Objective To investigate the value of combined prediction of serum 25-hydroxyvita-min D[25-(OH)-D],homocysteine(Hey)and brain natriuretic peptide(BNP)for pregnancy out-comes in patients with hypertensive disorders of pregnancy(HDP).Methods A total of 200 patients with HDP were selected as research subjects and divided into gestational hypertension(GH)group(n=84),mild preeclampsia(PE)group(n=67)and severe PE group(n=49)according to the severity of the disease.Additionally,50 healthy pregnant women were selected as control group.The serum levels of 25-(OH)-D,Hey and BNP were compared among the groups,and their relationships with the severity of HDP were analyzed.According to the pregnancy outcomes of HDP patients,they were divided into poor pregnancy outcome group(n=82)and good pregnancy outcome group(n=118).The serum levels of 25-(OH)-D,Hey and BNP were compared between the poor and good pregnancy outcome groups.Logistic regression analysis was used to screen for the influencing factors of poor pregnancy outcomes in HDP patients.Results Compared with the control group,the severe PE group had the lowest serum 25-(OH)-D level,followed by the mild PE group and the GH group,with statistically significant differences(P＜0.001).Compared with the control group,the severe PE group had the highest serum Hcy and BNP levels,followed by the mild PE group and the GH group,with statistically significant differences(P＜0.001).Serum 25-(OH)-D was negatively cor-related with the severity of HDP in patients(r=-0.427,P＜0.001),while serum Hey and BNP were positively correlated with the severity of HDP in patients(r=0.585 and 0.682;P＜0.001).The serum 25-(OH)-D level in the poor pregnancy outcome group was significantly lower than that in the good pregnancy outcome group,while the serum Hcy and BNP levels were significantly higher than those in the good pregnancy outcome group(P＜0.05).Logistic regression analysis results showed that elevated serum Hey and BNP levels,severe PE and elevated systolic blood pressure were independent risk factors for poor pregnancy outcomes in HDP patients,while high 25-(OH)-D level was a protective factor(P＜0.05).The area under the curve(AUC)of the prediction model constructed based on the Logistic regression analysis results was 0.911(95％CI,0.863 to 0.947),with asensitivity of 91.46％and specificity of 75.42％.Conclusion As the severity of HDP in pa-tients increases,their serum 25-(OH)-D level decreases,while serum Hey and BNP levels in-crease.The combined prediction of serum 25-(OH)-D,Hey and BNP has a high value for predic-ting poor pregnancy outcomes in HDP patients.

Objective:To search and summarize the best evidence for blood pressure management in patients with intracerebral hemorrhage to provide evidence for blood pressure management in these patients.Methods:PIPOST model was used to establish evidence-based questions; with "intracerebral hemorrhage/cerebral hemorrhage/ICH/HICH/stroke" AND "blood pressure/hypertension" as English search terms, and with "脑出血/颅内出血/脑卒中"+"血压" as Chinese search terms, the official websites of related associations and domestic and foreign databases, such as GUIDE.com, UpToDate, Cochrane Library, CNKI, VIP Chinese journal Service platform, and Wanfang Data Knowledge Service platform, were searched. Two researchers independently evaluated the quality of the literature, including guidelines, systematic reviews, and expert consensus, and extracted the evidence.Results:A total of 17 articles were selected; 2 were clinical decision type, 7 were guideline type, 7 were systematic review type, and 1 was expert consensus type. Twenty-six pieces of evidence were summarized into 5 aspects: timing and methods of lowering blood pressure, benefits and risks of lowering blood pressure, drug selection and selection methods, recurrence prevention of stroke, and matters for attention.Conclusion:It is necessary to pay attention to blood pressure management in patients with intracerebral hemorrhage; in the process of evidence application, it's suggested to make an appropriate blood pressure management plan for the patients according to clinical situation.

Objective To investigate the clinical value of re-using ultrafiltrated and concentrated ascites fluid for refractory ascites in patients with hepatitis B cirrhosis. Methods A retrospective study was conducted, one hundred and thirteen patients with intractable ascites (all patients received intraperitoneal reinfusion of ultrafiltrated and concentrated ascites fluid therapy) admitted to the Department of Gastroenterology of No.254 Hospital of the Chinese People's Liberation Army from December 2013 to November 2016 were enrolled and assigned as the study group, fifty-two patients with intractable ascites admitted in the same period as above group in this hospital without undergoing above ascites fluid reinsfusion were served as the control group. Both groups were given conventional therapies, including measures for hepatoprotection, increase of plasma osmotic pressure, correction of hypoproteinemia (intravenous injection albumin 10 g, 3 times a week), reduction of portal venous pressure (octreotide 0.2 mg, q8 h), improvement of microcirculation, correction of water and electrolyte balance disorders, diuresis (furosemide 100 mg/d), etc. On the basis of the above conventional treatment, the system with ascites ultrafiltration, concentration and reinfusion into abdominal cavity was applied to carry out the concentrated ascites fluid reinfusion therapy in the study group. The relieve of abdominal bloating, conscious, blood pressure, 24-hour urine output, endogenous creatinine clearance rate (CCr), serum potassium ion (K+), serum sodium ion (Na+), ascites albumin quantity, serum albumin levels before treatment and after treatment for 1 week, abdominal infection situation after treatment for 1 week were observed in the study group. The difference in incidence of abdominal infection between the study group and control group (at the end of 12 weeks after treatment) was compared. Results In the study group, after treatment, the patients with abdominal bloating had different degrees of relief, 24-hour urine output was increased compared with that before treatment (mL: 1291.3±123.4 vs. 1265.0±61.5, P = 0.051), no cases with conscious changes, blood pressure instable. There were no statistical significant difference in blood K+ and Na+ (P > 0.05). And ascites albumin concentration was increased compared with before treatment (g/L: 19.1±2.9 vs. 17.2±4.1, P = 0.000); 1 week after treatment, CCr was significantly higher than that before treatment (μmol/L: 71.2±8.7 vs. 56.1±5.4, P = 0.000); serum albumin was increased after 3 times of treatment in 1 week (g/L: 25.7±4.4 vs. 24.6±3.0), but the difference was not statistically significant (P = 0.054). No abdominal infection occurred within 1 week after treatment were observed in patients of study group. There was no statistical significant difference in the incidence of abdominal infection between the study group and control group in 12 weeks after treatment [9.7% (11/113) vs. 13.6% (7/52), P = 0.476]. Conclusions The re-using of ultrafiltrated and concentrated ascites fluid can effectively relieve the abdominal bloating symptom, improve CCr, be beneficial to the re-use of ascites albumin, and does not increase the incidence of abdominal infection within 12 weeks after the therapy, therefore the treatment has relatively high therapeutic value for intractable ascites in patients with hepatitis B cirrhosis.

Objective To explore the effects of diversified continuing nursing on recovery of patients with breast cancer after modified radical mastectomy. Methods A total of 90 patients with breast cancer after modified radical mastectomy were divided into observation group ( 45 cases ) and control group ( 45 cases ) according to random number table method. Patients in two groups received health guidance before leaving hospital, while those in observation group also received continuing nursing after leaving hospital. One month after leaving hospital, recovery of flaps and function of affected upper limb were evaluated. Results The flaps recovery of patients in observation group were better than those in control group with a significant difference ( P<0. 05). There were statistically significant differences in horizontal abduction of shoulder joint, upward abduction of shoulder joint, dorsiflexion of middle finger, distance of seventh cervical vertebra between two groups ( P<0. 05). Conclusions Diversified continuing nursing can effectively reduce complications of breast cancer after modified radical mastectomy and promote function recovery of the upper limb of patients.

Background and purpose: Human epididymis protein 4 (HE4) has been suggested to be a novel biomarker of epithelial ovarian cancer (EOC). The present study aimed to evaluate and compare HE4 with the commonly used marker, carbohydrate antigen 125 (CA125) and imaging examinations in detecting the recurrence of postoperative EOC. Methods:In this study, 92 patients with the recurrence of postoperative EOC were analyzed retro-spectively. The treatments method included the secondary operation (48 patients) and chemotherapy (44 patients). The sensitivity of CA125, HE4 and CT/MRI examinations in detecting the recurrence of postoperative EOC were analyzed and correlated with surgical pathology and clinical follow-up results. Results:The sensitivity of CA125 and HE4 were 58.7%and 61.9%with no signiifcant difference (P>0.05). The diagnostic sensitivity of CA125 combined with HE4 (80.4%) was statistically higher than that of 2 tumor marks being applied independently (P>0.05). The diagnostic sensitivity of CT/MRI examinations (88.0%) was statistically higher than that of CA125 and HE4 (P<0.05), and no signiifcant difference was observed between CT/MRI and combined CA125 and HE4 (P>0.05). The highest diagnostic sensitivity (97.8%) was attained by combining of CA125, HE4 and CT/MRI examinations, which was statistically high-er than that of CA125 combined with HE4 (P<0.01), and CT/MRI examinations (P<0.05). Conclusion:Serum HE4 is an effective tumor marker in detecting the recurrence of postoperative EOC as well as serum CA125. HE4 and CA125 may improve the diagnostic sensitivity statistically. The highest diagnostic sensitivity was attained by combining of CA125, HE4 and CT/MRI examinations, which is the suitable strategy in screening the patient of postoperative EOC.

Objective To optimize the preparative procedure for stachydrine in Fructus Leonuri. Methods The preparation was screened by orthogonal experiment, and a mathematical model of relationship of extraction time, methanol concentration, and solid-liquid ratio with the content of stachydrine hydrochloride was established by using back-propagation (BP) neural network. And the process parameters were optimized with genetic algorithm (GA) . Results The optimum process parameters were as follows: extraction with 69% of methanol concentration and with solid-liquid ratio being 11 times for 62 min. The content of stachydrine obtained by BP neural network modeling and GA was higher than that achieved by orthogonal experiment. Conclusion The optimum preparative procedure could be achieved by combining BP modeling with GA. The model developed in this study was proved to be predictable and feasible for the optimization of process parameters of multi-dimension nonlinear system.

Objective To understand the epidemiological distribution and epidemic situation of brucellosis cases in Zhejiang Province in 2003 - 2012. Methods Questionnaires of confirmed brucellosis cases, annual reports of prevention and control work of brucellosis in the cities and monitoring points were collected and analyzed in 2003 - 2012. Population distribution, regional distribution, infection sources and routes of infection, aetiology and clinical symptoms and signs of the brucellosis cases were analyzed descriptively. Results A total of 323 brucellosis cases were reported in 2003 - 2012, the average annual incidence rate was 0.070/one hundred thousand, the incidence rate in 2012(0.190/one hundred thousand) was high. There were 272 people of the 323 brucellosis cases were from occupational populations, accounting for 84.21%(272/323); people worked in buying, slaughtering and trafficking of livestock products were majority of the cases, accounting for 65.02%(210/323); and unoccupational population was accounting for 15.79%(51/323). Regional distribution of brucellosis was gradually spreading; the average incidence rate of Shaoxing City was the highest ( 0 . 226/one hundred thousand ) . Three hundred patients were infected by sheep, accounting for 92.88%(300/323), and only 7.12%(23/323) of the patients were infected by cattle. Two hundred and eighty-seven acute phase patients of brucellosis were checked by blood culture, and thirty-nine Brucella melitensis strains and two Brucella abortus strains were detected. The chronicity survey of 120 confirmed cases of brucellosis were conducted, chronicity rate was 3.33%(4/120). Conclusions Trends in the epidemic situation of brucellosis in Zhejiang Province has continued to spread. The main source of infection is sheep from the North. Occupational populations are major populations at risk. The key of prevention and control is to strengthen the active monitoring of occupation personnel , health education and behavior intervention.

Objective To assess the prognosis and effect on renal function of pediatric urolithiasis caused by melamine-contaminated milk powder (PUMMP) in a long-term follow-up.Methods One hundred and two of 8335 children (≤ 6-year-old) with history of consuming melamine-contaminated milk powder screened in our hospital were followed up for eighteen months after diagnosis. Urinary system ultrasonography, urinalysis, urinary microprotein profiles [microalbumin (ALBU), immunoglobulin G (IgG), and N-acetyl-β-D-glucosidase (NAG)], urinary melamine and cyanuric acid were examined in the first visit and at the end of follow-up. Results Follow-up was completed in 91 children and the stone was excreted in 82 children (90.1%).Stones less than 5 mm in diameter were most vulnerable to discharge, and stones larger than 10 mm could not be expelled without interventions. At the end of follow-up, no melamine or cyanuric acid was found in the urine samples of 74 patients. Urinalysis showed that incidences of proteinuria, microscopic hematuria and leukocyturia were 0%, 5.1% and 2.0%, which were significant different from those in the first visit (Pproteinutria=0.123, Phemnatuna=0.038 and Pleukocyhuris=0.005).Urinary microprotein profiles revealed that some children whose urinalysis was normal still presented glomerular and renal tubular injury and the abnormal rates were 8.8% and 12.1%respectively. The glomerular injury was mainly related to persistent stone, male and younger.Conclusions 90.1% of children with PUMMP passes urinary stones at the end of follow-up.Stone size is the major risk factor of discharge. No melamine or cyanuric acid is found in the urine of children. After eighteen months, glomerular and renal tubular injury is still found in some patients. Further follow-up is necessary.

Objective To investigate the urinary iodine level and thyroid function during different trimesters of pregnancy in Hangzhou residents and to provide evidence for monitoring iodine nutrition or screening thyroid function. Methods The urinary iodine level and thyroid function of 395 subjects from 5 hospitals in Hanzhou were investigated. The urinary iodine level was measured by arsenic-cerium contact process method. The serum TSH, FT3 and FT4 were measured by chemiluminescence method. Results (1) The urinary iodine median concentration during pregnancy in the 1st, 2nd and 3rd trimesters were 170.3, 170.2, 162.4 μ/L respectively, all significantly lower than that of non-pregnant women (251.9 μg/L, all P < 0.05); (2) The mean value of TSH during the 1st trimester of pregnancy was significantly lower than that of non-preguant women (P < 0.05). The mean values of FT4 and FT3 in the 2nd and the 3rd trimesters of pregnancy were significantly lower than those of the control (P < 0.05); (3) During 2nd trimester, there were 8.7% (9/104, in FT4) and 9.6% (10/104, in FT3) pregnant women below normal lower range while during 3rd trimester, these figures reached 22.7% (22/97) and 17.5% (17/97) resfectively. Conclusions More than half of the pregnant women in Hangzhou have good nutritional status of iodine. There are significant differences in thyroid hormone levels between the non-pregnant and pregnant women as well as between gestation periods. Therefore, it is necessary to establish a trimester-specific reference range of thyroid hormones for normal pregnancy. The screening for thyroid function is recommended for pregnant women besides monitoring routine urinary iodine.

OBJECTIVE: To observe the clinical efficacy of intratympanic dexamethasone (IT-DEX) for sudden deafness (SD) which were inefficient and contraindicant for systemic steroid. METHOD: Thirty-four patients who were inefficient and contraindicant for systemic steroid were treated by IT-DEX (5 g/L) for 4 times within 12 days. The improvement of audits, tinnitus and stuffy were observed. And the results between the different influencing factor such as age, sex and course of disease were compared by statistical analysis. RESULT: 1) For total patients, the effective power of audits, tinnitus and stuffy were 52.9%, 58.8% and 82.4% respectively. And the patients who treated within 2 weeks result in higher effective power of audits and tinnitus than those having been treated for more than 2 weeks, but there was no significant difference between these two groups (P >0.05). 2) For the patients who were inefficient and contraindicant for systemic steroid, the audible effective power of them were 44.4% and 62.5% respectively. CONCLUSION IT-DEX can treat refractory SD effectively and safely. It is an effective treatment for the patients who were contraindicant for systemic steroid, and it could be used for salvage for the patients who were inefficient for systemic steroid.
Adolescent ; Adult ; Aged ; Dexamethasone ; administration & dosage ; therapeutic use ; Drug Administration Routes ; Female ; Hearing Loss, Sudden ; drug therapy ; Humans ; Male ; Middle Aged ; Tympanic Membrane ; Young Adult