We analyze the experiences and the problems,which are accumulated in Residencytraining work of Tianjin in nearly twenty years,and state the feasibility of specialist system and give some suggestions.

Objective To investigate the prevalence and risk factors of hyperuricemia (HUA) in rural residents of Gaoyou City,Jiangsu Province.Methods A total of 4504 rural residents were investigated in a cross-sectional study.Questionarre survey and physical examination were used for the stndy.Fatsing venous blood samples were collected for biochemical examination.T-test,chi-square test for multiple-group data comparison and logistic regression analysis were used for statistical analysis.Results The prevalence of HUA was 11.9％,15.7％ in male,which was significantly higher than 8.6％ in the female (P＜0.01),the risks of HUA in male was 1.98 times higher than in female.The average value of serum uric acid in this population was higher than.that of female.The prevalence of HUA in female increased with age.Non-conditional logistic regression analysis showed WHR,Cr,Tg,hypertension were the independent risk factors of male patients with HUA.Age,BMI,Cr,Tg,hypertension were independent risk factors of HUA in female.Conclusion The prevalence of HUA can be affected by age and sex.Weight control,keeping blood pressure and blood lipid profiles in normals levels are important for the prevention of HUA.

Objective During pregnancy , exosomes can be released from the placenta into maternal circulation and play im-portant roles in normal pregnancy or placenta-related diseases .We aimed to establish a simple and efficient method for isolating and i-dentifying placental exosomes from maternal serum and lay a foundation for the studies of pregnancy -related diseases . Methods Using sucrose gradient centrifugation with 8% PEG6000 precipitation twice , we isolated and purified placenta-derived exosomes from normal maternal serum and detected their molecular markers CD 63 , CD81 and PLAP by Western blot , followed by silver staining anal-ysis of the protein profile of the exosome pellet .We identified the morphology of the placenta-derived exosomes by transmission electron microscopy ( TEM) and measured the size and distribution of the particles by dynamic light scattering ( DLS) . Results Silver stai-ning of the protein profiles of the exosomes after sucrose gradient centrifugation clearly revealed the bands of the protein molecules . Western blot showed the expressions of CD 63, CD81, and PLAP in the 21-34%density layer, which demonstrated the presence of serum placental exosomes mainly in the 1.09-1.16 g/mL density layer.TEM exhibited that the placenta-derived exosomes were round or oval cup-shaped, specifically expressing PLAP, and the particles were uniform in size, with a mean diameter of (41.79 ±11.94) nm. Conclusion A simple, fast, and efficient method was successfully established for isolating placenta-derived exosomes from ma-ternal serum, which provides a basis for studying the roles of placental exosomes in normal pregnancy and placenta -related diseases.

30%) might be a risk factor in HAPE susceptibility.

Objective:To construct a risk assessment model based on hesitant probabilistic fuzzy set(HPFS)and to explore its application value in the risk control and management of safe operation of anesthesia equipment.Methods:Taking the whole life cycle safety and management safety as the important risk assessment dimensions,the risk index system of safe operation of anesthesia equipment was constructed,HPFS and hierarchical-superior-inferior solution distance method were used to realize the quantitative analysis of risks,and the safety self-inspection and risk control treatment strategies were formulated.A total of 150 surgical patients and 16 anesthesia equipment used in surgery used in the operation were selected from July 2020 to June 2023 in Tongzhou District Maternal and Child Health Hospital,and into control group and observation group according to different management modes of anesthetic equipment,with 75 cases in each group.The 10 anesthesia machines used during the surgical treatment of the control group adopted the conventional risk control mode,and the 12 anesthesia machines used in the observation group(including 6 in the control group and the 6 newly added ones)adopted the risk assessment control mode.The incidence of perioperative anesthesia equipment-related risk events,the awareness rate of anesthesia medical staff about potential safety risks,and the failure rate of anesthesia equipment were compared between the two groups.Results:The number of perioperative risk events of improper operation of anesthesia equipment,unreasonable dosage of anesthesia,associated infection and missing records in the observation group were 4 cases(5.3%),0 cases(0%),1 case(1.3%)and 1 case(1.3%),respectively,which was lower than that in the control group,the difference was statistically significant(x2=4.478,4.110,6.857,4.754;P<0.05).The average scores of theoretical knowledge of safety management,safe use,management awareness and fault judgment ability of medical staff operating anesthesia equipment in the observation group were(96.27±3.93)points,(94.31±2.69)points,(91.82±1.94)points and(84.97±4.36)points,respectively,which were higher than those in the control group,the difference was statistically significant(t=5.176,5.322,5.541,5.942;P<0.05).The total number of equipment operation setting,anesthetic gas path,anesthesia depth monitoring,threshold alarm and other faults in the two groups were 90,37,25,316 and 125,respectively,and the failure incidence rates in the observation group were 30%(27/90),35%(13/37),28%(7/25),22%(69/316)and 39%(49/125),respectively,which were lower than those in the control group,the difference was statistically significant(x2=28.800,6.541,9.680,200.532,11.664;P<0.05). Conclusion:The risk assessment model based on HPFS can reduce the incidence of risk events related to anesthesia equipment,enhance the awareness of safety risk control of anesthesia medical staff,and improve the quality of clinical operation of anesthesia equipment.

This article collects related literatures which is about the Chinese medicine adjuvant treatment of bladder urothelial carcinoma, and sums up the etiology, pathogenesis and TCM auxiliary treatment methods of this disease. Through the analysis, it is believed that the pathogeny of the disease is mainly concentrated in the aspects of damp, heat, blood stasis and poison. The literature on the adjuvant treatment of bladder urothelial carcinoma mainly focuses on the treatment of syndrome differentiation, postoperative recovery, postoperative perfusion, adjuvant chemotherapy and palliative therapy. The progress of its research is summarized as follows.

OBJECTIVE To explore the distribution of airborne pollen in Cangzhou,to analyze the correlation between pollen characteristics,meteorological factors and the rate of allergic rhinitis visits,and to provide a reference basis for the precise prevention and treatment of allergic rhinitis in Cangzhou.METHODS The gravity deposition method was applied to collect daily airborne pollen from the monitoring sites in Cangzhou from March to October 2022 and record the pollen species and quantities.We also collected information on allergic rhinitis patients who visited the ENT Department of Cangzhou Central Hospital during the same period and meteorological data(daily maximum temperature,minimum temperature,maximum relative humidity,maximum precipitation,and maximum wind speed at ground level)during the same period,and analyzed the relationship between the number of AR patients'visits,the amount of pollen,and the meteorological factors.RESULTS 1.A total of 229 pollen exposures were collected from March to October 2022,totaling 19 368 pollen grains,of which 18 750 grains of pollen could be identified in 19 families and 618 grains were difficult to identify the families.2.There were two peaks of pollen during the period,in April and September respectively.Spring pollen to tree-based category,to the pine family,willow willow family,Xylariaceae(ash)most often;summer pollen volume has declined,but still tree-based category;fall pollen to herbaceous category,to the Asteraceae Artemisia,mulberry,Gramineae most often.3.The pollen concentration in Cangzhou City was negatively correlated with maximum humidity,maximum precipitation,maximum temperature,and minimum temperature.Maximum wind speed at ground level was positively correlated with pollen concentration.4.Pollen concentration was positively correlated with the number of visits.The correlation analysis between daily medical visits from June to October and air pollen concentration showed a significant positive correlation,while the results from March to May showed no significant correlation.CONCLUSION The peak of airborne pollen dispersal in April and September in Cangzhou.Spring and summer pollen is dominated by tree species,and the dominant pollen is Pinaceae,Willow genus of Populus,and Xylariaceae(ash genus);fall pollen is dominated by herbaceous species,and the dominant pollen is Artemisia,Asteraceae,Mulberry,and Gramineae.Meteorological factors are important factors affecting pollen concentration.Within a certain range,the lower the maximum humidity,the lowest maximum precipitation,the lower the highest or the lowest temperature,the higher the pollen concentration,and the pollen concentration is more affected by the lowest temperature.There is a correlation between pollen concentration and the number of AR patients'visits from June to October,which can be used as an environmental early warning indicator of the prevalence of AR.

Auscultation of heart sounds is an important method for the diagnosis of heart conditions. For most people, the audible component of heart sound are the first heart sound (S1) and the second heart sound (S2). Different diseases usually generate murmurs at different stages in a cardiac cycle. Segmenting the heart sounds precisely is the prerequisite for diagnosis. S1 and S2 emerges at the beginning of systole and diastole, respectively. Locating S1 and S2 accurately is beneficial for the segmentation of heart sounds. This paper proposed a method to classify the S1 and S2 based on their properties, and did not take use of the duration of systole and diastole. S1 and S2 in the training dataset were transformed to spectra by short-time Fourier transform and be feed to the two-stream convolutional neural network. The classification accuracy of the test dataset was as high as 91.135%. The highest sensitivity and specificity were 91.156% and 92.074%, respectively. Extracting the features of the input signals artificially can be avoid with the method proposed in this article. The calculation is not complicated, which makes this method effective for distinguishing S1 and S2 in real time.
Diastole ; Heart ; Heart Sounds ; Neural Networks, Computer ; Rivers

Humans ; Asthma/drug therapy* ; Biological Therapy