Objective: To investigate the impact of change of ideal cardiovascular behavior and related factors on healthy vascular aging(HVA). Methods: This study was a multi-center cross-sectional survey. Six thousand three hundred and sixteen participants who underwent at least 2 healthy examinations from 2006 to 2015 at 11 hospitals, including Kailuan Hospital and so on, and examined brachial-ankle pulse wave velocity (baPWV) during 2010 and 2016, with available information about cardiovascular behavior and factors were included. The cardiovascular health score (CHS) was calculated. Basic CHS was collected from the first examination. The second CHS derived from the healthy examination in the same year of baPWV examination. Change of cardiovascular health score (ΔCHS) was calculated. Participants were defined into 5 groups according to ΔCHS, namely ΔCHS≤-2 (n=2 166), ΔCHS=-1 (n=1 284), ΔCHS=0 (n=1 187), ΔCHS=1 (n=860), and ΔCHS≥2 (n=819). Participants′ characteristics, value of baPWV and proportion of HVA were compared among different groups. Multiple logistic regression analysis was used to investigate the association between ΔCHS and HVA. The ΔCHS was recalculated and included in multiple logistic regression analysis model again after each component of the cardiovascular health metrics was removed separately in order to investigate effects of removal factors on HVA by observing changes in effect values. Results: The percentage of the participants with HVA in the group of ΔCHS≤-2, ΔCHS=-1, ΔCHS=0, ΔCHS=1 and ΔCHS≥2 were 23.3%(505/2 166), 27.8%(357/1 284), 28.7%(341/1 187),31.9%(274/860) and 33.9%(278/819), respectively. After adjustment for age, sex, income, education, alcohol consumption and the basic CHS, a significant positive association between ΔCHS and proportion of participants with HVA was observed (OR=1.50, 95%CI 1.44-1.56). Multiple regression analysis after removing each single cardiovascular behavior or factor showed that the OR value decreased as follow systolic blood pressure (OR=1.04, 95%CI 1.00-1.09), fasting blood glucose (OR=1.14, 95%CI 1.09-1.18), physical exercise (OR=1.16, 95%CI 1.11-1.21), salt intake (OR=1.17, 95%CI 1.12-1.22), body mass index (OR=1.18, 95%CI 1.13-1.23), smoking(OR=1.18, 95%CI 1.13-1.23) and total cholesterol (OR=1.20, 95%CI 1.16-1.24). Conclusion The improvement of every ideal cardiovascular behavior and factor is associated with the increase of the proportion of HVA population.

Objective To study the possible mechanisms,efficacy and safety of acetaminophen and platelet-rich plasma (PRP) on promoting the closure of ductus arteriosus in preterm infants.Method From January 2016 to May 2018,preterm infants (gestational age＜34 weeks) with symptomatic patent ductus arteriosus (sPDA) admitted to our neonatal intensive care unitwere enrolled prospectively.15 mg/kg of acetaminophen was orally given every 6 hours for three days (acetaminophen group).If acetaminophen was contraindicated (PRP group) or acetaminophen therapy failed (PRP rescue group),PRP transfusion was given at a single dose of 20 ml/kg.Echocardiogram,platelet-derived growth factors (PDGF) and urinary prostaglandin E2 (PGE2) were examined before and 72 hours after treatment.The data were analyzed using ANOVA,student's t test,Kruskal-Wallis H method and chi-square test.Result A total of 70 cases were enrolled.61 cases were treated with acetaminophen.The success rate (67.2％,41/61) was similar to PRP group (6/9) (P=1.000),and significantly higher than PRP rescue group (6/17) (P=0.017).The complications in acetaminophen group included 22 cases of hyperbilirubinemia (36.1％),5 cases of upper gastrointestinal hemorrhage (8.2％),4 cases of positive fecal occult blood test (6.6％),3 cases of oliguria (4.9％),1 case of Grade Ⅲ ～ Ⅳ intraventricular hemorrhage (IVH) (1.6％),and 1 case of≥ Ⅱ stage necrotizing enterocolitis (NEC) (1.6％).A total of 3 cases of hyperbilirubinemia were in PRP group.One case of hyperbilirubinemia,one oliguria,one Grade Ⅲ～ Ⅳ IVH and one ≥ Ⅱ stage NEC were in PRP rescue group.The urinary PGE2 level in post-treatment was lower than pre-treatment in acetaminophen group (t=6.878,P＜0.001).The blood platelet count and PDGF level in post-treatment were higher than pre-treatment in PRP group (t=-2.496,-8.906;P=-0.037,＜0.001) and PRP rescue group (t=-3.374,-2.503;P=0.004,0.024).Conclusion Oral acetaminophen and PRP transfusion had similar efficacy in promoting the closure of ductus arteriosus in preterm infants.If oral acetaminophen was contraindicated or failed,PRP transfusion could be one of the candidates for rescue therapy to promote the closure of ductus arteriosus in preterm infants.

Objective To study the influence factors on the accuracy of a smartphone software application (APP) , which is an automated image-based bilirubin (AIB) testing technique for neonatal bilirubin. Methods This was a prospective study involving 179 jaundiced neonates admitted to the Department of Neonatology of the Affiliated Xuzhou Hospital of Southeast University from August to December, 2017. If blood sampling was required to determine total serum bilirubin (TSB), the transcutaneous bilirubin (TcB) and AIB on the sternum (glabella or the visible darkest yellow area were tested in 36 cases at the same time) were also tested. The concentrations of AIB were measured using a mobile phone-based neonatal jaundice monitoring APP with images taken by OPPO R11 smartphone (55 cases were also taken by Huawei Mate 8 and iPhone 6). The accuracy and non-inferiority of AIB comparing with TcB, the correlation and consistency between AIB and TSB and the value of AIB in predicting TSB were analyzed. Non-inferiority trial, student's t test, variance analysis, Pearson's correlation analysis, Bland-Altman plots and receiver operating characteristic (ROC) curve were used as statistical methods. ResuLts A total of 179 neonates were enrolled in this study with the mean gestational age of (36.2±2.1) weeks and the mean birth weight of (2 871±735) g. Based on all data, the mean difference between the absolute value of AIB minus TSB (|AIB － TSB|) and the absolute value of TcB minus TSB (|TcB － TSB|) was 0.77 mg/dl (1 mg/dl=17.1 μmol/L) with the 95%CI of (0.60-0.95) mg/dl, suggesting that the accuracy of AIB was not inferior to that of the TcB. Furthermore, AIB was not inferior to TcB in its accuracy in different subgroups based upon the time after birth ( ≤ 48 h and >48 h), gestational age (≤35 weeks and >35 weeks) and in the daytime subgroup. In the nighttime subgroup, the mean difference between ∣ AIB － TSB ∣ and ∣ TcB － TSB ∣ was 1.47 mg/dl [95%CI: (1.08-1.87) mg/dl], which indicated that the accuracy of AIB was inferior to that of the TcB. There were good correlation (r=0.788) and highly consistency between AIB and TSB based on all data [96.4% (238/247) of the samples were within the 95% limits of agreement of (－4.75 to 5.71) mg/dl]. Such results were also found in different subgroups, such as smartphone brands, detection areas, the time after birth and gestational age. The correlation and consistency between AIB and TSB in daytime subgroup (r=0.924, 98.4%) were obviously stronger than those of the nighttime subgroup (r=0.727, 87.5%). The mean difference between the absolute value of ocular value minus TSB (|ocular value－TSB|)and|AIB－TSB|was 2.13 mg/dl [95%CI: (1.68-2.58) mg/dl], implying a superior accuracy of AIB than ocular estimation. The areas under the ROC curves, the sensitivity and the specificity of AIB for the prediction of TSB >10, >15 and >20 mg/dl were 0.94, 93% and 85%; 0.89, 75% and 87%; and 0.84, 50% and 88%, respectively. ConcLusions AIB is not inferior to TcB in accuracy, and is significantly superior to ocular estimation. There are good correlation and strong consistency between AIB and TSB. The accuracy of AIB, and the correlation and consistency between AIB and TSB are less likely to be affected by the time after birth, gestational age, smartphone brands and areas being examined, but are largely affected when examining during nighttime. Therefore, it is recommended to detect AIB at daytime with bright natural light.

In recent years, more and more people have recognized the importance of patients' family in the intensive care unit (ICU) in medical care, and advocated the use of patient- and family-centered care (PFCC) in the ICU. This article explains the content (family presence, family support, communication with family members, consultations and ICU team members, environmental issues) and significance of PFCC in the ICU, and provides guidance for the practice of PFCC in China.

Objective To investigate the characteristics and failure risk factors of sequential high-flow nasal cannula oxygen therapy (HFNC) after weaning from invasive ventilation. Methods The patients who received sequential HFNC after weaning from invasive ventilation admitted to surgical intensive care unit (ICU) of Peking University People's Hospital from June 1st 2016 to May 31st 2018 were retrospectively analyzed. Clinical variables, respiratory therapy parameters, respiratory variables, cardiac variables and outcomes were reviewed and analyzed. Treatment characteristics of HFNC after weaning was analyzed. Patients were divided into HFNC success group and HFNC failure group according to the failure of HFNC, and the differences between the two groups were compared. The independent risk factors of HFNC treatment failure were analyzed by Logistic regression analysis. The value of predictive treatment failure of risk factors and regression models were analyzed by receiver operating characteristic (ROC) curve. Results A total of 99 patients were included, 61 men, and the median age was 67.0 (57.0, 76.0) years old. The medianinitial HFNC flow was 50 (50, 60) L/min, and inspired oxygen concentration (FiO2) was 0.50 (0.40, 0.60). Eighteen patients experienced HFNC failure (18.2%). Compared with the HFNC success group, the sequential organ failure assessment (SOFA) score in the HFNC failure group was higher [4 (3, 5) vs. 2 (1, 3), P < 0.01], B type natriuretic peptide (BNP) before HFNC therapy were significant higher [ng/L: 647.2 (399.2, 1 331.3) vs. 127.2 (55.2, 369.5), P < 0.01], and respiratory frequency (RR) and heart rate (HR) were significant faster, mean arterial pressure (MAP) was significant higher, oxygen index (PaO2/FiO2) was significant lower after 30 minutes HFNC treatment [RR (times/min): 26 (22, 28) vs. 19 (17, 21), HR (bpm): 105 (97, 107) vs. 85 (77, 90), MAP (mmHg, 1 mmHg = 0.133 kPa): 104.3 (101.7, 110.7) vs. 92.3 (88.3, 97.7), PaO2/FiO2 (mmHg): 207.3 (185.8, 402.8) vs. 320.2 (226.2, 361.5), all P < 0.05]. It was shown by multiple Logistic regression analysis that the SOFA score [odds ratio (OR) = 2.818, P = 0.022, β = 1.036], BNP before HFNC treatment (OR = 1.002, P = 0.033, β = 0.002) and HR after HFNC treatment 30 minutes (OR = 1.140, P = 0.032, β = 0.131) were independent risk factors for HFNC treatment failure. It was shown by ROC curve that the area under the ROC curve (AUC) for the prediction of HFNC failure was 0.840, 0.859, 0.860 and 0.962 for SOFA, BNP before HFNC treatment, HR after HFNC treatment 30 minutes, and regression model, all had good forecast values (all P < 0.01). Conclusions HFNC is one of the commonly used oxygen therapy methods in the ICU, but not all patients who are treated as a sequential therapy after invasive mechanical ventilation weaning can benefit from it. SOFA score, BNP before HFNC treatment and HR after 30 minutes HFNC treatment were independent risk factors of HFNC failure. Each independent risk factor and regression model can predict the success of HFNC treatment.

Objective To assess the efficacy and safety of 100 mg or 200 mg yimitasvir phosphate combined with sofosbuvir in patients with non-cirrhotic chronic hepatitis C virus ( HCV) genotype 1 infection who were treatment-na?ve or had a virologic failure to prior interferon-based treatment.Methods A multicenter, randomized, open-label, phase 2 clinical trial was conducted.The patients were randomly assigned to yimitasvir phosphate 100 mg+sofosbuvir 400 mg group (Group 100 mg) and yimitasvir phosphate 200 mg+sofosbuvir 400 mg group ( Group 200 mg) in a 1∶1 ratio with the stratified factors of " treatment-naive" or"treatment-experienced" for 12 weeks and followed up for 24 weeks after the end of treatment.During the clinical trial, HCV RNA was tested in all patients.Resistance of virus in patients who didn′t achieved sustained virological response (SVR) was monitored.Safety and tolerability were assessed by monitoring adverse events , physical examination , laboratory examination, electrocardiogram, and vital signs during the study.The primary end point was SVR12 after the end of therapy.Descriptive statistics were used for categorical variables and eight descriptive statistics were used for continuous variables.Descriptive statistics were used and summarized according to HCV genotypes and treatment groups.Safety data were presented using descriptive statistics and summarized according to treatment groups.Results A total of 174 subjects were screened from July 31, 2017 to September 26, 2018.One hundred and twenty-nine patients were successfully enrolled and received treatment , and 127 completed the study.There were 64 patients and 65 patients assigned to Group 100 mg and Group 200 mg, respectively.Among the 129 patients who underwent randomization and were treated , 18.6% were treatment-experienced and: 100%were HCV genotype 1b infection.The total SVR rate was 98.4%(127／129), with 98.4%(63／64, 95%confidence interval [CI]: 91.60%-99.96%) in the Group 100 mg, and 98.50%(64／65, 95%CI: 91.72%-99.96%) in the Group 200 mg.There was no significant difference between the two groups (χ2 ＝0.000 2, P＝0.989 2).The SVR rates in treatment-naive group and treatment-experienced group were 98.10%(95%CI: 93.29%-99.77%) and 100.00%(24／24, 95%CI: 85.75%-100.00%), respectively.Virological failure during treatment ( including breakthrough , rebound and poor efficacy) and relapse after treatment did not occur during the trial.By Sanger sequencing , 11.6%(15／129) patients had baseline NS5A Y93H／Y or Y93H resistance-associated substitutions ( RAS), 1.6%( 2／129) patients had baseline NS5A L31M RAS.No mutation was observed in NS5B S282 at baseline.There was no S282 mutation in HCV NS5B.A total of 100 (77.5%) subjects had adverse events.No adverse events ≥Grade 3 or severe adverse events related to the study treatment.No patient prematurely discontinued study treatment owing to an adverse event.No life-threatening adverse event was reported.Conclusion Twelve weeks of yimitasvir phosphate 100 mg or 200 mg combined with sofosbuvir 400 mg daily is a highly effective and safe regimen for patients without cirrhosis with HCV genotype 1b infection who had not been treated previously or had a virologic failure to prior interferon-based treatment.

Objective: To analyze the correlation between the continuous opening of patent ductus arteriosus(PDA) in preterm infants and platelet parameters in the first 24 hours of life. Methods: The preterm infants (gestational age <34 weeks) admitted to Neonatal Intensive Care Unit(NICU)of the Affiliated Xuzhou Hospital of Southeast University from November 2012 to July 2018 were enrolled.The following data were collected retrospectively: the platelet parameters in the first 24 hours of life, clinical factors possibly related to continuous opening of PDA, and echocardiography examination fin-dings on the 4^th-7^th day after birth.According to the diagnostic criteria of PDA, all preterm infants were divided into symptomatic PDA(sPDA) group, non-sPDA (nsPDA) group, and non-PDA (nPDA) group.SPSS 20.0 software was used for data analysis.Data were analyzed by Chi-square test, LSD or Tambane′s T2 of One-Way analysis of variance, and binary Logistic regression analysis of the receiver operating characteristic (ROC) curve. Results: Totally 760 preterm infants were chosen, and among them there were 67 cases (8.8%) in sPDA group, 106 cases (14.0%) in nsPDA group, and 587 cases (77.2%) in nPDA group.There were significant diffe-rences in the terms of gestation age, birth weight, platelet counts (PLT), and plateletcrit (PCT) in the first 24 hours of life among 3 groups (all P<0.05). The smaller gestation age, the lower birth weight, the lower PLT and PCT in the first 24 hours of life, and the higher incidence of PDA in preterm infants.There were no significant differences in the platelet distribution width, mean platelet volume, and platelet large cell ratio in the first 24 hours of life among 3 groups (all P>0.05). The low lower birth weight and PCT in the first 24 hours of life were independent risk factors for the occurrence of sPDA in preterm infants (P=0.013, 0.000). The risk of occurrence of sPDA in preterm infants will be increased by 3.279-fold (95%CI: 2.369-4.479) if PCT in the first 24 hours of life is decreased by 0.10%.The area under the ROC curves of PCT and PLT in the first 24 hours of life for prediction of sPDA in preterm infants was 0.757 (95%CI: 0.712-0.814) and 0.718 (95%CI: 0.671-0.768), respectively.The best cutoff values of PCT and PLT were 0.178% (sensitivity was 75.7%, specificity was 71.9%) and 207.5×10⁹/L (sensitivity was 71.4%, specificity was 63.2%). Conclusions The continuous opening of PDA in preterm infants may have correlation with the platelet.The low PCT, rather than PLT, in the first 24 hours of life was an independent risk factor and has medium predictive value for the occurrence of sPDA in preterm infants on the 4^th-7^th day after birth.

Objective To investigate the clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit (ICU). Methods The patients with candidemia admitted to ICU of Peking University People's Hospital from January 2010 to December 2017 were enrolled. The general clinical data, indicators related to Candidia infection and prognosis were collected, and the clinical characteristics, infection characteristics and prognosis of patients with candidiasis were analyzed. Patients were divided into death group and survival group according to hospital survival status. The differences of each index were compared between two groups. The independent risk factors of mortality in patients with candidemia were analyzed by multivariate Logistic regression analysis. Results A total of 95 patients (55 males) with candidemia were included, with an average age of (69.3±16.5) years, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was 24.7±3.6, sequential organ failure assessment (SOFA) was 6.6±2.7. Candida albicans accounted for the largest proportion of Candida infections (n = 56, 58.9%). Thirty-two (33.7%) patients received inadequate antifungal therapy and 38 (40.0%) patients received inadequate source control. Fifty-five (57.9%) patients were died in hospital. Compared with the survival group, patients in the death group was older (years: 72.5±14.6 vs. 64.9±18.0, P < 0.05), had higher APACHEⅡ and SOFA scores (26.6±2.2 vs. 22.1±3.6, 7.9±2.0 vs. 4.7±2.4, both P ﹤ 0.01), higher rate of glucocorticoid treatment (18.2% vs. 10.0%, P < 0.05), and higher proportion of Candida albicans and Candida glabrata (69.1% vs. 45.0%, 10.9% vs. 7.5%, both P < 0.05), the rate of multi-site Candida infection also significantly increased (47.3% vs. 17.5%, P < 0.05). Intra-abdominal infection was the primary infection site and more common in death group (49.1% vs. 35.0%, P < 0.05). The rates of sepsis (87.3% vs. 62.5%), inadequate antifungal therapy (49.1% vs. 10.0%), inadequate source control (60.0% vs. 12.5%) in death group were all higher than those in survival group (all P < 0.01). It was shown by multivariate Logistic regression analysis that APACHE Ⅱ[odds ratio (OR) = 1.605, P = 0.002, β = 0.473], SOFA (OR = 1.501, P = 0.029, β = 0.406), inadequate antifungal therapy (OR = 12.084, P = 0.006, β = 2.492) and inadequate source control (OR = 7.332, P = 0.024, β = 1.992) were independent risk factors for mortality in ICU patients with candidemia. Conclusions Candidemia patients were severe and had poor prognosis. APACHE Ⅱ, SOFA, inadequate antifungal therapy and inadequate source control were independent risk factors of mortality.

Objective To evaluate the sensitivity and specificity of enzyme assays,and to provide disease spectrum of lysosomal storage diseases (LSDs).Methods Three thousand three hundred and sixty-four high risk individuals were screened for 24 LSDs at Guangzhou Women and Children's Medical Center between January 2009 and December 2016.Twenty-two kinds of enzyme activities from peripheral blood leucocytes or plasma were measured by using the fluorometry or colorimetry of corresponding artificial substrates,screening for 24 LSDs diseases.Measurement data were represented by (x) ± s,and count data were expressed as a percentage or composition ratio.Results A total of 283 subjects were diagnosed with 18 different kinds of LSDs,and the positive rate of high-risk screening was 8.4％.Among the identified patients,172 cases (60.8％) were mucopolysaccharidosis (MPS),79 cases (27.9％) were sphingolipidoses,18 cases (6.4％) were Pompe diseases,10 cases (3.5％) were affected with mucolipidoses,3 cases (1.1％) were glycoprotein storage diseases,and 1 case(0.4％) was Wolman disease.Of the MPS cases,there were 75 cases of MPS Ⅱ (43.6％),45 cases of MP5 ⅣA (26.2％),24 cases of MPS Ⅵ (14.0％) and 20 cases of MPS Ⅰ (11.6％).Gaucher disease (23/79 cases,29.1％) and metachromatic leukodystrophy (MLD) (21/79 cases,26.6％) were common in sphingolipidoses group.Both the sensitivity and specificity of enzyme assays on peripheral blood leucocytes for LSDs were 100％.Conclusions The most common kinds of LSDs are MPS Ⅱ,MPS Ⅳ A,MPS Ⅵ,Gaucher disease,MLD and Pompe disease.Leukocyte enzymology analysis of high-risk screening LSDs has high sensitivity and specificity.

Objective To investigate the effect of interventions based on Information-Motivation-Behavioral skills on the preoperative anxiety in patients with gynecological malignancies. Methods A total of 64 patients with malignant tumor were divided into two groups by random digits table method with 32 cases each. The patients in the two groups received routine nursing. In addition, interventions based on Information-Motivation-Behavioral skills were provided in the intervention group. All patients were investigated by the following indexes such as the Self-Rating Anxiety Scale (SAS), sleep quality scale, blood pressure and heart rate before and after the intervention. Results After the intervention, the SAS scores in the intervention group was (49.47 ± 3.81) points, sleep quality score was (3.66 ± 0.97) points, and systolic blood pressure and heart rate were (128.56±5.93) mmHg (1 mmHg=0.133 kPa), (75.09 ± 3.78) beats/min, which were lower than those in the control group (57.38 ± 3.75) points, (5.50 ± 1.50) points, (134.97 ± 7.19) mmHg, (81.34 ± 4.88) beats/min, the differences were statistically significant (t=-8.350--3.887, P<0.05). Conclusions The intervention focused on Information-Motivation-Behavioral Skills can help patients to relieve anxiety, reduce stress response, improve quality of sleep.