Objective To explore the risk factors of osteoporosis and the relation with pulmonary dysfunction in elderly patients with chronic obstructive lung disease (COPD). Methods One hundred and eighty patients (82 females and 98 males) with acute exacerbation of chronic obstructive lung disease (AECOPD) from March 2006 to June 2008 were selected in the study. The bone mineral density (BMD) of lumbar vertebrae and hip joint were determined by dual energy X-ray absorptiometry(DEXA). All the patients were divided into two COPD groups with and without osteoporsis. The smoking history, incidence of vertebral fractures, glucocorticosteroid using condition and so on were recorded. The pulmonary function, 6-minute walk distance(6MWD), body mass index (BMI) and serum albumin concentration were evaluated. Results The mean age of all patients was (72±7)years, and the average smoking amount was (59±27)pack years. The ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) was(36.46±9.8)%, and 30% of the patients had inhaled or oral glucocorticoids for more than 3 months. The BMD measurement results showed that BMD of 95% patients(171 cases) was lower than the normal level, and 119 cases (66%) had osteoporosis, including 61 males and 58 females (62%vs. 70%, x2 = 1.435, P=0.33), and 52 cases had (29%) osteopenia. Linear correlation analysis showed that BMI, 6MWD, RV% and FVC% had positive correlation with osteoporosis (r=0.362, 0.635, 0.688, 0.973;all P<0.05).Conclusions The prevalence of osteoporosis is high in elderly patients with moderate or severe COPD, and enough attention and active intervention shoule be paid.

Objective To compare the dosimetric differences between intracavitary brachytherapy in combination with interstitial brachytherapy or not for locally advanced cervical cancer.Methods From May 2016 to March 2017,35 patients with locally advanced cervical cancer treated with combined external beams and intracavitary/interstitial brachytherapy were selected in this study.The prescription of intensity-modulated radiation therapy was:46.8-50.4 Gy/26-28 fractions,1.8 Gy/fraction.The prescription for combined intracavitary/interstitial brachytherapy was 7 Gy/fraction × 4,once per week.Each patient was first implanted with a three tube applicator for brachytherapy,and the CT images were acquired for treatment planning.The three tube applicator was removed before a uterine tube and needles were implanted,thereafter planning images were acquired again.Dose to the targets and organs at risk were evaluated respectively for the two groups.Results A total of 212 brachytherapy plans were developed,including 106 intracavitary and 106 endoluminal combined interstitial plans.The target dose in endoluminal combined interstitial brachytherapy was significantly higher than that of intracavitary treatment alone,where D90 of the high-risk clinical target volume (CTV) and moderate CTV were both significantly increased (t =-6.01,-2.73,P ＜ 0.05).The D2 cm3 of the bladder,rectum and sigmoid colon were significantly reduced (t=3.07,4.52,2.91,P＜0.05).Conclusions The application of the endoluminal combined interstitial brachytherapy for locally advanced cervical cancer can significantly increase the target dose,and reduce the dose to organs at risk such as the bladder,rectum and sigmoid colon.

Objective To investigate the nutritional risk of hospitalized infants with severe pneumonia and its relationship with clinical outcome. Methods Totally 113 infants with severe pneumonia admitted to pediatric intensive care unit (PICU)were enrolled in the study. Nutritional risks were screened by STRONGkids, and the nutritional were assessment with WHO Anthro. Clinical outcomes were recorded and analyzed, including mechanical ventilation, length of PICU stay, total hospital expenses, prognosis, and biochemical test index. Results A total of 44 infants (38.9％) had high nutritional risk, 49 (43.4％) had medium nutritional risk, 20 (17.7％) had low nutritional risk when they admitted to PICU. A total of 59 (52.2％) infants were malnourished when they admitted to PICU. There was a significant correlation between the degree of malnutrition and nutritional risk (r =0.574, P<0.01).The incidence of high nutritional risk was significantly higher in 28d～1year-old group than in 1～3 year-old group (χ2=20.46, P<0.01). Nearly 42.5％(48/113) of the children had congenital disease and had higher incidence of high nutritional risk (χ2=11.375, P=0.003) and higher incidence of malnutrition (χ2=10.083, P=0.001) than those without congenital disease. The rate of mechanical ventilation (P=0.028), the duration of mechanical ventilation (P<0.01), total hospital expenses (P=0.002) and the incidence of poor prognosis(P=0.014) were significantly higher in high nutritional risk group than the low nutritional risk group. The retinol binding protein in the high nutrition risk group was significantly lower than the low nutrition risk group (χ2=6.333, P=0.021). Conclusions High nutritional risk and malnutrition are common in infants with severe pneumonia. Malnutrition and nutritional risk are increased in patients less than 1 year old or suffering from congenital disease. Patients with high nutritional risk are more likely to have worse clinical outcomes. STRONGkids is a valid tool for nutritional risk screening in hospitalized children, and early nutrition support is recommended.

With the arrival of aging, various industries in society are facing great pressure, especially higher requirements for the medical and nursing industries. The integrated eldercare services with medical care breaks through the traditional endowment pattern and integrates medical treatment, elderly care, rehabilitation, and nursing. However, many factors hinder the development of this model at present, and it requires the cooperation of the country and various departments to improve. From the perspective of a Healthy China, based on the release and implementation of policies such as the "Healthy China 2030" Plan Outline and the "Healthy China Action (2019-2030)" , this paper briefly summarized the current status and existing problems of the development of integrated eldercare services with medical care in China, and put forward rectification suggestions, aiming to provide reference to build a new endowment pattern of integrated eldercare services with medical care with Chinese characteristics.

Objective:To explore the effect of integrated comprehensive management model in the management of arteriovenous fistula in maintenance hemodialysis (MHD) patients.Methods:From January to December 2020, 174 patients undergoing MHD in the Blood Purification Center of the First Affiliated Hospital of Zhengzhou University were selected as the research object by convenience sampling. According to the random number table method, the patients were divided into the integrated management group and the routine management group, with 87 cases in each group. Patients in the routine management group received routine vascular access nursing after admission. On the basis of routine vascular access nursing, the integrated management group introduced a multidisciplinary vascular access management team to apply it to the access management of MHD patients, and divided the vascular access management into five key links of preoperative assessment, access establishment, access use, access monitoring and access maintenance, and formulated specific measures and content for each link to implemented an integrated comprehensive management model. After three months of intervention, the successful rate of one-time puncture, the use rate of the first dialysis internal fistula, the incidence of associated complications and dialysis tolerance were compared between the two groups.Results:The one-time puncture success rate and the first dialysis internal fistula usage rate in the integrated management group were higher than those in the routine management group, and the differences were statistically significant ( P<0.05) . The overall complication rate in the integrated management group was 6.90% (6/87) , which was lower than 31.03% (27/87) in the routine management group, and the difference was statistically significant (χ 2=16.491, P<0.01) . The scores of the two parts and total scores of the dialysis tolerance in the integrated management group were higher than those in the routine management group, and the difference was statistically significant ( P<0.05) . Conclusions:The integrated comprehensive management model applied in the management of vascular access in MHD patients can increase the one-time puncture success rate of arteriovenous fistula and the use rate of the first dialysis fistula, reduce the incidence of associated complications, and improve patient tolerance.

Objective To explore the scanning technique and image quality of coronary artery imaging with dual-source CT without oral Betaloc preparation in the patients with high heart rate.Methods 412 cases were undergone coronary imaging with dual-source CT (including plain and enhanced scans) ,among them,there were 30 cases with heart rate more than 100 bpm.Multi-planar reconstruction(MPR),maximum intensity projection(MIP) and volume rendering (VR) were performed using contrast-enhanced images.The image quality was classified into 3 grades, and coronary segments named according to AHA standard were evaluated.Results The average heart rate during enhanced scan in the 30 cases was (115.6?11.8)(101～139)bpm,the average breath hold time was (5.7?1.2) s.The best reconstruction phase was in the systolic phase. Altogether 424 coronary segments were evaluated, among them 93.9%(398/424)belonged to the first grade,5.0%(21/424)belonged to the second grade,and 1.2%(5/424) belonged to the third grade. Conclusion Without oral administration of Betaloc preparation, good coronary artery images can be obtained in the patients with high heart rate by dual-source CT.