Based on the references of relevant statistical data, the implementation of the overall situation of the basic medical insurance system in Henan were compared. The sample cities and counties of basic medical insurance data were analyzed through the field survey. Using empirical analysis methods to discuss the necessity and feasibility of integration between new rural cooperative medical system and urban residents medical insurance, put forward the integration path and propose related suggestions.

Objective To identify the incidence and risk factors of gastrointestinal bleeding in patients supported with mechanical ventilation over 48 hours. Method A total of 127 ICU patients supported with mechanical ventilation for over 48 hours were enrolled from January 1, 2007 to December 31, 2008 for the retrospective study. Exclusion criteria included the history of gastrointestinal bleeding and ulcer, recent gastrointestinal surgery, brain death and active bleeding from nose or throat. Demographics of patients including age, diagnosis at admission, duration of ICU stay, duration of mechanical ventilation, pattern and parameters of ventilation, ICU mortality, A-PACHE II score, multiple organ dysfunction score, and the results of biochemical assays including renal, hepatic and coagulation functions were recorded. Risk factors of gastrointestinal bleeding were analyzed by using univariate analysis And multiple logistic-regression analysis. Results Of the 127 patients, the incidence of gastrointestinal bleeding was 41.7% . and among them 3.9% patients suffered from clinically significant bleeding. However, the independent risk factors of gastrointestinal bleeding were the peak inspiratory pressure > 30 cmH20 (RR = 3.73, 95% CI = 1.59-9.46), renal failure (RR = 1.16,95% CI = 1.02 - 2.32), PLT count <50× 109 L-1(RR = 2.67, 95% CI = 1.32 - 15.78) and prolonged APTT (RR = 4.58, 95%CI = 2.32 - 12.96). The good entetal nutrition had a beneficial effect to the avoidance of gastrointestinal bleeding ( RR = 0.30, 95% CI = 0. 13 - 0.67). Conclusions The incidence of gastrointestinal bleeding is high in patients supported with mechanical ventilation, and the bleeding usually occurs within the first 48 hours. High pressure ventilator setting, renal failure, decreased PLT count and prolonged APTT are significant risk factors of gastrointestinal bleeding. However, the good enteral nutrition is the independent protective factors.

The rapidly aging population has attracted extensive attention to the health of elderly people .The elderly are a vulnerable group in society .Their adverse physical and mental health not only affects their own well-be-ing but also brings a heavy burden on families and society .Numerous studies have found that health inequality of the elderly is a problem throughout the world, and differences in gender, age, marital status, socioeconomic status, and social capital among the elderly are all contributing factors .This paper summarizes these factors through a literature review.We suggest that cross-sectional and longitudinal data should be combined and suitable indicators and mathe -matical models to Chinese conditions should be established in order to analyze the mechanisms of various factors and their effects on health inequality and serve as a reference for promoting the overall health of the elderly .

Objective To evaluate the effects of fluid resuscitation and large-volume hemofiltration (HVHF) on the Alveolar-arterial oxygen exchange in patients with refractory septic shock. Method A total of 89 intensive care patients with refractory septic shock treated with fluid resuscitation and/or HVHF were enrolled between August 2006 and December 2009. All the patients were randomly divided into two groups. In group A, patients were treated with fluid resuscitation, n = 41 cases) and in group B, patients were treated with large-volume hemofiltration and fluid resuscitation, n =48). The O2 content of central venous blood(CcvO2), arterial oxygen content (CaO2), Alveolar-arterial oxygen pressure difference (P(A-a)DO2), the ratio of arterial oxygen pressure/alveolar oxygen pressure (PaO2/PAO2), respiratory index (RI) and oxygenation index (OI) were checked. The levels of oxygen exchange in two groups were detected by arterial blood gas analysis before treatnent, 24 hour, 72 hour and 7 days after treatment. The APACHE Ⅱ scores in patients with refractory septic shock were measured before and the 7th day after treatment with HVHF and/or fluid resuscitation respectively. Data were analyzed by using t -test and chi-square test to compare the differences and ratio between two groups and were expressed in mean ± standard deviation, and the analysis of variance was done with SPSS version 12.0 software. Results ① The differences in CcvO2 and CaO2 between two groups were[(0.60±0.24) vs. (0.72±-0.28), P ＜0.05 and (0.84±0.43) vs. (0.94±0.46), P ＜0.05]; and the oxygen extraction rates (O2ER) were significantly different between two groups [(28.7±2.4) vs. (21.7±3.4), P<0.01];② The levels of P(A-a)DO2、ratio of PaO2/PAO2、RI and OI in group B were reduced more significantly than in group A (P<0.05 or P<0.01);③The APACHE Ⅱ scores in both groups were gradually reduced after treatment for 7 days, and the APACHE Ⅱscore in group B on the 7th day of treatment were lower than that in group A[(17.2 ± 6.8) vs. (8.2 ± 3.8), P ＜ 0.01]. Conclusions Fluid resuscitation and HVHF could improve alveolar-arterial-oxygen exchange in patients with refractory septic shock, and at the same time decreased the APACHE Ⅱ scores, improving the survival rate of patients.

Objective To observe the clinical efficacy of ulinastatin(UT) conjoined to high flow continuous blood purification( CBP) in the critical patients with multiple organ dysfunction syndrome(MODS). To evaluate the therapeutic potential of UT and CBP in systemic inflammatory response syndrome (SIRS) , severe sepsis( SS) , acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Method A total of 122 cases of emergency and critical patients with a score of more than 15 counted up from APACHE H (acute physiology and chronic health evaluation 11 ) were randomly divided into Ulinastatin treatment group (UT group, n = 35) .continuous blood pu-rification(CBP group, n = 31),UT plus CBP (combine group, n = 30) and routine treatment group (control group, n =26). Routine treatment was given to patients of all groups, and patients of UT group had Ulinastatin 0.4 MIU given intravenously every 8 hours for 7 days in addition. Patients of CBP group were managed with continuous blood purification round the clock for 7 days and those of combine group were treated with UT plus CBP for 7 days.The efficacy of the treatment in four groups was assessed,and serum high sensivity reactive protein(hs-CRP) and IL-6 levels were measured on admission and comparison was made between values of biomarkers taken before and 1 d,3 d,and 7 d after treatment in four groups. The changes in WBCs,arterial gas analysis and the oxygena-tion index PaO2/FiO2 were checked, and at the same time, the APACHE II values and the incidence of MODS were compared within four groups. Results (1)One, three and seven days after treatment the plasma hs-CRP and IL-6 levels in UT and CBP groups were reduced significantly more than those in control group ( P < 0. 05), and in combine groups those were more dramatically lowered ( P < 0.05, P < 0.01). Before treatment there was no significance diffience in those values between groups, and there was on diffience in those values between 3 rd day and 7 th day after treatment ( P > 0.05). (2) The 1 st,3 rd and 7 th day after treatment the arterial gas PaO2/FiO2 index in UT and CBP groups was improved more than that in control group ( P < 0.05) , and it in combine group was most significant improved (P < 0.05,P < 0.01). The ALT and creatinine were lower than those in control group ( P < 0.05), and there were no significant differences in ALT and creatinine between groups before treatment (P > 0.05). (3) The 1 st,3 rd and 7th day afer treatment,the APACHE II values in UT and CBP groups were decreased more than those in control group ( P < 0. 05) , and therefore, the incidence of MODS was lower ( P < 0.05). Conclusions Ulinastatin could significantly inhibit the production of inflammatory cytokines and CBP could effectively eliminate inflammatory factors from blood, and the combination of these two approaches produce a more effective therapeutic potential for preventing MODS development.

Objective To study the therapeutic effects of omeprazoie in high-dose given by continuous intravenous infusion in the treatment of stress-related mucosal injury of G-I tract in intensive care patients.Method Totally 98 intensive care patients with stress-related mucosal injury(SRMI)were enrolled from August 2006 to October 2008 Department in Intensive Care Unit(ICU)of the Provincial Hospital Affiliated to Shandong University.All the patients were randomly divided into high-dose omeprazoie group(group A)and control group(group B).In group A,omeprazoie was administrated in loading dose of 80 mg Ⅰ.Ⅴ.in 5 minutes followed by maintenance dose of 8.0 mg/h intravenous infusion for 72 hours,while in group B,omeprazoie was given in dose of 40mg/8h intravenous infusion for 72 hours.The pH value of gastric juice was determined by German Roche pH test paper every 2 to 8 hours in the patients of both groups.The coffee like or red juice in the gastrointestine decompressor was observed.At the same time,hemoglobin(HB)was detected by Automatic blood cell analyzer Sysmex XE-2100,blood urea nitrogen(BUN)was determined by Automatic Analyzer Au5400,and buffer excess(BE)was checked by GEM Premie arterial blood gas analyzer in all patients.Data were expressed as mean ± standard deviation(x-± s)and the analysis of variance was done with SPSS 12.0 software.Comparison of mean value between two groups was conducted with t-test and the ratio was calculated by using chi-square test(X2 test).The change was considered as statistically significant if P value was less than 0.05.Results Four,eight,and 24 hours after treatment with omeprazole,the pH values in patients of group A were higher than those in patients of group B(four hous:6.63 ±0.62 vs.3.14 ±0.26,P＜0.01;eight hours and 24 hours:P＜0.05 or P＜0.01).At 8 hours and 24 hours after treatment,the HB was higher,BUN and BE were lower in group A than those in group B(P＜0.03 or P＜0.01).The total rate of hemostasis of upper G-I tract bleeding in group A was higher than that in group B(95.35%vs.78.19%,P＜0.05).Conclusions For treating the intensive care patients with SRMI,the continues intravenous infusion of omeprazole inhigh dose is superior to conventional dosage.

Objective:To investigate polymorphism of human leukocyte antigen (HLA)-DRB1 and -DQB1 genes in Bai ethnic group in Dali,Yunnan province.Methods:Polymerase chain reaction-sequence specific primers (PCR-SSP) were used to determine HLA-DRB1 and -DQB1 alleles in 124 unrelated healthy Bai ethnic individuals living in Eryuan County of the Dali Bai autonomous prefecture,Yunnan province.Results:Among all the 21 DRB1 alleles and 15 DQB1 alleles were identified,the predominant alleles were DRB1*1202(26.61%),DRB1*0901(13.89%) and DRB1*0803(9.92%) on DRB1 locus and DQB1*0301(31.45%),DQB1*0601(10.08%),DQB1*0401(8.06%)and DQB1*0502(8.06%)on DQB1 locus.The most common haplotypes were DRB1*1202-DQB1*0301(20.08%)and DRB1*0803-DQB1*0601(7.19%).Conclusion:The phylogenetic tree constructed according to the HLA-DRB1,-DQB1 allele frequencies of Bais with those of other 10 populations suggests that the Bai ethnic group belongs to the southern group of China,but it keeps genetic distance from others and the HLA genes exhibits a unique profile.This study would provide HLA polymorphism information of Bai for the future investigation on the disease related to the genetic polymorphism.

Objective To evaluate the feasibility and safety of a delivery pathway for the performance of percutaneous left atrial appendage (LAA) occlusion in experimental canine models. Methods Transseptal puncture was performed via femoral vein approach under fluoroscopic and angiographic guidance in 12 experimental dogs. A pigtail catheter was advanced into the left atrium (LA), which was followed by LA angiography. The diameters of the neck of LAA were measured on LAA angiogram obtained in appropriate projection. After the delivery sheath was advanced along the wire into LA, a pigtail catheter was inserted into the ostium of the LAA and the sheath was then advanced over the pigtail into the LAA. LAA angiography was then performed through the delivery sheath to confirm the position of the delivery sheath. One hour after the procedure both electrocardiography (ECG) and transthoracic echocardiography (TTE) were carried out in five dogs to check the results, immediately after which the five dogs were sacrificed to macroscopically observe the damages of the puncture site of inter-atrial septum as well as inside the LA and LAA. One hour and 2 weeks after the procedure TTE was conducted in the remaining 7 dogs and these dogs were followed up for one month. Results One dog died of pericardial tamponade during the operation. In 8 dogs the LAA was clearly displayed in the projection position of right anterior oblique (RAO) 30°/cranial (CRA) 20°,while in 3 dogs the LAA was well visualized in the projection position of RAO 30° , and in one dog in the projection position of RAO 30°/caudal (CAU) 20°. The diameter of LAA neck was (13.6 ± 5.2) mm. The delivery sheath was safely advanced into the LAA along the pigtail catheter in all dogs, and no air embolism, thrombus or pericardial tamponade occurred. Hematoma at puncture point of groin occurred in 2 dogs, which was absorbed through pressure dressing. Macroscopic examination of the heart performed immediately after the operation showed that no bloody pericardial effusion was found, and mild hematoma at posterior wall of LA was seen in one dog and mild damage of the upper-margin intima of LAA was noted in 2 dogs. The mean fluoroscopy time was (10.1 ± 2.5) minutes and the mean operation time was (58 ± 12) minutes. TEE showed no pericardial effusion 2 weeks after the procedure. During the follow-up period of one month no sudden death, stroke or infection occurred. Conclusion This method of placing the delivery sheath into the LAA is clinically safe and effective, and it can reliably establish a pathway to advance the LAA occluder into LAA.

Objective:We aimed to analyze the spectrum of diseases of Experienced Ten Acupoints in clinical studies, in order to provide reference for further clinical trials.Methods:The Chinese academic journals full-text database (CNKI),Chinese science and technology journals full-text database (VIP),Wanfang database and Chinese biomedical database (SinoMed), PubMed, Cochrane Library and Web of Science Database were searched from the incecption to October, 2021. The quantitative analyses were conducted on the characteristics of the clinical studies, including years of publication, journals, affiliations of authors, interventions, diseases, types of studies, evaluation of efficacy, rate of citations.Results:A total of 81 articles were included in 44 journals. The majority types of studies were RCTs, the main intervention was acupuncture as well as acupuncture combined with Traditional Chinese Medicine or medicine. For types of diseases, digestive system diseases account for the major part (66.67%), followed by nervous system diseases (17.28%).Conclusions:The studies associated with Experienced Ten Acupoints were relatively few, the corresponding spectrum of diseases was in limit range, and experimental studies lacks. This study suggested that the clinicians should pay attention to the classical acupoints prescriptions, and the research progress of clinical trials should be more standardized.

Objective:To explore the incidence of secondary hemophagocytic lymphohistiocytosis (sHLH) in elderly patients with severe SARS-CoV-2 infection, and to analyze and summarize its clinical features and risk factors for early identification of high-risk groups.Methods:A retrospective cohort study was conducted. From January to May 2020, No. 960 Hospital of People's Liberation Army, the Second Hospital Affiliated to Cheeloo College of Medicine of Shandong Province, the First Rehabilitation Hospital of Shandong Province, the Public Health Clinical Center Affiliated to Shandong University, and Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine received 248 patients over 60 years old who were diagnosed with severe SARS-CoV-2 infection during their assistance to Hubei or support for diagnosis and treatment of SARS-CoV-2 infection in Shandong Province. The clinical data of patients were collected. According to the hemophagocytic lymphohistiocytosis diagnosis scoring (HScore) criteria, the patients were divided into sHLH group (HScore > 169) and non-sHLH group (HScore < 98). The demographic data, clinical features, laboratory results, the proportion of organ failure and 60-day mortality of patients were collected and compared between the two groups. The risk factors of sHLH and 60-day death were evaluated through binary multivariate Logistic regression analysis in elderly patients with severe SARS-CoV-2 infection. The receiver operator characteristic curve (ROC curve) was plotted to analyze the diagnostic value of indicators only or combined for sHLH.Results:Among 248 elderly patients with severe SARS-CoV-2 infection, 82 patients with incomplete data and untraceable clinical outcomes, and 35 patients with HScore of 98-169 were excluded. Finally, 131 patients were enrolled in the final follow-up and statistics, including 25 patients in the sHLH group and 106 patients in the non-sHLH group. Compared with the non-sHLH group, plasma albumin (ALB), hemoglobin (Hb), lymphocyte count (LYM), platelet count (PLT), fibrinogen (Fib) and prealbumin (PAB) in the sHLH group were significantly reduced, while alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), MB isoenzyme of creatine kinase (CK-MB), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ferritin (Fer), lactate dehydrogenase (LDH), procalcitonin (PCT), cardiac troponin I (cTnI), triglycerides (TG), interleukin-6 (IL-6), total bilirubin (TBil) were significantly higher. The fever and fatigue in the sHLH group were more severe than those in the non-sHLH group, and the patients in the sHLH group had higher rates of shock, acute kidney injury, liver dysfunction, and cardiac injury than the non-sHLH group. The 60-day mortality of patient in the sHLH group was significantly higher than that in the non-sHLH group [84.0% (21/25) vs. 40.6% (43/106), P < 0.01]. Binary multivariate Logistic regression analysis showed that high Fer [odds ratio ( OR) = 0.997, 95% confidence interval (95% CI) was 0.996-0.998], D-dimer ( OR = 0.960, 95% CI was 0.944-0.977), LDH ( OR = 0.998, 95% CI was 0.997-0.999) and TG ( OR = 0.706, 95% CI was 0.579-0.860) were independent risk factors for sHLH in elderly patients with severe SARS-CoV-2 infection (all P < 0.01), while elevated Fer ( OR = 1.001, 95% CI was 1.001-1.002), LDH ( OR = 1.004, 95% CI was 1.002-1.005) and D-dimer ( OR = 1.036, 95% CI was 1.018-1.055) were independent risk factors for 60-day death of patients (all P < 0.01). The death risk of the sHLH patients was 7.692 times higher than that of the non-sHLH patients ( OR = 7.692, 95% CI was 2.466-23.987, P = 0.000). ROC curve analysis showed that a three-composite-index composed of LDH, D-dimer and TG had good diagnostic value for sHLH in elderly patients with severe SARS-CoV-2 infection [area under the ROC curve (AUC) = 0.920, 95% CI was 0.866-0.973, P = 0.000]. Conclusions:Elderly patients with severe SARS-CoV-2 infection complicated by sHLH tend to be critically ill and have refractory status and worse prognosis. High Fer, LDH, D-dimer and TG are independent risk factors for sHLH, and are highly suggestive of poor outcome. The comprehensive index composed of LDH, D-dimer and TG has good diagnostic value, and can be used as an early screening tool for sHLH in elderly patients with severe SARS-CoV-2 infection.