Objective To investigate the relationship between retinal vascular lesions and cerebral microbleeds ( CMBs) . Methods One hundred twenty-three consecutive patients with cerebral infarction who could sit and finish fundus photography at the Department of Neurology, General Hospital of Beijing Military Command from August 2013 to August 2014 were enrolled prospectively. After informed consent, the patients underwent head MRI examination and bilateral eye fundus photography. They were divided into either a cerebral microbleed group ( CMB group, n =52 ) or a non-cerebral microbleed group ( nCMB group,n=71) according to whether they had CMBs or not. The general clinical data and retinal vascular lesions ( microaneurysms,hard exudates,cotton wool spots,bleeding spots,focal retinal arteriolar narrowing, arteriovenous cross sign,and silver thread-like changes) of both groups were compared. Results (1)There were significant differences in age,hypertension,diabetes,systolic blood pressure,diastolic blood pressure, fasting blood-glucose,triglyceride,and C reaction protein between the CMB group and the non-CMB group (all P<0. 05). (2) The incidences of hard exudates,focal retinal arteriolar narrowing,and arteriovenous cross sign of patients with CMB were higher than those with non-CMB,and there were significant differences (χ2 =6.233,7.675,and9.544,respectively;P=0.040,0.031,and0.019,respectively).(3)There were significant differences in the incidences of hard exudates,focal retinal arteriolar narrowing,and arteriovenous cross sign in patients with different severity of CMBs (Z= -2. 317,-2. 294 and -2. 157,respectively;P=0. 029,0. 033,and 0. 039,respectively). In patients with severe CMB,there were more patients with hard exudates,focal retinal arteriolar narrowing,and arteriovenous cross sign. (4) The age (OR,3. 623, 95%CI 2. 631-7. 866),hypertension (OR,4. 348,95%CI 3. 734-10. 563),diabetes (OR,3. 831,95%CI 2.126-9. 245),fasting blood-glucose (OR,3. 329,95%CI 2. 631-11. 012),arteriovenous cross sign (OR,5. 437,95%CI 3. 441-13. 606),and hard exudates (OR,4. 054,95%CI 3. 137-13. 252) were the independent risk factors for the occurrence of CMBs. Conclusion The arteriovenous cross sign, focal retinal artery narrowing,and hard exudates in retinal vascular lesions are associated with the CMBs and different degree of CMBs classification. Both the arteriovenous cross sign and hard exudates are the independent risk factors for CMBs.

Objective To investigate the risk factors for occurring cerebral microbleeds( CMBs)in patients with ischemic stroke Methods A total of 184 consecutive patients with ischemic stroke admitted from January 2012 to January 2014 in General Hospital of Beijing Military Command were enrolled prospec-tively. They were divided into either a CMB group( n=60 )or a non-CMB group( n=124 )according to whether head MRI magnetic sensitive weighted imaging( SWI)revealed CMBs or not. The general clinical data and serum biochemical results of the patients in both groups were collected. Renal creatinine clearance ( Ccr)was calculated,and the data of both groups were analyzed by the univariate and multivariate analyses. Results (1)The results of univariate analysis showed that there were significant differences in age(63 ± 10 vt. 58 ± 10 ),male( 65. 0%[ 39/60 ]vs. 49. 2%[ 61/124 ]),the incidence of leukoaraiosis( LA ) (73. 3%[44 cases]vs. 47. 6%[59 cases]),and serum homocysteine(Hcy)levels(20 ± 8 vs. 16 ± 6μmol/L)between the CMB group and the non-CMB group(P<0. 05). The Ccr level(89 ± 10 mL/(min·1.73m2)of the CMB group was lower than(106 ±6mL/(min·1.73m2)of the non-CMB group. There was significant difference(P <0. 05).(2)Multivariate logistic regression analysis showed that age(OR,1. 103,95%CI1. 024—1. 989,P =0. 028),LA(OR,3. 121,95%CI 1. 310—7. 436;P <0. 05)and impaired kidney function(OR,1. 890,95%CI 1. 358—3. 076;P<0. 01)were the independent risk factors for the occurrence of CMBs in patients with ischemic stroke. Conclusion Age,LA and impaired kidney function are the independent risk factors for occurring CMBs in patients with ischemic stroke.

Objective To measure the equity of resources allocation in obstetric healthcare in Zhejiang Province, and provide evidence for decision making by healthcare departments of the government. Methods Lorenz curve and Gini coefficient were used to measure the equity of obstetric healthcare resources. Results The investigation found such allocation as equitable as measured by the layout of the number of live births, as the Gini coefficient of the distribution of obstetric doctors, nurses and beds was 0.1697,0.1971 and 0.1497 respectively by total birth, failing within the equitable range. However, when measured by geographic distribution, such coefficient were 0.2701, 0.3216 and 0.3341 respectively in cities, which were less equitable yet still within equitable range. Conclusions The government and health bureaus are recommended to scientifically predict the number of immigrants and rationally deploy healthcare resources according to the service radius of healthcare resources;moreover, more gynecologic doctors and nurses should be trained to improve the human resource structure in gynecologic departments. These effort can cater to the growing healthcare demands of the society resulting from a growing population of immigrants.

Objective To investigate awareness about tuberculosis (TB) prevention and treatment and influence of professional training on TB detection among health-care workers (HCWs) in general hospitals.Methods In total,750 HCWs were trained for TB-related knowledge for eight class-hours in a two-day course in three general hospitals,and 20 HCWs from each of the three hospitals classified as grade 3A and grade 2A in urban Beijing and grade B at suburban Beijing,respectively,were interviewed with questionnaire designed to understand their awareness about TB prevention policy,epidemiology,diagnosis and treatment,and to evaluate effectiveness of the training,respectively.All the trainees responded before and after the training,with a hundred percent of response rate.TB diagnosis and reporting one year before training in the three hospitals were compared to those one year after it.Results Scores of knowledge about TB diagnosis and treatment averaged 64-80 for HCWs before training,with statistically significant difference among three hospital (F = 5.984,P ＜ 0.01).Scores increased after training,but without significant difference from those before it (P ＞ 0.05).Awareness of TB prevention policy,regulations and epidemiology was insufficient in most HCWs of those hospitals,with lowest and highest average scores of 38.3 and 71.7 before training,respectively,but scores increased significantly after training (P ＜ 0.01).Proportion of TB diagnosis with chest roentgenograph at grades 3A and 2A hospitals was significantly higher one month,three months and six months after training,as compared to that at suburban hospitals (P ＜0.01).There was significant decrease (P ＜ 0.01) in proportion of chest roentgenograph at respiratory departments in hospitals grade 3A and grade 2A after training.There was no significant difference in reporting of pulmonary TB and positive sputum smear (P ＞ 0.05) before and after training.Conclusions HCWs in general hospitals had experience and capacity in diagnosis and treatment of pulmonary TB,but their knowledge of TB prevention policy and epidemiology was insufficient.Their ability in finding and reporting TB can not been improved with short-term training.

Objective To explore the insertion of the teaching contents of nursing in rural doctors'higher education,so as to increase their understanding of medical knowledge and improve their medical skills.Method 90 rural doctors of Grade 2014 were chosen as the research object,and according to their willingness to participate,they were divided into control group and observation group.The students in the control group were mainly taught by the relevant knowledge of clinical medicine,while nursing teaching content was inserted in the teaching of observation group.In the teaching process,firstly,the teaching contents of nursing were reorganized,and then the teaching content of clinical medicine was taken as the main line,according to the development of teaching content,flexibly inserting nursing teaching part.The results of the final examination of the internal medicine of the two groups were compared and the specific learning experience of rural doctors was investigated.SPSS 20.0 was used to analyze the data,the count data was expressed as percentage,and chi square test was performed.Results The number of students in the control group and the observation group whose subjective score was more than 40 was 17.65％ and 48.72％ respectively.The number of students scoring ＜30 points accounted for 23.53％ and 5.13％ of the total number of students,and there was a statistically significant difference between the two groups(P＜0.05).The observation group had a better learning experience,and had little influence on the learning of clinical medical knowledge.Conclusion In the stage of education for rural doctors,inserting the teaching contents of nursing can improve the teaching effect.

Objective To study the gene expressions of nestin and stem cell factor(SCF)in neurons after ischemia-reperfusion injury in rat brain. Methods Thirty-six adult female rats were subject to left middle cerebral artery occlusion for 1.5h and different hours of reperfusion. In site hybridization was used to examine the expression of nestin and SCF mRNA in the rats subjected to 2h, 6h, 12h, 24h, 2d, 3d, 7d, 14d of reperfusion and sham-operation group (n=4). Results (1) Nestin expression in cortex, striatum and extraventricular zone was weak in the sham-operation group, and increased markedly in the ischemic hemisphere compared with sham-operation group except of reperfusion 2h in cortex, 2h, 6h in striatum, 2h, 6h and 14d in extraventricular zone. (2)SCF expression in cortex, striatum and extraventricular zone was weak in the sham-operation group, and increased markedly in the ischemic hemisphere compared with sham-operation group except of reperfusion 2h, 6h, 12h in cortex, 2h, 6h in striatum, 2h and 14d in extraventricular zone. Conclusion It is suggested that SCF expression might enhance the proliferation of neural stem cells following ischemia-reperfusion in rats.

ObjectiveTo study the modes of case finding and diagnosis for inpatients of active pulmonary tuberculosis with primary treatment.MethodsData of 1000 inpatients with active pulmonary tuberculosis input into a computer were analyzed retrospectively.including clinical symptoms,signs and relevant laboratory examinations.to evaluate their diagnostic value.ResultsAmong 1000 active tuberculosis case8 hospitalized with symptoms and signs,95.9 percent suffered by cough,77.7 percent by expectoration and 50.8 percent (n=508) by fever,and 51.5 percent (n=777) with strong positive purified protein defivative (PPD) skin test,61.5 percent with positive serum anti-tuberculosis antibody,48.8 percent with positive acid-fast staining on sputum smear and 57.9 percent with positive sputum bacteriologle culture.And,49.4 percent of the patients were diagnosed by laboratory positive sputum,and 50.6 percent of those with negative sputum were diagnosed by comprehensively clinical considerations,ineluding 51.6 percent positive PPD skin teat, or positive serum anti-tubereulosis antibody,but 48.4 percent of them were all negative in varied laboratory examinations.ConclusionsHospital visit due to symptom is the main method for tuberculosis finding in our country.All those with Cough for two or more weeks should be screened by routine examinations for excluding tuberculosis.Case finding rate Was low by sputum examinations.so comprehensive diagnosis is still important for those tuberculosis patients with negative sputum.

Objective To evaluate value of narrow band imaging(NBI) endoscopy for children with abdominal Henoch?Schonlein purpura ( HSP ) . Methods A total of 46 patients with abdominal HSP were enrolled into the observation group(NBI intervention) from November 2010 to February 2016.Diagnostic rates of white light and NBI endoscopy in abdominal HSP patients, IgA positive rates of targeted biopsies and severe complications were retrospectively analyzed. A total of 25 abdominal HSP patients with no NBI intervention admitted from 2007 to 2009 were randomly enrolled into control group. Data of the control group were compared with those of observation group. Results In observation group, the diagnostic rate under NBI was significantly higher than that under white?light endoscopy[91. 3%(42/46)VS 67. 4%(31/46),χ2=8. 02,P<0. 05]. IgA positive rates of targeted biopsies under NBI was significantly higher than that under white?light endoscopy [ 95. 7%( 88/92 ) VS 69. 6%( 64/92 ) ,χ2 = 21. 79, P<0. 05 ] . Three patients developed such serious complications as digestive hemorrhage as predicted. Compared with control group, abdominal pain and blood stool relief time (10. 96±5. 32 d VS 19. 68±4. 29 d,t=7. 50,P<0. 01), fasting time(10. 37±5. 42 d VS 8. 80± 3. 71 d,t=7. 73,P<0. 01), hospital stay (18. 80±7. 11 d VS 23. 12±4. 36 d, t=3. 16,P<0. 01), time of stool occult blood negative ( 11. 41 ± 6. 30 d VS 19. 12 ± 4. 09 d, t=6. 22, P<0. 01 ) in observation group were significantly shortened. Conclusion NBI endoscopy is valuable for improving the diagnostic accuracy and biopsy accuracy and complication prediction of abdominal Henoch?Schonlein purpura in children.

Objective To investigate the effect of sleep position guidance on deformational plagiocephaly and/or brachycephaly (DPB) in the prematures. Methods 321 preterm infants in neonatal intensive care unit from October, 2012 to September, 2015 were divided into sleep positions guidance group (n=159) and control group (n=162). The sleep positions guidance group accepted sleeping positions guidance when they were in neonatal intensive care unit and followed up in child care clinic, and the control group accepted routine treatment and nursing. The incidences of DPB were compared. Results The incidences of mild (χ2=6.591, P=0.010), moderate (χ2=4.862, P=0.027) and se-vere (χ2=11.261, P=0.001) DPB were less in the sleep positions guidance group than in the control group. Conclusion Sleeping positions guidance may reduce the incidence of DPB in prematures.

Objective Rhabdomyolysis (RM) is a common disorder resulting from a large variety of causes. Acute injury is one of the main reasons. The purpose is to describe the MRI manifestations of rhabdomyolysis caused by 5.12 Wenchuan earthquake in Sichuan province and to discuss their importance in diagnosis and treatment of rhabdomyolysison in clinic practice. Methods Three patients with rhebdomyolysis caused by earthquake were studied via 1.5 T MRI. In all the patients, T, and T2 weighted sequences with and without fat suppression, and short time inversion recovery (STIR) of both lower extremities were obtained in axial, coronal and sagittal planes. All patients were given contrast material during imaging, and MRA (magnetic resonance angiography) of both lower extremity vessels were performed. The MRI characteristics of damaged extremities in 3 cases were studied. Results MRI showed swelling of the affected muscles and subcutaneous fat tissue on both T1 and T2 weighted images. The margins of involved muscles were blurred. On T1 weighted images, swollen muscles showed equal or slightly decreased intensity with small patterns of increased intensity in some local areas. On T2 weighted and STIR sequences, the affected muscles showed inhomogeneons increased signal intensity with clearer margin. Slight fluid collection in spatium intermusculare was observed. Contrast-enhanced scanning showed nonhomologous intensification of damaged muscles, the enhancement inside the muscles was decreased when compared with normal muscles. The locations of all these abnormal intensity were correlated with the injury history and clinic physical examinations. MRA showed no lower extremity vessels were affected. Conclusion MRI has very high sensitivity in detecting the injury of muscles. It's very useful in evaluating the extent and severity of muscles affected in rhabdomyolysis caused by trauma. Also it's very valuable to evaluate the condition of blood vessels in involved extremity for predicting the prognosis of the disease. Therefore MRI possesses a very important role in the diagnosis and treatment of RM.