Objective:To explore the relationship between the hypertensive snowbirds′ length of migratory stay and their blood pressure control and blood pressure levels.Methods:This study was a cross-sectional study. A population of snowbirds with hypertension was recruited between October and November 2022, and a structured questionnaire was used to collect their self-measured blood pressure and length of stay in Hainan Province. The blood pressure control status is determined based on self-measured blood pressure. According to the self-measured blood pressure to determine whether the blood pressure was well controlled. The associations between snowbirds′ length of stay and their blood pressure control as well as their self-measured blood pressure were analyzed using restricted cubic splines.Results:A total of 362 research subjects were included, 169(46.7%) of whom were male, and their age was (69.7±7.0) years old. The participants′ self-measured systolic blood pressure and diastolic blood pressure were (129.1±16.2) mmHg (1 mmHg=0.133 kPa) and (78.9±10.1) mmHg, respectively. Overall, 174 (48.1%) participants attained adequate blood pressure control. The median length of stay in Wuzhishan City was 7(6, 7) months. There was an inverted U-shaped association between snowbirds′ length of stay and blood pressure control (overall: P=0.023; nonlinearity: P=0.014), where participants with a length of stay of 7 months had the highest rate of blood pressure control. There is a U-shaped curve relationship between length of stay and systolic blood pressure (overall: P=0.001; nonlinearity: P=0.033), and a linear negative correlation with diastolic blood pressure ( β=-1.19, P=0.003). Conclusions:Compared with hypertensive snowbirds with too long or too short lengths of stay, snowbirds who stayed in Wuzhishan City for seven months have better blood pressure control, and systolic blood pressure is also lower.

BACKGROUND: Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. This study aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018. METHODS: We compared the data from the Henan STEMI survey conducted in 2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment. RESULTS: STEMI patients in 2016-2018 were younger (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and β-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after adjustment. CONCLUSIONS Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.
Humans ; Female ; Middle Aged ; ST Elevation Myocardial Infarction/drug therapy* ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use* ; Cross-Sectional Studies ; Aspirin/therapeutic use* ; Platelet Aggregation Inhibitors/therapeutic use* ; Adrenergic beta-Antagonists/therapeutic use* ; Hospital Mortality ; Registries ; Treatment Outcome ; Percutaneous Coronary Intervention

Hypertension is an important risk factor for the morbidity and mortality of cardiovascular and cerebrovascular diseases. Improving compliance is the key to the prevention and control of hypertension in community. This paper summarizes the improvement of compliance of patients with hypertension， analyzes the ideas and feasibility of assisting hypertension community prevention and control from three aspects： improving medication compliance， improving behavior compliance and digital intelligent management， and puts forward corresponding suggestions to improve the compliance of patients with hypertension.

Humans ; Child ; Adolescent ; Cardiovascular Diseases/prevention & control* ; Healthy Lifestyle ; Life Style ; Primary Prevention

Objective:To investigate the current situation of insomnia in patients with acute coronary syndrome (ACS), and analyze the influencing factors of insomnia in the ACS patients, so as to provide information on the development of new strategies for the treatment of insomnia in ACS patients.Methods:This is a multicenter and prospective observational study. A total of 771 ACS patients who met the criteria were selected from March 2013 to June 2015. The baseline social demographic information, sleep quality questionnaire, general anxiety disorder scale-7(GAD-7),patient health questionnaire-9(PHQ-9), short-form 12 health survey questionnaire(SF-12), and enhancing recovery in coronary heart disease patients social inventory(ESSI) were completed within 7 days after admission. Logistic regression analyses were used to analyze the influencing factors of insomnia in ACS patients.Results:A total of 741 subjects with valid questionnaires were collected, including 510 males (68.8%) and 231 females (31.2%). Among them, 487 (65.7%) subjects had at least one insomnia symptom: 308 (41.6%) subjects had difficulty in falling asleep, 369 (49.8%) subjects were easy to wake at night, 116 (15.7%) subjects woke up earlier than they expected, 74 (10.0%) subjects experienced both woke up earlier and difficulty in falling asleep, and 53 (7.2%) subjects woke up earlier, woke up at night and had difficulty in falling asleep at the same time. Logistic regression analyses showed that before admission physical activity ( OR =0.636, 95% CI 0.411-0.984), depression ( OR=1.908, 95% CI 1.101-3.305) and low social support ( OR=0.278, 95% CI 1.198-3.301) were independent factors of insomnia in ACS patients. Conclusions:Nearly 2/3 ACS patients have symptoms of insomnia. Difficulty in falling asleep and easy to wake up at night are the most common manifestations. Physical activity, depression and social support independently are associated with insomnia.

【Objective】 To study the clinical characteristics and treatment of patients with acute hemolytic anemia crisis induced by levofloxacin. 【Methods】 The levofloxacin antibody was detected by the microcolumn gel method and scored by the Naranjo Adverse Drug Reaction Probability Scale(APS). Patients suffered from acute hemolysis anemia induced by levofloxacin was rescued by whole blood exchange(WBE) and therapeutic plasma exchange(TPE). 【Results】 The patient was diagnosed as acute hemolysis induced by levofloxacin as levofloxacin antibody was yielded, and 7 points scored by the Naranjo APS. After WBE and TPE treatment, the patient′s clinical symptoms and signs improved rapidly. Supplemented with immunoglobulin and hormone therapy, the patient was discharged on d 10 after treatment. 【Conclusion】 Levofloxacin can induce acute hemolytic anemia crisis, and WBE and TPR are effective rescue methods.

Objective:To investigate the impact of diabetes mellitus (DM) and stroke on long-term outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Methods:Total 411 consecutive ACS patients undergoing PCI at the Ninth People′s Hospital of Zhengzhou between December 2014 and June 2018 were recruited, including 319 males and 92 females with a mean age of (64.7±10.1) years. These patients were divided into 4 groups according to the presence or absence of history of diabetes or stroke: non-DM non-stroke group ( n=192) , DM group ( n=140), stroke group ( n=41), and DM+stroke group ( n=38). The data of baseline demographic characteristics, clinical feature, coronary angiographic findings, and cardiovascular adverse events during long-term follow-up were obtained. Kaplan-Meier curves were used to investigate the long-term clinical outcomes among groups. Results:The mean interval of follow-up was (24.1±13.8) months. Patients with DM+stroke had the highest rates of non-fetal myocardial infarction (χ 2=24.932) , non-fetal stroke (χ 2=9.434) , hospitalization due to heart failure/angina (χ 2=69.290) , revascularization (χ 2=22.918) , cardiovascular death(χ 2=13.473)and all-cause death(χ 2=17.724)as well as hard endpoint events (the sum of non-fetal myocardial infarction, non-fetal stroke, and all-cause death) (χ 2=30.268)and combined major adverse cardiovascular events (MACE) (the sum of hard endpoint events, hospitalization due to heart failure/angina, and revascularization) (χ 2=119.556)among 4 groups(all P<0.01). In Kaplan-Meier survival analysis, the cumulative ratio of freedom from all-cause death decreased significantly in DM+stroke group compared with no DM no stroke group ( HR=17.121, 95 %CI: 2.527-115.934, P<0.01), but no statistical difference was observed in the cumulative ratio of freedom from all-cause death between DM+stroke group and DM group or stroke group respectively ( HR=3.178, 95 %CI: 0.744-13.582; HR=1.383, 95 %CI: 0.374-5.118; all P>0.05) . Meanwhile, patients with DM+stroke presented significantly lower cumulated ratio free from combined MACE than patients with non-DM non-stroke ( HR=5.423, 95 %CI:2.941-10.036, P<0.01), and the cumulated ratio free from combined MACE also decreased significantly in DM+stroke group as compared to DM group or stroke group respectively ( HR=1.859,95 %CI: 1.167-2.962; HR=1.991,95 %CI: 1.178-3.364; all P<0.01) . Conclusions:ACS patients with combined history of DM and stroke have a worse long-term outcomes after PCI than those with DM alone or stroke alone or without DM or stroke. DM and stroke seemed to have an additive effect on decrease in the cumulative ratio free from combined MACE in ACS patients following PCI.

OBJECTIVE: To investigate the effect of P53 expression on prognosis of patients with double expressor lymphoma(DEL) and the interaction between the expression of MYC, BCL2 and P53 in diffuse large B-cell lymphoma(DLBCL). METHODS: Eighty-eight patients with newly diagnosed DLBCL from 1st September 2012 to 31th May 2018 in Shanxi Dayi Hospital affiliated to Shanxi Medical University were selected. The expressions of MYC、BCL2、P53、CD10、BCL6、MUM and Ki-67 were tested by immunohistochemistry method. The overall survival of patients was analyzed by the Kaplan-Meier method and compared by the log-rank test. The prognostic effect of MYC, BCL2 and P53 expression was analyzed by univariate and multivariate analysis. RESULTS: Compared with patients without P53 expression, the patients with P53 expression had higher LDH level, higher NCCN-IPI scores, lower response to chemotherapy，poorer overall survival(OS) and a higher rate of death(P<0.05). In patients who had diffuse large B-cell lymphoma associated with MYC, BCL2 expression or MYC/BCL2 double expression， compared with the patients whom without P53 expression, P53 expression associated with a significant worse OS (P<0.05). The patients with concurrent MYC and P53 expression had a worse OS, compared with patients with either P53 or MYC expression(P<0.05). In patients with MYC/P53 co-expression, BCL2 expression did not correlate with poorer survival significantly(P>0.05). Among lymphoma patients with MYC/P53, MYC/BCL2 and BCL2/P53 co-expression, the patients with MYC/P53 co-expression had the worse OS (3 year OS rate：31.6%), followed by the subgroup of patients with MYC/BCL2/P53(3 year OS rate：46.2%), patients with MYC/BCL2/P53 expression(3 year OS rate： 636%) showed a longer OS compared with the other two subgroups（P<0.05）. Multivariate analysis demonstrated that P53 expression and NCCN-IPI were independent prognostic factors in this patient cohort. CONCLUSION P53 and MYC expressions have a synergistically negative prognostic effect in DLBCL patients. P53 expression augments the negative prognostic effect of MYC/BCL2 double expression. Patients with MYC/P53 co-expression have a worse prognosis in comparison with the patients with MYC/BCL2 double expression.
Humans ; Lymphoma, Large B-Cell, Diffuse ; genetics ; Prognosis ; Proto-Oncogene Proteins c-bcl-2 ; Proto-Oncogene Proteins c-myc ; Tumor Suppressor Protein p53 ; genetics

OBJECTIVE: To investigate the distribution of pathogenic bacteria and drug resistance analysis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD), so as to guide clinical medication. METHODS: A retrospective study was conducted in Shanxi Dayi Hospital. Totally 1173 cases of AECOPD patients, hospitalized with infection from September 2013 to August 2018, were included. Then relevant laboratory data was collected, including sputum culture, drug sensitivity test, and some commonly used laboratory results. The data was analyzed. RESULTS: A total of 231 strains were isolated in 1173 AECOPD patients,the mian pathogenic bacteria were Gram-negative bacteria(115, 49.7%), fungi(66, 28.6%), Gram-positive bacteria(48, 20.8%),other bacteria(2, 0.9%). Drug-resistant strains of producing ESBLs mainly included Acinetobacter(88.9%), Escherichia coli(87.5%),Pseudomonas aeruginosa(70.6%) and Klebsiella pneumoniae(19.4%). The drug-resistance of Acinetobacter to carbapenems and quinolones was more than 70%. The drug-resistance of Escherichia coli to quinolones was 87.5%. The drug-resistance of Streptococcus pneumoniae to penicillin and first and second generation cephalosporins was 66.7%. The drug-resistance of Staphylococcus to penicillin and first and second generation cephalosporins, quinolones and methicillin was 92.3%, 76.9% and 46.2%, respectively. In all Gram-positive bacteria, drug-resistant strains for Vancomycin and linezolid can't be found. The positive rate of bacteria in the group of PaO_2≤60 mmHg(37.3%) was higher than that in the group of PaO_2> 60 mmHg(8.8%). The detection rate of bacteria in the WBC≥10×10~9/L group(18.7%), NLR≥7.3 group(19.7%)and PCT>0.5 ng/mL group(50.7%),which in turn was higher than that in the WBC<10×10~9/L group(12.7%), NLR<7.3 group(12.0%) and PCT≤0.5 ng/mL group(23.9%). The detection rate of bacteria in the Neu%≤75% group, Neu%(76%～90%) group and Neu%>90% group was 10.6%, 16.9% and 30.1%, respectively. The results of trend chi-square test showed that the detection rate of bacteria increased with the decrease of PaO_2 and the increase of WBC, Neu%, NLR and PCT. CONCLUSION: The distribution and drug resistance of pathogenic bacteria in sputum culture of AECOPD are serious, and the distribution of pathogens in AECOPD patients with different levels of PaO_2, WBC, Neu%, NLR and PCT was different. Therefore, we should pay more attention to sputum culture and some commonly used laboratory results in AECOPD patients, so as to provide the basis for the clinical medication.