Objective To identity the risk factors for supine hypotension syndrome (SHS) after spinal anesthesia in parturients.Methods A total of 204 parturients,scheduled for elective cesarean section,were divided into either control group or SHS group depending on whether or not SHS (systolic blood pressure [SBP] in the upper extremity decreased by ＞ 30 mmHg or decreased to ＜ 80 mmHg) developed after spinal anesthesia.The baseline patient characteristics such as age,body height and weight,gestational weeks and biparietal diameter were recorded.Supine stress test (SST) was performed.Heart rate,blood pressure in upper and lower extremities,perfusion index,pleth variability index and intravesical pressure were recorded when patients were in supine position and in left lateral position before spinal anesthesia.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the risk factors for SHS.Results Among the 204 patients,99 cases developed SHS after spinal anesthesia,and the incidence was 48.5％.Logistic regression analysis showed that maternal body weight,biparietal diameter,the difference in SBP between upper and lower extremities in supine position,the difference in SBP in upper extremities caused by changing position and positive SST were risk factors for SHS after spinal anesthesia (P＜0.05 or 0.01).Conclusion Maternal body weight,biparietal diameter,the difference in SBP between the upper and lower extremities in supine position,the difference in SBP in upper extremities caused by changing position and positive SST are risk factors for SHS after spinal anesthesia in parturients.

BACKGROUND:Endothelial progenitor cel s have been shown to play an important role in the pathogenesis of traumatic diseases in recent years. OBJECTIVE:To explore the effect of magnetic labeled endothelial progenitor cel transplantation on renal function of diabetic rats through a MRI imaging study.METHODS:Sixty Wistar rats were randomly divided into normal (no treatment), control and experimental groups. Intraperitoneal injection of 40 mg/kg streptozotocin was performed to make a rat model of type 1 diabetes in the control and experimental groups. Four weeks after modeling, rats in the experimental group were given intravenous injection of magnetic labeled endothelial progenitor cel s (0.15 mL, 1×109/L). Fasting blood glucose, serum insulin, serum creatinine, urea nitrogen and 24-hour urinary protein levels in rats were measured at 8 weeks after cel transplantation. MRI was used to trace transplanted cel s in vivo in comparison with renal biopsy findings, and rat body mass and kidney weight were measured to calculate kidney weight index. RESULTS AND CONCLUSION:After modeling, fasting blood glucose, serum creatinine, urea nitrogen and 24-hour urinary protein levels as wel as kidney weight index were increased significantly (P<0.05), while the insulin level decreased (P<0.05). Compared with the model group, the endothelial progenitor cel transplantation reversed these indices (P<0.05). Additional y, in the experimental group, there was slightly longer T1 and shorter T2 signals as wel as marked lesion edge, and the FLASH sequence became more remarkable compared with the T2-weighted RARE sequence. The other groups showed no significant low signal changes. Magnetic-labeled positive cel s in the experimental group showed by the MRI were consistent with the tissue biopsy results, while no positive cel s were found in the model and normal groups. To conclude, the magnetic labeled endothelial progenitor cel transplantation can improve renal dysfunction in diabetic rats to a certain extent.

Teaching and research section of orthodontics of the Affiliated Hospital of Stomatology of Chongqing Medical University took the lead in carrying out ‘ three early education' Students of stomatology in Chongqing Medical University established ‘ social practice volunteer team' and conducted ‘ three early education' in orthodontic clinic during winter,summer holiday and weekend.This let students of low grades contact with society,clinical practice and scientific research at early stage thus to comprehensively improve their overall quality.Questionnaire for student volunteers of the Affiliated Hospital of Stomatology of Chongqing Medical University showed that ‘ three early education' can effectively improve medical students' comprehensive quality.In the early stages of learning for students of stomatology,we cultivated students' occupation spirit,innovation consciousness,scientific literacy,clinical thinking and teamwork ability by strengthening training of students' social practice ability,communication ability,organization and coordination ability,professional interests,professional senses of belonging,team spirit and moral emotion.We achieved certain results and our experiences are worth extending.

OBJECTIVE To investigate the risk factors for nosocomial pneumonia(NP) caused by imipenem-resistant Acinetobacter baumannii(IRAB) and its antimicrobial susceptibility in vitro. METHODS The data of 34 cases of IRAB-NP were analyzed and 68 cases of NP caused by imipenem-susceptible A.baumannii(ISAB) were randomized as control.Antimicrobial susceptibility(MIC) was determined with the method of agar dilution. RESULTS The two independent factors associated with the development of IRAB-NP: previous fluoroquinolone(OR=5.738) and imipenem/meropenem(OR=7.129) use.The drug sensitivity test in vitro showed that these strains were multiresistant to commonly used antibiotics,and only ampicillin/sulbactam and cefoperazone/sulbactam whose resistance rate was less than 30%. CONCLUSIONS Previous imipenem/meropenem and fluoroquinolone use is independent risk factors for IRAB-NP.These strains are high drug resistant.

Objective To analyze the epidemiological characteristics and the detection of pathogenic microorganisms in the cases of foodborne diseases under active surveillance in Xi'an, and to provide references for prevention and control of foodborne diseases. Methods Information on surveillance cases of foodborne diseases reported by two sentinel hospitals in Xi'an from 2017 to 2019 was collected. Data was statistically analyzed. Results From 2017 to 2019, a total of 904 cases of active surveillance of foodborne diseases were reported by two active surveillance sentinel hospitals in Xi'an. There were more cases in the age groups of 1-5 and 5-8, accounting for 35.18% and 20.02%, respectively. There was a statistically significant difference in the number of cases reported in four quarters（χ²=545.38，P<0.05）. The majority of cases were reported in the third quarter, accounting for 53.76% of the total. The majority of suspicious foods were mainly mixed foods and the most suspicious dining places were families. Of the 901 samples, 251 were positive with a positive rate of 27.86%. There was a statistically significant difference in the detection ratio of different foodborne pathogens（χ²=321.92，P<0.05）. The detection rates of Norovirus and salmonella were higher, accounting for 14.98% and 11.43%, respectively. There was a statistically significant difference in the detection rate of Salmonella in different seasons（χ²= 26.49，P<0.05）, and the detection rates were higher in the second and third quarter. There was also a statistically significant difference in the detection rate of Norovirus（χ²=92.17，P<0.05） in different seasons, and the detection rate was higher in the first and fourth quarters. Conclusion The main pathogens of food-borne diseases are Norovirus and Salmonella in Xi'an. It is suggested that active surveillance should be strengthened. The prevention and control knowledge of foodborne diseases should be carried out according to the epidemiological characteristics.

Objective Retrospectively investigate the application of anterolateral thigh flow-through flap in reconstruction of the extremities,to estimate its role and characteriscts.Methods From March,2010 to January,2016,anterolateral thigh flow-through flap was performed for reconstruction of the extremities in 87 patients (56 males,and 31 females).Patient ages ranged from 13 to 68 years,average of 34.4 years.Of all cases,there were 37 legs,21 ankles or foots,1 arm,19 forearms,and 9 hands.The role and result of anterolateral thigh flow-through flap was analyzed retrospectively.Results The result showed that when anterolateral thigh flow-through flap was transferred,which simutaneously played various roles as follows:①rebuilding main vascular defect,to revascularise the distal limb.② preserving recipient vessels,to prevent flow impaired.③rebulding recepient vessel defect.④ protecting vascular anastomosis and preserving recipient flow simultaneously.⑤avoiding the dilemma of end-to-side anastomosis when recipient vessels is deep.⑥ balancing blood flow,the blood supply of the flap was more stable.⑦ linking another tissue in a series fashion,to achieve complex reconstruction.Vascular compromise occurred in 3 cases after surgery,total necrosis occurred in 1 case and partial necrosis in 1 case after reexploration.One case presented deep infection and secondary with renal failure,and received amputation.Local infection presented in 3 cases,wound dehiscence in 2 cases.All the other flaps survivled uneventfully,and its texture and color was normal.In donor site,local infection occurred in 1 case,wound dehiscence in 2 cases.Conclusion Anterolateral thigh flow-through flap has function of many sided reconstruction,which is able to play a vital role in reconstruction of the extremities.

IgG4-related disease (IgG4-RD) has been proved to be associated with malignancy.The incidence and risk factors of malignancy development in IgG4-RD were not clear.Nine IgG4-RD patients with malignancies and 27 IgG4-RD control cases were analyzed for risk factors and clinical features.The incidence of malignancy in IgG4-RD was 3.3％,higher than age-controlled general population.Smoking history was significantly more common in patients with malignancies than in the control group (9/9 vs 16/27,P ＜ 0.05).A total of 6/9 malignancies occurred within the first year after the diagnosis of IgG4-RD.Colorectal,biliary and thyroid cancers were the leading types.Smoking history is a risk factor for IgG4-RD associated malignancy.Careful vigilance to monitor malignancy needs to be paid during follow-up.

Objective To explore the causes of subclinical hypothyrodism in children and the effects of the interventional therapy with thyroixine on the course of it.Methods Two hundreds children with subclinical hypothyroidism were measured for thyroglobulin antibody(TGAb),thyroid microsomal antibody(TMAb) in the blood serum,examined by colord Dopplor ultrasonic,examined by fine needle aspiraton cytology of the throid and measured the rate of 131I absorbed by thyroid in order to find out the causes of the disease.Two hundreds cases were randomly divided into two groups on the base of the cause of diseases,treatment group 100 cases and control group 100 cases.The treatment group were treated by throxine 25-75 ?g/d and the therapeutic dosage were chosen with the normal value of free triiodothyronine(FT3),free thyroxine(FT4)and high sensitive thyrotropin(sTSH) in the blood serum .After one year thyroxine therapy were stopped.Thyroid function was examined 6 months later after stopping the thyroxine.Results Among all of the causes of subclinical hypothyroidism in children,Hasgumoto′s thyroiditis accounts for 56%,simple goiter accounts for 26%,antithyroid drug accounts for 6%,the lack of thyroxine substitution therapy on the hypothyroidism accounts for 5% and undefined causes accounts for 7% .The thyroid function could keep normal for 1 year with an alternative therapy with thyroxine on subclinical hypothyroidism in children.Half a year later after stopping thyroxine,the thyroid function turned normal in most of the children.There were obvious differences in the ratio of cure and the ratio of effectiveness between treatment group and control group (t=20.2,3.2 Pa

Objective:To explore the preoperative diagnostic value of endoscopic ultrasonography (EUS) for intraductal papillary mucinous neoplasms (IPMN).Methods:Data of 62 patients with IPMN confirmed by pathology who underwent EUS before surgery from 2008 to 2018 in Peking Union Medical College Hospital were analyzed. Characteristics that could distinguish low-grade dysplasia (LGD), high-grade dysplasia (HGD) and invasive carcinoma (IC) were explored. A scoring system based on EUS findings was established to determine the preoperative pathology of IPMN by using logistic model.Results:Of the 62 patients, 15 (24.2%) were diagnosed as having LGD, 20 (32.3%) HGD and 27 (43.5%) IC. Univariate analysis showed that the size of mural nodules and width of main pancreatic duct (MPD) were predictive factors for IPMN pathology. The possibility of higher pathological grading would increase 8% for every 1 mm increment in mural nodules. Multivariate analysis showed that only mural nodules≥5 mm ( OR=7.31, 95% CI : 2.49-21.40, P<0.001) was an independent risk factor to distinguish LGD, HGD and IC. Mural nodules≥5 mm, main pancreatic duct (MPD)≥10 mm and mural nodules <5 mm were assigned 2 points, 1 point and 1 point, respectively. The sensitivity, specificity, and area under receiver operator characteristic curve (AUC) of the EUS scoring system to distinguish benign and malignant IPMN were 0.830, 0.867, and 0.867, respectively. Conclusion:Preoperative EUS helps to distinguish LGD, HGD and IC. The size of mural nodules and the width of MPD are vital risk factors to distinguish benign and malignant IPMN.

Township and Village Health Services Integration Management (TVHSIM) is an essential form of China's two-tiered health service integration plan at the township and village level.Its main purpose,also one of the target goals in China's new healthcare reform,is to gradually integrate rural health services and appropriately allocate rural health resources.This study aims to assess the village doctors' satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM.A cross-sectional study was carried out in which 162 village doctors from Qinghai,Inner Mongolia and Xinjiang in western China were interviewed.Descriptive analysis,independent t-test,one-way ANOVA,Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors' personal characteristics and their satisfaction with TVHSIM and six subscales.Village doctors with different years of practice,social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels (all P＜0.05).Age (P＜0.05) and years of practice (P＜0.01) were negatively correlated with Drug and Medical Device Management and Financing Management.Essential medical knowledge level (P＜0.05) was negatively correlated with Operations Management as well.However,social insurance status (P＜0.05) was positively correlated with Human Resources Management and Drug and Medical Device management.Gender,age and years of practice respectively had significant influence on village doctors' satisfaction with TVHSIM (P＜0.01).In conclusion,in order to further promote TVHSIM policy in rural China,a well-rounded social insurance model for village doctors is urgently needed.In addition,the development of TVHSIM is regionally imbalanced.Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.