Objective To study the financial inputs into community health School of Medicine and Health Management, TONGJI Medical College of HUAZHONG[service (CHS) institutions by entities of different ownerships, by comparison of their investment, housing and human resources for policy recommendations.Methods Choose 6 cities in the East, Central and West of China through stratified random sampling. Collect data by literature review, in-depth interview, focus group discussion and questionnaire survey. Analyze quantitative data through EPI data 3.02 and SPSS 13.0.Results The institutions owned by the government and hospitals were advantageous in financial investment and housing; institutions under social organizations or individuals were inferior with development supports (P=0.00). Conclusion The community health service principle of government dominance and social involvement should be advocated, with equal opportunities for community service providers of various ownership. Emphasis should be placed on betterment of policies and measures, specific budget subsidy, as well as performance appraisal and service supervision. These measures aim at encouraging non-government providers to play greater role in community health service.

Objective:To analyze clinical characteristics of ketosis-associated prurigo pigmentosa after ketogenic diet and bariatric surgery.Methods:Clinical data were collected from patients with ketosis-associated prurigo pigmentosa, who were diagnosed and treated in Department of Dermatology, Peking University People′s Hospital from September 2018 to September 2020. The clinical characteristics, sequelae and therapeutic effect of dietary modification were analyzed and summarized.Results:A total of 6 patients with ketosis-associated prurigo pigmentosa were collected, including 5 females who developed prurigo pigmentosa after ketogenic diet, and 1 male who developed prurigo pigmentosa after bariatric surgery. The skin lesions mainly involved the chest, back, waist and abdomen, and rarely involved the eyelids, axillae, elbows and mons pubis. Common skin lesions included urticaria-like erythema, papules and pigmentation arranged in a reticular distribution, and rare skin lesions included mung bean- to soybean-sized blisters, whose walls were liable to break. Among 5 patients undergoing routine urine analysis, 4 were positive (from + to ++++) for ketone bodies in the urine, and 3 were positive for urinary protein (+) . Pathological examination in 2 patients showed epidermal spongiosis, scattered necrotic keratinocytes, basal cell liquefaction, lymphocyte infiltration in the superficial dermis, and erythrocyte extravasation. The 6 patients were advised to eat staple foods. After dietary modification, 5 patients were nearly cured within 1 week; 1 patient, who continued ketogenic diet for weight loss, still received marked improvement after the treatment with minocycline at a dose of 100 mg/d in spite of restriction of carbohydrate intake. The levels of urinary ketone bodies and urinary protein in the 6 patients all returned to normal within 1 week after treatment.Conclusions:Ketosis plays an important role in the occurrence of prurigo pigmentosa. Dietary modification alone or adjuvant medical treatment such as minocycline is effective for the treatment of ketosis-related prurigo pigmentosa.

OBJECTIVETo determine the percentage of hypercholesterolemic patients who had met the criteria as total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), defined by the Chinese National Recommendations for Prevention and Treatment of Dyslipidemia.

METHODSAdult patients with hypercholesterolemia, who had been receiving the same lipid-lowering therapy for at least 2 months, were enrolled. Lipid levels were determined at the time of enrollment, to assess whether the patients' lipid levels had reached the criteria for treatment. Patients' cardiovascular risk factors and lipid-lowering treatments were also collected.

RESULTSOne hundred and eighty patients with mean age of 65.8 were studied. Of these, 6.7% had no risk factors and no definite disease of atherosclerosis (low-risk group), 65.5% had risk factors but no documented atherosclerosis (high-risk group), and 27.8% had established atherosclerosis diseases or diabetes mellitus. Overall, only 44% of patients achieved both TC and LDL-C target levels. The success rates were higher among low and high-risk groups than that among patients with atherosclerosis or diabetes mellitus. The relationship between four different lipid-lowering drug therapies and successful patient outcome was also investigated. The success rates were 51.8% for simvastatin, 42.9% for pravastatin, 31.6% for fluvastatin, 12.5% for other drugs respectively.

CONCLUSIONMore than half of the hypercholesterolemic patients receiving lipid-lowering therapy had not achieved TC and LDL-C target levels. Data from this study indicated that a significant gap still existed between dyslipidemia prevention principles and clinical practices, suggesting that more aggressive treatment of dyslipidemia is needed.

Aged ; Anticholesteremic Agents ; therapeutic use ; Cholesterol ; blood ; Cholesterol, LDL ; blood ; Female ; Humans ; Hypercholesterolemia ; blood ; drug therapy ; Male ; Middle Aged

Objective To explore the establishment of disabled grade assessment scale for long-term care insurance (LTC).Methods Based on the results of literature review and long-term care needs survey,an initial scale of disabled grade assessment was formulated,then the Delphi method was combined to conduct the consultation on 22 specialists.Results After two rounds of expert consultation,the unanimous disabled grade assessment scale included four first-class indexes of sensation perception,daily activity ability,recognition ability and emotion behavior,the importance mean (M) was 4.64-5.00 points,which ≥4.0 points,the variable coefficient (CV) was 0.00 ％-13.86 ％,which ≤25 ％,the full mark rate (Fr) was 72.73 ％-100.00 ％,which ≥50 ％,recognition rate (Ar) was 90.91％-100.00％,which ≥80％,which indicated that the experts reached a consensus opinion.Among the 22 second-class indexes,the M was 4.27-4.95 points,which ≥4.0 points,CV was 4.20％-25.62％,Fr was 63.64％-95.46％,Ar was 77.27 ％-100.00 ％.The two items of touch sense and getting up from sitting position were newly added,the transferring of table and chair,recent memory and procedural memory were modified into sitting down on the bench and chair,immediate memory and short term memory,the experts reached the consistent opinion.Conclusion The replenished and modified disabled grade assessment scale for LTC has higher authority and expert consistency,which can provide a theoretical reference for the disabled grade assessment work of LTC.

Objective To explore the effect of comprehensive nursing intervention on patients′ pain and quality of life after endoscopic sinus surgery.Methods A total of 136 cases who were treated with nasal endoscopic surgery were chosen according to inclusion criteria from June 2015 to May 2016 in hospital and were randomly divided into control group and observation group. Patients in the control group received conventional nursing after nasal endoscopic surgery,while the observation group received extra comprehensive nursing intervention after nasal endoscopic surgery. Pain of patients,nursing satisfaction on postoperative 1 day,and improvement of top 5 of SNOT-20 of two groups were compared.Results Postoperative pain of two groups was none and mild,and postoperative pain response of the observation group was better than that of the control group (P<0.01). Top 5 signs of SNOT-20 were nasal congestion,need to blow nose,inattention,runny nose and tiredness. Top 5 signs of observation group were improved more compared with control group(P<0.01). The total nursing satisfaction of observation group was better than that of the control group (P<0.01).Conclusions Comprehensive nursing intervention could effectively improve the pain response of patients after nasal endoscopic surgery and elevate quality of life of patients and their satisfaction to medical care and nursing.

Beta-amyloid (Aβ) is considered to be a central event in Alzheimer's disease (AD). However, it has been found that some population have Aβ deposition in the brain and even AD related pathology without obvious cognitive impairment, which indicates that there are factors in the body to avoid or cope with Aβ damage, and this phenomenon is called Aβ tolerance. Starting from the concepts of resilience and reserve, this paper intends to sort out the epidemiology and quantitative methods, brain characteristics and influencing factors of Aβ tolerance, in order to further deepen clinicians' understanding of Aβ tolerance in AD diagnosis and treatment, so as to provide new ideas for prevention and treatment of the disease.

OBJECTIVE: To explore the effective treatment regimen for osteoradionecrosis of temporal bone. METHOD: Twenty-seven patients with massive osteoradionecrosis in temporal bone were included and retrospectively analyzed, in which, 15 cases received surgery and the other 12 cases adopted non-surgical treatment. RESULT: In the surgery group, three cases died one year postoperatively and died of massive hemorrhage due to internal carotid blowout. One case died four years after surgery without clear cause of death, and two cases were lost to follow up. Out of the nine survivors, the follow up period ranged from four months to eight years (one was followed up eight years, one was followed up over four years, four were followed up two-three years, one was followed up over one year, one was followed up nine months, and one was followed up four months, respectively). Patients classified as the type III received best outcome, and patients of type V and IV without invasion of the internal carotid artery received good surgical effects, while patients classified as the type IV with internal carotid artery invasion presented low survival rate. Two cases in the non-surgical group died of internal carotid rupture, and the other ten cases presented with repeated infection and expansion of the osteoradionecrosis lesion. CONCLUSION The new classification criteria is helpful in diagnosis of location of lesions,and can serve as a guide for clinical therapy. Massive osteoradionecrosis in temporal bone responded unfavorably to conservative treatment, compared to that, surgery can effectively control the expansion of the lesion and markedly improve patient quality of life. Long-term follow up is necessary because of the slow development of osteoradionecrosis after surgery.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; classification ; pathology ; surgery ; Osteoradionecrosis ; classification ; pathology ; surgery ; Retrospective Studies ; Temporal Bone ; pathology

We reported a case of microcephaly-capillary malformation(MIC-CAP)caused by STAMBP gene variant,in order to improve the clinical diagnosis and treatment.The patient is a 3-month-old male with recurrent convulsions and the main clinical manifestations are multiple forms of seizures,microcephaly,multiple small capillary malformations in the skin,and generalized hypotonia.The genetic test showed that a heterozygous variant in the STAMBP gene was present in the child.Both parents were heterozygous carriers.He was administrated various anti-seizure medications and ketogenic diet,but still had frequent seizures.He then underwent corpus callosotomy,and was followed up until he was 4 years and 10 months old.The post operational outcome was grade IV on Engel's classification.Based on the clinical data of 22 patients in literature,in addition to severe psychomotor retardation,microcephaly,and cutaneous capillary malformations,early-onset drug-refractory epilepsy is also a major feature of MIC-CAP syndrome,which is clinically rare and has a poor prognosis;Callosotomy may help to reduce seizures in the short term.However,the long-term outcome is poor.STAMBP gene is the main responsible gene for this syndrome.

Objective: Patients with acute coronary syndrome due to multivessel disease (MVD) were at the highest risk of adverse cardiovascular events. Neutrophil to lymphocyte ratio (NLR) was proposed as a marker of cardiovascular risk. Present study evaluated the independent predictive value of NLR for acute myocardial infarction (AMI) patients with MVD. Methods: AMI patients with MVD (n=1 433) underwent percutaneous coronary intervention (PCI) between January 2013 and December 2013 were followed up for 2 years. Patients were divided into 2 sub-groups based on an optimal cut off value of NLR to predict 2-year all-cause mortality. The primary endpoint was all-cause death. The secondary endpoint was long-term major adverse cardiovascular and cerebrovascular events (MACCE). Results: By receiver operating characteristics curve analysis, the optimal cut-off value of admission NLR to predict 2-year all-cause mortality was 3.39 (area under the curve 0.765, sensitivity 71%, specificity 73%). The high NLR group(n=396) had higher prevalence of prior myocardial infarction, prior PCI and intra-aortic balloon pump use (IABP)(P<0.01). Compared to the low NLR group (n=1 037), patients in the high NLR group were older, had higher level of neutrophil count and high-sensitivity C-reactive protein (hs-CRP) (P<0.001), but lower level of lymphocyte count, estimated glomerular filtration rate (eGFR) and ejection fraction (P<0.001). During the follow-up period, rate of long-term all-cause death was significantly higher in the high NLR group than in the low NLR group (5.1% (20/396) vs. 0.8% (8/1 037), P<0.001). Cardiac death (4.0% (16/396) vs. 0.7% (7/1 037), P<0.001) and MACCE (21.7% (86/396) vs. 12.6% (131/1 037), P<0.001) were also significantly higher in the high NLR group than in the low NLR group. Multivariate Cox analysis showed that NLR ≥ 3.39 was determined as an independent predictor of 2-year all-cause mortality (HR=3.23, 95%CI 1.38-7.54, P=0.007) and MACCE (HR=1.58, 95%CI 1.19-2.10, P=0.002) in this patient cohort after adjusting for other risk factors. Correlation analysis showed that the NLR was positively correlated with hs-CRP levels (r=0.241, P<0.001). Conclusion Our study demonstrates that admission NLR ≥ 3.39 is an independent predictor of long term all cause death and MACCE in AMI patients with MVD post PCI.

Objective:To compare the influence of single and staged percutaneous coronary intervention (PCI) on long-term prognosis in patients with multi-vessel coronary artery disease.Methods:Using prospective research methods, 1 832 patients with multi-vessel coronary artery disease from January to December 2013 in Fuwai Hospital, Chinese Academy of Medical Sciences were selected. According to the time of PCI, the patients were divided into single PCI group (1 218 cases) and staged PCI group (614 cases). The patients were followed up for 2 years, the primary endpoint was major cardiovascular and cerebrovascular event (MACCE), including target vessel-related myocardial infarction (TV-MI), target vessel-related revascularization (TVR), cardiogenic death and stroke, and the secondary endpoint was stent thrombosis. The propensity score matching (PSM) was applied to balance the discrepancies between 2 groups, and the baseline and follow-up data were compared. The Kaplan-Meier survival curves were drawn to evaluate the survival rates events; multifactor Cox proportional risk regression was used to analyze whether staged PCI was an independent risk factor for the endpoint events.Results:The in-hospital stay, duration of procedure and synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score in single PCI group were significantly lower than those in staged PCI group: (5.54±3.09) d vs. (9.50±4.06) d, (43.12±28.55) min vs. (79.54±44.35) min, (14.04±7.63) scores vs. (18.51±7.79) scores, and there were statistical differences ( P<0.01); there were no statistical difference in complete revascularization rate and SYNTAX score after PCI between 2 groups ( P>0.05). Based on 2-year follow-up, the incidences of TV-MI and stent thrombosis in staged PCI group were significantly higher than those in single PCI group: 2.1% (13/614) vs. 0.5% (6/1 218) and 2.0% (12/614) vs. 0.4% (5/1 218), and there were statistical differences ( P<0.01). Kaplan-Meier survival curves analysis results showed that the event-free survival rates of TV-MI and stent thrombosis in single PCI group were better than those in staged PCI group (99.5% vs. 97.9% and 99.6% vs. 98.0%, P<0.01). Multifactor Cox proportional risk regression analysis results showed that staged PCI was an independent risk factor for stent thrombosis ( HR = 3.91, 95% CI 1.25 to 12.18, P = 0.019). After PSM, the incidences of TV-MI and stent thrombosis in staged PCI group were significantly higher than those in single PCI group: 2.1% (13/614) vs. 0.7% (4/614) and 2.0% (12/614) vs. 0.5% (3/614), and there were statistical differences ( P<0.05); Kaplan-Meier survival curve analysis results showed that the event-free survival rates of TV-MI and stent thrombosis in single PCI group were significantly higher than those in staged PCI group: (99.3% vs. 97.9% and 99.5% vs. 98.0%, P<0.05); multifactor Cox proportional risk regression analysis results showed that staged PCI was not an independent risk factor of stent thrombosis ( HR = 2.29, 95% CI 0.58 to 9.00, P = 0.234). Both before and after PSM, there were no evidences for interaction between the type of angina pectoris and staged PCI ( P>0.05). Conclusions:Although a seemingly increase exists in the incidence of TV-MI and stent thrombosis in the staged PCI group, staged PCI is an independent risk factor neither for MACCE and its components, nor for stent thrombosis. In addition single PCI reduces the in-hospital days and duration of PCI procedure, which may be a relatively reasonable approach to clinical practice.