity of depression was evaluated with the Hamilton Depression Scale-17(HAMD-17).Results:The performance scores of errors,perseverative responses,perseverative errors,percent of perseverative errors in the WCST were significantly higher in the patient group then in the control group[(61 ± 23) vs.(41 ± 25),(44 ± 27) vs.(27± 19),(36 ± 20) vs.(23 ± 16),(28 ± 15) vs.(19 ± 11),P ＜ 0.01].The scores of conceptual level responses [(36±24) vs.(54 ±26)],the correct scores of consistent group in Stroop test[(19 ±3) vs.(20 ±2)] and the scores of VFT in WCST[(10 ±2) vs.(11 ±2)] were lower in the patient group than in the control group (Ps ＜0.01).The scores of perseverative responses in the WCST were positively correlated with retardation factor scores(r =0.38,P ＜ 0.05).The correct scores of consistent group in the Stroop test were negatively correlated with retardation factor scores(r =-0.41,P ＜ 0.05).The scores of VFT were negatively correlated with retardation factor scores(r =-0.52,P ＜ 0.01).Conclusion:There may be impairment of cognitive function in late-onset depression,especially severe executive dysfunction.

Objective To compare the dose distribution of the target and normal tissues in gastric cancers between three-dimension conformal radiation therapy (3DCRT) and intensity modulated radiation therapy (IMRT) plan when respiratory motion factors integrated in the plan. Methods From January 2005to November 2006, 10 patients with post-operatively radiation of gastric cancer were enrolled in this study.Planning CT were acquired conventionally with free-breath mode and the static treatment plans of the 3DCRT and IMRT were designed respectively. Probability distribution functions (PDF) were generated and convoluted with the static dose distributions from 3DCRT and IMRT plans to obtain the integrated plans. The dose distributions of the target and normal tissues were compared between 3DCRT and IMRT integration treatment plans, such as V45 of clinical target volume, V4o of liver and V15, V18 of left and right kidney.Results In the respiratory integrated treatment planning, the target volume coverage and homogeneity with IMRT are superior to those with 3DCRT ( ( V45 98%∶ 87% (t = -3. 35 ,P =0. 010) ,mean dose 46. 81 Gy ±0. 75 Gy∶45.99 Gy ± 1.12 Gy (t = -0. 31 ,P=0. 020) ). The V40 of teh liver in IMRT are smaller than those in 3DCRT ( 12%∶ 16% ;t=3.75,P=0.010). For the left kidney, the V15 and V18 in IMRT are smaller than those in 3DCRT ( (34%∶ 50% (t = 2. 17 ,P = 0. 050) and 27%∶46% (t = 3. 11 ,P = 0. 020) ),but for the right kidney, V15 and V18 in 3DCRT are smaller than those in IMRT ( ( 15%∶ 21% (t = - 2. 42,P=0.040) and 11%∶15% (t= -2.71,P=0.030)). Conclusions When respiratory motion factor integrated in the treatment plan, IMRT showed advantage both in target coverage and normal tissue sparing in the high dose region of liver and left kidney.

Objective To observe and evaluate the effects of metformin and pioglitazone on blood glucose,insulin,glucagon,β-cell function and insulin resistance among patients with diabetes and metabolic syndrome,so as to discuss the role of pancreatic α cells in pathogenesis of type 2 diabetes mainly caused by insulin resistance and the change of α-cell function after treatment.Methods A total of 60 patients diagnosed with diabetes and metabolic syndrome were selected in Beijing Chaoyang District Diabetes Center from April 2012 to April 2013 and divided with random number table into metformin group (treated with metformin 0.5 g orally thrice a day for 1 year,n =30) and pioglitazone group (treated with pioglitazone 15 mg orally once a day for 1 year,n =30).30 normal healthy people who had physical examination at the Center during the same period were enrolled into the control group,matched in age and gender with the intervention groups.The general condition of the 3 groups,and blood levels of glucose,insulin,and glucagon,insulin sensitivity index (ISI)-Matsuda,homeostasis model assessment of insulin resistance (HOMA-IR),β-cell function index (HOMA-β),1-phase index,2-phase index,and insulin secretion sensitivity index (ISSI) at baseline in the 3 groups and after treatment in the metformin group and the pioglitazone group were measured and calculated.Results Compared with the control group before treatment,the intervention groups as a whole had significantly higher fasting glucagon level [(146.22 ±25.41) pmol/L vs.(21.31 ±7.85) pmol/L,P =0.002] and area under curve (AUC) of glucagon [(469.84 ±13.12) pmol/(L · h) vs.(100.94 ± 7.73) pmol/(L · h),P =0.006].Compared with the results before treatment,the metformin group exhibited significantly reduced fasting glucose [(6.46 ± 1.38) mmol/L vs.(7.54 ± 0.43) mmol/L,P=0.031],fasting insulin [(119.22 ± 69.01) pmol/L vs.(139.38 ±71.13) pmol/L,P =0.042],fasting glucagon [(91.69 ±22.11) pmol/L vs.(142.81 ±24.56) pmol/L,P=0.029],AUC of glucose [(25.19 ± 1.31) mmol/ (L · h) vs.(32.68 ± 1.12) mmol/ (L · h),P =0.043],AUC of insulin [(468.65 ±20.10) pmol/ (L· h) vs.(786.32±21.37) pmol/ (L· h),P=0.017],and AUC of glucagon [(280.60±8.26) pmol/ (L · h) vs.(487.14±14.31) pmol/ (L · h),P=0.032];while the pioglitazone group after treatment also showed significantly decreased fasting glucose [(6.58 ±2.21) mmol/L vs.(7.68±0.59) mmol/L,P=0.028],fastinginsulin [(107.92±17.81) pmol/L vs.(144.66±74.43) pmol/L,P =0.033],fasting glucagon [(76.07 ±20.57) pmol/L vs.(148.34 ±28.94) pmol/L,P=0.025],AUC of glucose [(25.58 ±1.22) mmol/(L·h) vs.(35.07 ±1.38) mmol/(L· h),P=0.038],AUC of insulin [(435.54±19.30) pmol/ (L· h) vs.(854.75 ±20.61) pmol/(L·h),P=0.013],andAUCofglucagon [(223.43 ±5.83) pmol/ (L·h) vs.(458.55 ±12.96) pmol/ (L·h),P =0.026].The before-after-treatment differences were significantly smaller in the metformin group than in the pioglitazone group in terms of fasting insulin [(20.16 ± 2.98) mmol/L vs.(36.74 ± 2.88) mmol/L,P =0.011],fasting glucagon [(51.12 ± 3.67) pmol/L vs.(72.27 ± 4.58) pmol/L,P =0.016],AUC of insulin [(317.67 ±13.45) pmol/(L · h) vs.(419.21 ±15.44) pmol/(L · h),P=0.031] and AUC of glucagon [(206.54±9.66) pmol/(L· h) vs.(235.12±10.29) pmol/(L· h),P=0.046].Conclusions Glucagon in patients with diabetes and metabolic syndrome is higher than that in normal individuals.Metformin and pioglitazone can decrease the level of glucagon in patients with metabolic syndrome and diabetes as well as improve the glucose control,β-cell function and insulin resistance,suggesting improving effect of these two drugs on α-cell function.Pioglitazone manifests a stronger effect than metformin does.

Objective:To evaluate the effect of early mobilization on mortality in intensive care unit (ICU) patients with mechanical ventilation after discharge by Meta-analysis.Methods:Databases including SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang data, PubMed, the Cochrane Library, Web of Science, and Embase were searched from inception to September 17th, 2020, to collect randomized controlled trials (RCT) about early mobilization on mortality of patients with mechanical ventilation in ICU after discharge, the references included in the literature were traced. The control group was given routine care, the experimental group was given early mobilization on the basis of the control group, including passive or active mobilization on the bed, sitting on the bed, standing by the bed, transferring to the bedside chair and assisting walking. The literature screening, data extracting, and the bias risk assessment of included studies were conducted independently by two reviewers. Stata 12.0 software was then used to perform Meta-analysis. Funnel plot was used to test publication bias.Results:A total of 10 RCT studies involving 1 323 patients were included, with 660 patients in the control group and 663 patients in the experimental group. The results of literature quality evaluation showed that 7 studies were grade A and 3 studies were grade B, indicating that the overall quality of included literatures was high. The Meta-analysis results showed that early mobilization did not increase the mortality of patients with mechanical ventilation in ICU after discharge [odds ratio ( OR) = 0.92, 95% confidence interval (95% CI) was 0.75-1.13, P = 0.449]. Subgroup analysis results showed that early mobilization had a tendency to reduce the mortality of ICU patients with mechanical ventilation at 3, 6 and 12 months after discharge, but the difference was not statistically significant (3-month mortality: OR = 1.02, 95% CI was 0.74-1.40, P = 0.927; 6-month mortality: OR = 0.95, 95% CI was 0.70-1.27, P = 0.712; 12-month mortality: OR = 0.60, 95% CI was 0.33-1.10, P = 0.101). Funnel plot showed that the distribution of included literatures was not completely symmetrical, suggesting that publication bias might exist. Conclusions:Early mobilization does not increase the mortality of ICU patients with mechanical ventilation after discharge. Although it tends to have a favorable outcome in reducing mortality, and has a trend to reduce the mortality. However, due to the small number of included literatures, small sample size and differences in the specific implementation of early mobilization among various studies, a large number of high-quality RCT studies are still needed for further verification.

Purpose To evaluate changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency using three-dimensional speckle tracking imaging (3D-STI).Materials and Methods Twenty-six patients with mild chronic renal insufficiency (CKD2-3 group),20 patients with moderate-severe chronic renal insufficiency (CKD4-5 group),who accepted treatment in the West Coast Medical Center,Qingdao University Affiliated Hospital from June 2015 to June 2016,and 20 healthy volunteers (control group) were enrolled.Routine two-dimensional echocardiography was carried out,and the indicators were compared,including inter-ventricular septum end-diastolic thickness (IVSTd) and left ventricular posterior wall end-diastolic thickness (LVPWTd).In addition,3D-STI analysis was conducted,and the indicators were compared,including left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),three-dimensional left ventricular ejection fraction (3D-LVEF),left ventricular global longitudinal strain (GLS),global radial strain (GRS) and global circumferential strain (GCS).The efficacy of GLS,GCS and GRS in the diagnosis of left ventricular systolic dysfunction in patients with chronic renal insufficiency was compared by ROC curve analysis.Results Compared with the control group,serum creatinine and triglyceride increased (t=22.152 and 2.655),glomerular filtration rate (GFR) and hemoglobin content decreased (t=-36.527 and-19.610),IVSTd increased (t=6.035),and 3D-LVEF,GLS,GRS and GCS decreased (t=-2.958,-5.336,-9.552 and-4.384) in CKD2-3 group.Compared with the control group,systolic blood pressure,serum creatinine,total cholesterol and triglyceride increased (t=15.060,29.461,8.210 and 6.512),GFR and hemoglobin content decreased (t=-67.557 and-28.071),IVSTd increased (t=10.959),and 3D-LVEF,GLS,GRS and GCS decreased (t=-7.315,-7.460,-17.99 and-6.052) in CKD4-5 group.Compared with CKD2-3 group,systolic blood pressure,serum creatinine and total cholesterol increased (t=14.551,28.902 and 8.555),GFR and hemoglobin content decreased (t=-18.455 and-16.832),IVSTd increased (t=7.331),and 3D-LVEF,GRS,GCS and GLS decreased (t=-4.977,-3.847,-4.929 and-2.553) in CKD4-5 group.All the above differences were statistically significant (P＜0.05).ROC curve showed that determining left ventricular systolic dysfunction in patients with chronic renal insufficiency using GLS,GCS and GRS,when the cutoff value of GLS was 17.80％,the sensitivity was the highest (88.89％),and the Youden index was 0.673;however,when the cutoff value of GCS was 14.70％,the specificity was the highest (89.47％),and the Youden index was 0.561.Conclusion In patients with chronic renal insufficiency,left ventricular systolic function reduces,and with the progress of the disease,the cardiac function also gradually reduces.3D-STI can accurately assess changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency.

There are few reports in China on the laparoscopic Burch procedure in the treatment of female stress urinary incontinence. Twenty-two female stress urinary incontinence patients admitted to our hospital were treated with laparoscopic Burch procedure, with an overall effective rate of 100%. The score of the International Continence Advisory Committee Urinary Incontinence Questionnaire-Short Form (ICI-Q-SF) at one month after treatment was lower compared to that before the procedure. There were no complications during two months of follow-up.

Objective:To explore the influencing factors for compliance to colonoscopy screening for colorectal cancer in outpatients.Methods:Patients aged 40-74 years who visited the outpatient gastroenterology department of 7 tertiary hospitals in 7 regions of Xinjiang from January 2022 to June 2022 were enrolled. Recommendations for colonoscopy screening were made according to the patient's medical conditions, and the questionnaire was used to collect information. The Chi-square test was used to compare the differences of compliant and non-compliant patients. Multivariate logistic regression was used to analyze the influencing factors of compliance to colonoscopy screening.Results:A total of 463 valid questionnaires were obtained from 7 centers, in which, 427 outpatients (92.2%) followed the recommendation for colonoscopy screening, and 36 (7.8%) did not. Chi-square test results showed that there were statistically significant differences between the two groups in gender, age, education, subjective cognition of intestinal polyps, personal history of colorectal polyps, family history of colorectal cancer, family history of colorectal polyps, abdominal pain or distension, and defecation habit or stool changes ( P<0.05). The results of multivariate regression analysis showed that the screening compliance of patients aged 40-49 years ( P=0.005, OR=0.141, 95% CI: 0.036-0.549) and 50-59 years ( P=0.039, OR=0.257, 95% CI: 0.071-0.932) was lower than that of patients aged 60-74 years. The screening compliance of patients with high school education ( P=0.011, OR=3.121, 95% CI: 1.304-7.473) and college education or above ( P=0.016, OR=3.544, 95% CI: 1.270-9.890) was higher than those with primary school education and below. Patients with personal history of colorectal polyps ( P=0.015, OR=12.288, 95% CI: 1.629-92.719), family history of colorectal cancer ( P=0.038, OR=8.506, 95% CI: 1.124-64.351) and changes in defecation habit or stool trait ( P=0.039, OR=4.794, 95% CI: 1.085-21.192) also had higher compliance. Conclusion:Age, educational level, personal history of colorectal polyps, and family history of colorectal cancer are related to colonoscopy screening compliance in outpatients of 7 tertiary hospitals in 7 regions of Xinjiang. The independent risk factors affecting compliance to colorectal cancer screening in outpatients are age of 40-59 years, lower educational level, no previous history of polyps or family history of colorectal cancer, and no defecation habit or stool changes.