ObjectiveTo explore the syndrome elements and evolving patterns of patients with hepatitis B virus-related acute on chronic liver failure （HBV-ACLF） at different stages. MethodsClinical information of 1,058 hospitalized HBV-ACLF patients， including 618 in the early stage， 355 in the middle stage， and 85 in the late stage， were collected from 18 clinical centers across 12 regions nationwide from January 1， 2012 to February 28， 2015. The “Hepatitis B-related Chronic and Acute Liver Failure Chinese Medicine Clinical Questionnaire” were designed to investigate the basic information of the patients， like the four diagnostic information （including symptoms， tongue， pulse） of traditional Chinese medicine （TCM）， and to count the frequency of the appearance of the four diagnostic information. Factor analysis and cluster analysis were employed to determine and statistically analyze the syndrome elements and patterns of HBV-ACLF patients at different stages. ResultsThere were 76 four diagnostic information from 1058 HBV-ACLF patients， and 53 four diagnostic information with a frequency of occurrence ≥ 5% were used as factor analysis entries， including 36 symptom information， 12 tongue information， and 5 pulse information. Four types of TCM patterns were identified in HBV-ACLF， which were liver-gallbladder damp-heat pattern， qi deficiency and blood stasis pattern， liver-kidney yin deficiency pattern， and spleen-kidney yang-deficiency pattern. In the early stage， heat （39.4%， 359/912） and dampness （27.5%， 251/912） were most common， and the pattern of the disease was dominated by liver-gallbladder damp-heat pattern （74.6%， 461/618）； in the middle stage， dampness （30.2%， 187/619） and blood stasis （20.7%， 128/619） were most common， and the patterns of the disease were dominated by liver-gallbladder damp-heat pattern （53.2%， 189/355）， and qi deficiency and blood stasis pattern （27.6%， 98/355）； and in the late stage， the pattern of the disease was dominated by qi deficiency （26.3%， 40/152） and yin deficiency （20.4%， 31/152）， and the patterns were dominated by qi deficiency and blood stasis pattern （36.5%， 31/85）， and liver-gallbladder damp-heat pattern （25.9%， 22/85）. ConclusionThere are significant differences in the distribution of syndrome elements and patterns at different stages of HBV-ACLF， presenting an overall trend of evolving patterns as "from excess to deficiency， transforming from excess to deficiency"， which is damp-heat → blood stasis → qi-blood yin-yang deficiency.

Objective To study the application effect of quality control circle(QCC)in reducing the dissatisfaction rate of physical examination clients in health management center.Methods To establish QCC,selected the health check-up popula-tion in our hospital in September-2019 and March-2020,through the questionnaire investigation and analysis,compare the dis-satisfaction of the clients before and after the quality control circle.Results After carrying out QCC activities,the dissatisfaction of physical examination clients was significantly lower than that before QCC,and the difference was statistically significant(P＜0.05).Conclusion The activities of QCC in the health management center can effectively improve the quality of the physical examination work and reduce the dissatisfaction of the customers in the physical examination.It is of great significance to the health management.

Objective:To investigate the application value of serum fibroblast growth factor 21 (FGF21) levels in assessing disease status in patients with liver cancer.Methods:A cross-sectional study was conducted involving 157 hospitalized patients who received treatment at the Department of Infectious Disease, The First Hospital of Jiaxing between July 2020 and August 2021 (54 patients with liver cancer and 103 patients with chronic liver disease). General patient data were collected, and serum FGF21 levels were measured using the enzyme-linked immunosorbent assay. Pearson correlation analysis was performed to investigate the correlation between FGF21 levels and various indicators. Logistic regression analysis was performed to identify risk factors associated with the severity of liver cancer. Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of FGF21 levels for liver cancer.Results:Serum FGF21 levels differed significantly between the liver cancer and chronic liver disease groups [399.91 (293.05, 572.65) ng/L vs. 174.16 (105.39, 255.16) ng/L, Z = 7.32, P < 0.001). Pearson correlation analysis indicated that FGF21 levels were positively correlated with sex, age, smoking, alcohol consumption, fasting blood glucose, total bilirubin, and prothrombin time (all P < 0.05). Logistic regression analysis revealed that FGF21 is an independent risk factor for liver cancer ( OR = 1.102, P < 0.001). According to the receiver operating characteristic curve, the area under the curve for FGF21 levels was 0.856, with an optimal cutoff value of 274.99 ng/L. This cutoff value demonstrated a sensitivity of 0.833 and a specificity of 0.796 for predicting liver cancer. Conclusion:In patients with liver cancer, elevated levels of FGF21 can be observed even when fasting blood glucose is normal, indicating its potential as a predictor for the occurrence of liver cancer. Furthermore, increased FGF21 levels are an independent risk factor for the development of liver cancer.

Objective:To investigate the application value of serum fibroblast growth factor 21 (FGF21) levels in assessing disease status in patients with liver cancer.Methods:A cross-sectional study was conducted involving 157 hospitalized patients who received treatment at the Department of Infectious Disease, The First Hospital of Jiaxing between July 2020 and August 2021 (54 patients with liver cancer and 103 patients with chronic liver disease). General patient data were collected, and serum FGF21 levels were measured using the enzyme-linked immunosorbent assay. Pearson correlation analysis was performed to investigate the correlation between FGF21 levels and various indicators. Logistic regression analysis was performed to identify risk factors associated with the severity of liver cancer. Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of FGF21 levels for liver cancer.Results:Serum FGF21 levels differed significantly between the liver cancer and chronic liver disease groups [399.91 (293.05, 572.65) ng/L vs. 174.16 (105.39, 255.16) ng/L, Z = 7.32, P < 0.001). Pearson correlation analysis indicated that FGF21 levels were positively correlated with sex, age, smoking, alcohol consumption, fasting blood glucose, total bilirubin, and prothrombin time (all P < 0.05). Logistic regression analysis revealed that FGF21 is an independent risk factor for liver cancer ( OR = 1.102, P < 0.001). According to the receiver operating characteristic curve, the area under the curve for FGF21 levels was 0.856, with an optimal cutoff value of 274.99 ng/L. This cutoff value demonstrated a sensitivity of 0.833 and a specificity of 0.796 for predicting liver cancer. Conclusion:In patients with liver cancer, elevated levels of FGF21 can be observed even when fasting blood glucose is normal, indicating its potential as a predictor for the occurrence of liver cancer. Furthermore, increased FGF21 levels are an independent risk factor for the development of liver cancer.

Humans ; Asthma/drug therapy* ; Biological Therapy

Object the current radiological health situation of different ranks medical institutions of interventional radiology in a city of Pearl Delta. Methods all the medical institutions in the city, which had carried out interventional radiology before December 31, 2019 as the research objects by survey. By using the method of field epidemiological investigation, the basic situation of general messages, the status of protective facilities, environmental radiation does, personal protective equipment, occupational health monitoring were investigated. Results There were 12 interventional radiology equipment and 180 employees in 7 medical institutions in the city, before December 31, 2019. There was no statistical significance in the composition of employees of different ranks medical institutions (P > 0.05). There was no statistical significance in the composition of protective facilities for interventional treatment in different ranks hospitals (P > 0.05). The environmental radiation dose in interventional radiology devices room of grade A class 3 hospital was higher than that of grade A class 2 hospital (P < 0.05). There was no statistical significance in the composition of individual protective equipment for interventional therapy in different ranks medical institutions (P > 0.05). The proportion of occupational health examination before work and during work in grade A class 2 hospital was higher than A class 3 hospital (P < 0.01). Conclusion The current situation of radiological health of different ranks medical institutions of interventional radiology in a city of Pearl Delta was good momentum. It may be helpful to improve the radiological health protection level of interventional therapy in this city by strengthening the radiological protection management of applying for interventional therapy, actively carrying out the evaluation of radiological protection against occupational disease hazards in construction projects, and urging the employee to carry out the occupational health monitoring inspection as required.

Objective: To analyze the dynamic changes of serum M30 and M65 levels in patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) during artificial liver support system(ALSS) therapy, and to explore their predictive efficiency and clinical values for short-term prognosis of HBV-ACLF. Methods: Seventy-six patients with HBV-ACLF who underwent ALSS therapy for the first time from May 2016 to May 2019 in the First Hospital of Jiaxing were selected.The patients were divided into improvement group (38 cases) and non-recovered group (38 cases)according to their prognosis, and 38 healthy persons were selected as control group during the same period.The serum levels of M30 and M65 were detected by enzyme-linked immunosorbent assay(ELISA). The predictive values of M30 and M65 levels for short-term prognosis in patients receiving ALSS were calculated by receiver operating characteristic analysis curve (ROC). M30 and M65 levels before and after ALSS were compared by two-way repeated measures analysis of variance. Results: The levels of M30 and M65 in the improvement group, non-recovered group and control group were significantly different before the first ALSS therapy (F=109.36 and 90.42, respectively, both P<0.01). The levels of M30 and M65 were not significantly different between improvement group and non-recovered group before treatment (t=0.836 and 0.286, respectively, both P>0.05). However, after twice ALSS therapy, the levels of M30 and M65 in non-recovered group were significantly higher than those in improvement group (t=30.699 and 64.777, respectively, both P<0.01). Moreover, after the second ALSS therapy, the levels of M30 and M65 were both significantly lower compared to those after the first-time therapy in the improvement group (t=3.350 and 5.932, respectively, both P<0.01). The areas under curve (AUC) of M30, M65 and the combination of M30 and M65 for prognosis prediction were 0.796, 0.844 and 0.906, respectively. The AUC of combination of M30 and M65 was significantly higher than M30 or M65 alone (Z=2.163 and 2.141, respectively, P=0.031 and 0.032, respectively). The cut-off values of M30 and M65 were 591.91 and 924.50 U/L, respectively. The sensitivity and specificity of combined M30 and M65 were 94.7% and 82.5%, respectively. Conclusions Serum M30 and M65 levels can predict the short-term prognosis of HBV-ACLF patients after ALSS therapy.The combination of M30 and M65 is of better diagnostic value.

Objective To explore the effects of sleep status on the cognition of the elderly in community, so as to provide evidence for the prevention and reduction of cognitive decline. Methods A total of 192 healthy elderly people from 2 communities in Haidian District of Beijing were selected by convenience sampling method. All the objects were investigated with Mini Mental State Examination (MMSE), repeatable Battery for the Assessment of Neuropsychological Status (rBANS), Activities of Daily Living (ADL) and Physical Activity Scale for the Elderly (PASE) after signing the consent form. The influencing factors of the cognition function were analyzed by multiple linear regression. Results Within the 192 healthy elderly, 42 individuals reported having subjective sleep problems, and 150 individuals reporting normal sleep. There was no significant difference in gener, age and education level between the two groups (P> 0.05). In rBANS assessment, the score of list learning of the sleep problem group (19.21±6.06) was lower than that of the normal sleep group (21.69±5.82), with statistical significance (t=2.42, P=0.02). However, there was no significant difference between two groups in the other 11 subtests of rBANS, such as story memory and figure copy (P> 0.05). In addition, there were no significant differences in the total score of MMSE, ADL and PASE between the two groups (P>0.05). Multiple linear regression analysis showed that age, year of education, and sleep disorder had impacts on list learning (P< 0.05). Conclusions The subjective reporting of poor sleep has an adverse effect on the short-term verbal memory in elderly who are in a general healthy situation. Sleep health management and care is a critical issue in the prevention of cognitive decline in elderly people.

Objective To investigate the morbidity, diagnostic profile and perinatal outcome of pregestational diabetes mellitus (PGDM) in 15 hospitals in Guangdong province. Methods A total of 41338 women delivered in the 15 hospitals during the 6 months,195 women with PGDM(PGDM group) and 195 women with normal glucose test result(control group)were recruited from these tertiary hospitals in Guangdong province from January 2016 to June 2016. The morbidity and diagnostic profile of PGDM were analyzed. The complications during pregnancy and perinatal outcomes were compared between the two groups. In the PGDM group, pregnancy outcomes were analyzed in women who used insulin treatment (n=91) and women who did not (n=104). Results (1)The incidence of PGDM was 0.472%(195/41338). Diabetes mellitus were diagnosed in 59 women (30.3%, 59/195) before pregnancy, and 136 women (69.7%,136/195) were diagnosed as PGDM after conceptions. Forty-six women (33.8%) were diagnosed by fasting glucose and glycohemoglobin (HbA1c) screening. (2) The maternal age, pre-pregnancy body mass index (BMI), prenatal BMI, percentage of family history of diabetes, incidence of macrosomia, concentration of low density lipoprotein were significantly higher in PGDM group than those in control group (all P<0.05). Women in PGDM group had significantly higher HbA1c concentration((6.3±1.3)% vs (5.2±0.4)%), fasting glucose [(6.3±2.3) vs (4.8±1.1) mmol/L], oral glucose tolerance test(OGTT)-1 h glucose((12.6±2.9) vs (7.1± 1.3) mmol/L)and OGTT-2 h glucose [(12.0±3.0) vs (6.4±1.0) mmol/L] than those in control group (P<0.01). (3)The morbidity of preterm births was significantly higher (11.3% vs 1.0%, P<0.01), and the gestational age at delivery in PGDM group was significantly smaller [(37.6±2.3) vs (39.2±1.2) weeks, P<0.01]. Cesarean delivery rate in the PGDM group (70.8% vs 29.7%) was significantly higher than the control group (P<0.01). There was significantly difference between PGDM group and control in the neonatal male/female ratio (98/97 vs 111/84, P=0.033). The neonatal birth weight in PGDM group was significantly higher((3159±700) vs (3451±423) g, P<0.01). And the incidence of neonatal hypoglycemia in the PGDM group was higher than the control group (7.7% vs 2.6%, P=0.036).(4)In the PGDM group, women who were treated with insulin had a smaller gestational age at delivery [(36.9±2.9) vs (37.9±2.5) weeks, P<0.01], and the neonates had a higher neonatal ICU(NICU)admission rate (24.2% vs 9.6% , P<0.01). Conclusions The morbidity of PGDM in the 15 hospitals in Guangdong province is 0.472%. The majority of PGDM was diagnosed during pregnancy; HbA1c and fasting glucose are reliable parameters for PGDM screening. Women with PGDM have obvious family history of diabetes and repeated pregnancy may accelerate the process of diabetes mellitus. Women with PGDM have higher risk for preterm delivery and neonatal hypoglycemia. Unsatisfied glucose control followed by insulin treatment may increase the need for NICU admission.