Objective: To assess the trend of early beta receptor blocker (β-blocker) application (with 24h of admission) for acute myocardial infarction (AMI) patients in western rural China from 2001 to 2011. Methods: A 2-stage random sampling design was performed. The 1st stage: a simple random sampling was used to identify participating hospitals and the 2nd stage: a systematic random sampling approach was conducted in 3 specific years of 2001, 2006 and 2011 to take case study for central medical information abstraction. The changing trends and impact factors of early β-blocker application for AMI patients in western rural area were assessed by multivariate model analysis. Results: 35 hospitals were sampled and 33 of them were finally participated. With necessary exclusion, a total of 486 AMI patients without β-blocker contraindication were enrolled for 2 groups: Suitable group, the patients were suitable for early β-blocker application, n=247 and High risk group, the patients with the high risk for shock occurrence, n=239. The application rates for β-blocker within 24h of admission at 2001, 2006 and 2011 in Suitable group were 19.06%, 54.30% and 56.20%, Ptrend=0.0020; in High risk group were 31.53%, 59.49% and 69.62%, Ptrend=0.0001. In Suitable group, the patients with history of hypertension (OR=1.87, 95% CI 1.06-3.29), smoking (OR=1.97, 95% CI 1.11-3.48) or admitted in 2006 (OR=2.93, 95% CI 1.22-7.03) and 2011(OR=4.67, 95% CI 2.06-10.59) had the higher chance to use β-blocker within 24h of admission. Conclusion: Application of β-blocker within 24h of admission in AMI patients presented the increasing trend in western rural China from 2001 to 2011, while there was still difference from the guideline recommendation. Improved normative application of β-blocker is helpful to enhance the quality of care and prognosis in AMI patients.

Objective To understand the present situation and requirements of health education in schistosomiasis control in Hubei Province,so as to improve the health education to the targeted people. Method Through the questionnaire survey and field investigation,the data of the present situation and requirements of health education in schistosomiasis control were collect-ed in 24 counties(cities)of Hubei Province,and these data included the related institution structure of health education,basic information of personnel,equipment,funds,and health education working form. All the data collected were analyzed and evalu-ated. Results Among the 24 counties,there were 12 independent departments of health education,accounting for 50%. In terms of the basic information of the health education staff,the youngest person was 34 years old and the eldest was 58 years old,and the mean age was 46.55± 6.9 years. For the formal school education of the staff,5 had senior high school or below edu-cation (20.8%),16 had college education (66.7%),3 had bachelor degree or above (12.5%). There were 10 counties (41.70%)with the special funds for health education work but there were 3 counties(12.50%)without the special funds. Con-clusion The effectiveness of health education work in schistosomiasis control is remarkable,but there are still deficiencies in professional staff and funds in Hubei Province.

Objective Skin disease is multiple,common disease,and there are so many therapeutic methods.In recent years,physical non-invasive therapy of skin disease has developed rapidly.On the basis of Pennes equation,a series of simulation analysis was completed,and the results confirmed the feasibility and availability as well as the definite safety of curing skin diseases by direct heating.In order to achieve the maximum efficacy and the minimum side effects simultaneously and based on the previous research,exploratory simulation experiment of non-isothermal heating was carried out.Methods The skin temperature fields with non-isothermal heating were simulated by utilizing mathematical tools (Matlab).Results Compared to the previous isothermal heating,during the non-isothermal heating,the temperature of inner skin displayed the rising trend,while it displayed the declining trend during the isothermal heating.Conclusion As compared to isothermal heating,non-isothermal heating has better restraining effect for the bacterium within the inner skin,and less side-effect.

RhD-negative pregnant women with an RhD-positive fetus are at risk of hemolytic disease of the fetus and newborn (HDFN), which may lead to fetal/neonatal death. While these would not affect those RhD-negative fetuses. With the advancement of technology in genetics, the administration of anti-D immunoglobulin to women with an RhD-positive fetus could reduce the risk of HDFN. Therefore, non-invasive prenatal testing on fetal RHD genotype plays an important role in the management of RhD-negative pregnant women. Selective usage of anti-D immunoglobulin is important in perinatal management in these women. The non-invasive prenatal screening for fetal RHD gene which has been carried out in Caucasian is not applicable to Asians because of the difference in RHD genotype. In addition to complete or partial RHD gene deletion, point mutations are also common RHD genotypes among Asians. This enlightens us to establish a non-invasive prenatal screening method for Asians. This article reviews the progress of fetal RHD screening in Asian RhD-negative pregnant women.

Objective:To observe any effect of functional magnetic stimulation (FMS) of the sacral 3 nerve root on relieving urine retention after a spinal cord injury.Methods:Forty-four patients with neurogenic bladder disorders after a spinal cord injury were divided at random into a 5Hz group ( n=14), a 20Hz group ( n=15), and a sham stimulation group ( n=15). In addition to conventional bladder control training, the 5Hz and 20Hz groups were given 20 minutes of FMS of the sacral 3 nerve root at the appropriate frequency five days a week for 4 weeks. The sham stimulation group was not given any stimulation. A detailed urination diary was kept during the treatment, and before and after the 4 weeks, everyone′s bladder pressure volume was assessed and an electromyogram was recorded. Results:After the treatment those in the 5Hz and 20Hz groups had improved significantly in terms of average bladder capacity, bladder pressure, residual urine volume, daily number of urethral catheterizations, daily micturition frequency, single urine output, H-reflex latency, and the amplitude and incubation period of the F wave. Those in the sham stimulation group showed no consistent improvement in any of these indicators. Moreover, the average residual urine volume, daily urination frequency and H-reflex latency and amplitude of the 20Hz group were significantly better than those of the 5Hz group.Conclusions:Magnetic stimulation of the S3 nerve roots can effectively improve the urination of persons with neurogenic bladder disorders after a spinal cord injury. The preferred frequency is 20Hz.

Objective:To investigate the clinical efficacy of precise hepatectomy for the treatment of recurrent unilateral hepatolithiasis and prognostic factors.Methods:The retrospec-tive case-control study was conducted. The clinicopathological data of 166 patients with recurrent unilateral hepatolithiasis who were treated by precise hepatectomy in the First Affiliated Hospital of Anhui Medical University from January 2015 to January 2021 were collected. There were 51 males and 115 females, aged (58±12)years. Observation indicators: (1)diagnosis and classification; (2) surgical and intraoperative situations; (3) postoperative situations; (4) follow-up; (5) analysis of prognostic factors. Follow-up was conducted using the outpatient examination and telephone inter-view to detect final stone clearance or recurrence and survival of patients up to August 2021. Patients with T-tube were performed T-tube cholangiography or choledochoscopy to evaluate the final stone clearance rate at postoperative week 8. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. Univariate and multi-variate analyses were conducted using the Logistic regression model. Results:(1) Diagnosis and classifica-tion: 166 patients were diagnosed as hepatolithiasis by preoperative imaging examination and intraoperative evaluation, including 134 cases with common bile duct stones. Of the 166 patients, 115 cases had stones located in the left lobe of liver and 51 cases had stones located in the right lobe of liver. There were 111 cases with bile pigment stones, 31 cases with cholesterol stones, 24 cases with mixed type of stones. There were 9 cases classified as Tsunoda type Ⅰ, 89 cases as Tsunoda type Ⅱ, 65 cases as Tsunoda type Ⅲ, 3 cases as Tsunoda type Ⅳ. There were 12 cases classified as type Ⅰ, 99 cases as type Ⅱ, 47 cases as type Ⅲ, 8 cases as type Ⅳ according to Japanese classification in 2001. All the 166 patients were classified as type Ⅰ based on Chinese classification. According to the classification of author team, 166 patients were classified as type Ⅱ. (2) Surgical and intra-operative situations: 119 of 166 patients had liver lobe or segment atrophy. All the 166 patients underwent precise hepatectomy combined with different methods of drainage, of which 28 cases underwent left hemihepatectomy, 11 cases underwent right hemihepatectomy, 1 case underwent liver resection of segment Ⅰ, 5 cases underwent liver resection of segment Ⅱ, 5 cases underwent liver resection of segment Ⅲ, 8 cases underwent liver resection of segment Ⅳ (left medial lobe), 3 cases underwent liver resection of segment Ⅴ, 2 cases underwent liver resection of segment Ⅵ, 2 cases underwent liver resection of segment Ⅷ, 68 cases underwent liver resection of segment Ⅱ and Ⅲ (left lateral lobe), 3 cases underwent liver resection of segment Ⅴ and Ⅵ, 6 cases underwent liver resection of segment Ⅴ and Ⅷ (right anterior lobe), 21 cases underwent liver resection of segment Ⅵ and Ⅶ (right posterior lobe), 1 case underwent liver resection of segment Ⅱ, Ⅲ and Ⅳa, 1 case underwent liver resection of segment Ⅴ, Ⅵ and Ⅶ, 1 case underwent liver resection of segment Ⅰ, Ⅱ, Ⅲ and Ⅳ. For biliary drainage methods of 166 patients, 120 patients received T-tube external drainage, 23 cases received choledochojejunostomy, 23 cases received choledochojejunostomy combined with T-tube external drainage. The original cholangiojejunal anastomotic stenosis was found and reconstructed in 10 patients. The operation time was (258±87)minutes and intraopera-tive blood transfusion rate was 16.87%(28/166) of 166 patients. All the 166 patients underwent fiber choledochoscopy, showing 77 cases with normal function of Oddi sphincter, 38 cases with disorder, 40 cases with dysfunction. There were 11 patients undergoing choledochojejunostomy who were not evaluate the function of Oddi sphincter. There were 21.69%(36/166)of patients with intra-hepatic biliary stricture. One hundred and forty-nine of 166 patients were conducted bile culture, showing the positive rate as 75.17%(112/149). There were 22 cases cultured multiple kinds of bacteria. The most common bacterium was Escherichia coli (43 cases), followed by Pseudomonas aeruginosa (12 cases), Klebsiella pneumoniae (9 cases), Klebsiella oxytoca (7 cases), Enterococcus faecium (7 cases). (3) Postoperative situations. The postoperative complication rate of 166 patients was 16.87%(28/166). In the 8 patients with serious complications of Clavien-Dindo grade Ⅲ, 6 cases were performed thoracocentesis or abdominocentesis for effusion, 1 case was stopped bleeding under gastroscopy for stress ulcerbleeding, 1 case was performed surgery for adhesive intestinal obstruction. Two patients with septic shock of Clavien-Dindo grade Ⅳ were converted to intensive care unit for treatment and discharged after recovery. There were 13 patients with biliary leakage, 10 patients with pulmonary infection, 6 cases with incision infection, which were improved after conservative treatments. There was no perioperative death. The instant stone clearance rate of 166 patients was 81.93%(136/166). The duration of postoperative hospital stay of 166 patients was (11±6)days. (4) Follow-up: 166 patients were followed up for (37±17)months. The final stone clearance rate and stone recurrence rate of 166 patients were 94.58%(157/166) and 16.87%(28/166), respectively. According to Terblanche classification of prognosis, there were 91, 36, 25, 14 cases of grade Ⅰ, Ⅱ, Ⅲ, Ⅳ in 166 patients, respectively. Five of the 166 patients underwent intrahepatic secondary malignancy in which 4 cases died. (5) Analysis of prognostic factors: results of univariate analysis showed that biliary culture, the number of previous surgeries, immediate stone clearance, final stone clearance were related factors affecting the prognosis of precise hepatectomy in patients with recurrent unilateral hepatolithiasis ( odds ratio=2.29, 7.48, 2.69, 4.52, 95% confidence interval as 1.09?4.85, 2.80?19.93, 1.16?6.25, 1.15?17.77, P<0.05). Results of multivariate analysis showed that the number of previous surgeries ≥3 was an independent risk factor affecting the prognosis of precise hepatectomy in patients with recurrent unilateral hepato-lithiasis ( odds ratio=6.05, 95% confidence interval as 2.20?16.62, P<0.05). Conclusions:Precise hepatectomy is safe and effective for the treatment of patients with recurrent unilateral hepato-lithiasis. The number of previous surgeries ≥3 is an independent risk factor affecting the prognosis of precise hepatectomy in patients with recurren t unilateral hepatolithiasis.

To investigate the prenatal sonographic feature in the early diagnosis of amniotic band syndrome at 11 －14 weeks′ gestation . Methods A retrospective study was conducted to analysis and summarize the ultrasonographic features of 4 fetuses without band‐like echoes in amniotic cavity at 11－14 weeks′gestation ,but verified as amniotic band syndrome in Peking Union M edical College Hospital . Results T wo cases ( cases 1 ,2) showed the fixed head position with skull defect and intracranial structure disorders . Cases 3 and 4 showed one upper limb in a fixed position ,and the hand seemed to adhere to the umbilical cord isolatedly . In addition ,case 1 showed complete chorioamniotic membrane separation . T here were multiple band‐like echoes adhered to body of 3 fetals during the follow‐up scan at 14 －18 weeks . T he parents of cases 1 and 2 chose to terminate the pregnancy after counseling ,the other 2 cases also induced labor due to intrauterine fetal death at 15+2 weeks and 19+2 weeks respectively . All 4 cases were confirmed as amniotic band syndrome by pathology . Conclusions When the fetal sonographic images showed fixed head position ,disordered intracranial structure ,or adhesion between umbilical cord and hand with limited movement at 11 －14 weeks′ gestation ,it should be paid attention to observing the band‐like echoes and followed up closely to prevent missed diagnosis of amniotic band syndrome .

Objective:To evaluate the placental micro-vascular circulation by microvascular flowing imaging (MVFI) method, and to explore the clinical value of microvascular index (MVI) for the diagnosis of fetal growth restriction (FGR).Methods:A total of 21 fetuses at 24-34 weeks of gestation at the Peking Union Medical College Hospital from October to November 2019 were enrolled in this study, including 7 fetal growth restriction (FGR) fetuses, and 14 normal fetuses as control group. The fetuses of the two groups were matched according to the gestational weeks at the ratio of 1∶2. Fetal biometry parameters were measured and the placenta was observed by two-dimensional ultrasound.Uterine artery pulse index (UtA-PI), middle cerebral artery pulse index (MCA-PI), and umbilical artery S/D ratio were evaluated by color and pulse-wave Doppler. The placenta mico-circulation was displayed by the MVFI method and MVI was measured.Results:The study included 14 normal fetuses and 7 FGR fetuses. Compared with the control group, more placenta in the FGR group manifested as thickened and heterogeneous with decreased MVI and increased UtA-PI. There was statistically significant difference in placental mean MVI between two groups ( P=0.044). Besides, a trend towards significant negative correlation was observed between MVI and placenta thickness, although this was not statistically significant ( rs=-0.35, P=0.065). MVI had a higher specificity (100%) in the prediction of FGR. Conclusions:MVFI can display the micro-circulation of the placenta, and provide a direct and quantitative assessment method for placental perfusion.

OBJECTIVE: To explore the genetic etiology and related factors in 1 065 women with spontaneous abortions. METHODS: All patients have presented at the Center of Prenatal Diagnosis of Nanjing Drum Tower Hospital from January 2018 to December 2021. Chorionic villi and fetal skin samples were collected, and the genomic DNA was assayed by chromosomal microarray analysis (CMA). For 10 couples with recurrent spontaneous abortions but normal CMA results for abortive tissues, non-in vitro fertilization-embryo transfer (IVF-ET) pregnancies and no previous history of live births and no structural abnormalities of the uterus, peripheral venous blood samples were collected. Genomic DNA was subjected to trio-whole exome sequencing (trio-WES). Candidate variants were verified by Sanger sequencing and bioinformatics analysis. Multifactorial unconditional logistic regression analysis was carried out to analyze the factors that may affect chromosomal abnormality in spontaneous abortions, such as the age of the couple, number of previous spontaneous abortions, IVF-ET pregnancy and history of live birth. The incidence of chromosomal aneuploidies in spontaneous abortions during the first trimester was compared in young or advanced-aged patients by chi-square test for liner trend. RESULTS: Among the 1 065 spontaneous abortion patients, 570 cases (53.5%) of chromosomal abnormalities were detected in spontaneous abortion tissues, which included 489 cases (45.9%) of chromosomal aneuploidies and 36 cases (3.4%) of pathogenic/likely pathogenic copy number variations (CNVs). Trio-WES results have revealed one homozygote variant and one compound heterozygote variants in two pedigrees, both of which were inherited from the parents. One likely pathogenic variant was detected in the patient from two pedigrees. Multifactorial unconditional Logistic regression analysis suggested that age of patient was an independent risk factor of chromosome abnormalities (OR = 1.122, 95%CI: 1.069-1.177, P < 0.001), the number of previous abortions and IVF-ET pregnancy were independent protective factors for chromosomal abnormalities (OR = 0.791, 0.648; 95%CI: 0.682-0.916, 0.500-0.840; P = 0.002, 0.001), whilst the age of husband and history of live birth were not (P > 0.05). The incidence of aneuploidies in the abortive tissues has decreased with the number of previous spontaneous abortions in young patients (χ² = 18.051, P < 0.001), but was not significantly correlated with the number of previous spontaneous abortions in advanced-aged patients with spontaneous abortions (P > 0.05). CONCLUSION Chromosomal aneuploidy is the main genetic factor for spontaneous abortion, though CNVs and genetic variants may also underlie its genetic etiology. The age of patients, number of previous abortions and IVF-ET pregnancy are closely associated with chromosome abnormalities in abortive tissues.
Pregnancy ; Humans ; Female ; Aged ; Abortion, Spontaneous/genetics* ; DNA Copy Number Variations ; Chromosome Aberrations ; Chromosome Disorders/genetics* ; Aneuploidy ; Abortion, Habitual/genetics*

Comprehensively improving the new efficiency of high-quality development of public hospitals is the key top-level design for deepening the reform of public hospitals during the"14th Five-Year Plan"period.In view of the changes in the macro environment faced by public hospitals in recent years,such as the cancellation of the addi-tion of pharmaceutical consumables and the deep promotion of the reform of payment methods,as well as the out-standing problems existing at the micro level of public hospital operation,such as the separation of diagnosis and treatment business from economic operation activities,extensive decision-making methods,unreasonable alloca-tion of resources and urgent optimization of processes.By referring to relevant theories such as value management theory,a new"trinity"public hospital lean operation management model based on"integration of industry and fi-nance,lean operation and evidence-based decision-making"is explored and constructed.It breaks the relatively parallel operation barriers of clinical diagnosis and treatment business and economic operation management,innovates a new method of linear staff management with the integration of industry and finance,gives full play to the role of experts in governing hospitals,and integrates the professional committee system driven by"technology+manage-men"into the hospital decision-making staff system to provide data evidence-based basis for assisting the hospital leadership to make scientific decisions.