Objective To explore the application value of popaverine combined with stage rehabilitation for patients after free flap grafting for hand trauma.Methods Data of postoperative patients who underwent hand trauma from January 2021 to January 2022 in The 903rd Hospital of the Joint Logistics Support Force of the People's Liberation Army of Chinawere retrospectively collected,and they were divided into the combined rehabilitation group(poppadine combined with stage rehabilitation care)and the stage rehabilitation group(only stage rehabilitation care was applied)according to the treatment methods.Visual analog scale(VAS)scores,rehabilitation exercise adherence scores,postoperative rates of excellent cutaneous sensory function of the hand,total active mobility(TAM)of the fingers,Jamar grip strength,upper extremity functional assessment(DASH)scale scores,and the incidence of vascular crises were compared between the two groups.Results A total of 120 cases were included in the study,with 57 cases in the combined rehabilitation group and 63 cases in the stage rehabilitation group.There was no statistically significant difference in VAS scores,Jamar grip strength and DASH scores between the two groups before surgery(P＞0.05);at 14 days and 3 months of intervention,VAS scores of the two groups decreased compared with the pre-intervention period(P＜0.05),and VAS scores of the patients in the combined rehabilitation group were significantly lower than those in the stage rehabilitation group(P＜0.05).After 3 months of intervention,the rehabilitation exercise adherence score,the rate of excellent hand skin sensory function,and finger TAM of the patients in the combined rehabilitation group were higher than those in the stage rehabilitation group(P＜0.05);Jamar grip strength were elevated in both groups compared with the pre-intervention period,but the combined rehabilitation group were higher than those in the stage rehabilitation group(P＜0.05);DSAH scores were lower in both groups compared to pre-intervention,and were lower in the combined rehabilitation group than in the stage rehabilitation group;and during the 3 months of intervention,the incidence of vascular crisis was significantly lower in patients in the combined rehabilitation group than in the stage rehabilitation group(P＜0.05).Conclusion Opium poppy alkaloids combined with stage rehabilitation can effectively reduce patients'postoperative pain,enhance patients'adherence to rehabilitation exercises,effectively improve postoperative hand function and upper limb motor function,and reduce the incidence of vascular crisis.

OBJECTIVE: To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program. METHODS: A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed. RESULTS: NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035. CONCLUSION NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.
Aneuploidy ; Cost-Benefit Analysis ; Female ; Humans ; Noninvasive Prenatal Testing ; Pregnancy ; Retrospective Studies ; Trisomy 18 Syndrome/genetics*

ObjectiveTo investigate the prevalence rate and influencing factors of depression and anxiety in disabled people in Guang'an during the post-pandemic period， so as to provide references for promoting mental health of disabled people. MethodsFrom April to May 2021， the disabled people dwelling in low-risk areas for coronavirus infections in Guang'an for half a year and met the criteria outlined in Classification and Grading Criteria of Disability （GB/T26341-2010） were selected as the survey subjects， and their depression and anxiety symptoms were evaluated via the Patients' Health Questionnaire Depression Scale-9 item （PHQ-9） and the Generalized Anxiety Disorder Scale （GAD-7） through Wenjuanxing platform. Then binary Logistic regression analysis was performed to screen the risk and protective factors for depression and anxiety in disabled people. ResultsThe detection rates of moderate-to-severe and severe depressive symptoms were 9.05% and 8.35%， and the detection rates of moderate and severe anxiety symptoms were 9.40% and 11.25%. Regression analysis denoted that being laid-off and job-waiting were risk factors for depression and anxiety in disabled people （OR=2.354， 2.353， P<0.01）. Being unmarried （OR=0.418）， married （OR=0.414）， visual disability （OR=0.254）， limb disability （OR=0.460）， good family function （OR=0.241）， moderate family dysfunction （OR=0.288）， complete self-care （OR=0.062） and partial self-care （OR=0.416） were protective factors for depression in disabled people （P<0.05 or 0.01）. Visual disability（OR=0.382）， hearing disability（OR=0.143）， limb disability（OR=0.432）， good family function （OR=0.246）， moderate family dysfunction （OR=0.402）， complete self-care （OR=0.093） and partial self-care （OR=0.378） were protective factors for anxiety in disabled people （P<0.05 or 0.01）. ConclusionThe disabled people in Guang'an during the post-pandemic period suffer a high detection rate of depression and anxiety， and the detection rate is even higher among those being laid-off or job-waiting， while good family function and complete or partial self-care ability are conducive to protecting the mental health of the disabled.

The coronavirus disease 2019(COVID-19)pandemic has affected the normal diagnosis and treatment of patients with prostate cancer. In response to the special period of medical behavior, the European Association of Urology (EAU) has issued guidelines for the management of prostate cancer during the pandemic in addition to the conventional guidelines. According to the patients’ priorities and different stages, the clinical activities were recommended. We do an introduction of this guideline and give commons based on medical situation of China.

Objective:To explore the association between snoring and prevalent hypertension among adults in Zhejiang with a cross-sectional study.Methods:After excluding participants with self-reported, physician-diagnosed heart diseases, stroke and cancer at baseline study, 56 728 participants aged 30-79 in the China Kadoorie Biobank study from Tongxiang, Zhejiang were included for the final analysis. Three multivariable logistic regression models were used to estimate the ORs for the associations of snoring with prevalent hypertension. Results:The proportion of participants who snored frequently, snored sometimes, and never snored were 24.55%, 23.94%, and 51.51%, respectively. The corresponding figures of males were 32.40%, 26.55%, and 41.05%, respectively. The corresponding figures of females were 19.00%, 22.08%, and 58.92%, respectively ( P<0.001). After adjusted socio-demographic factors, behavioral lifestyle, BMI, waist circumference, and sleep duration etc., in comparison with participants who never snored, the odds ratios (95% CI) of hypertension for those who snored frequently and snored sometimes were 1.17 (1.12-1.23) and 1.12 (1.07-1.18), respectively. The effects of snoring on hypertension were statistically significantly different between women and men, participants who were central obese and those who were not, and between premenopausal and post-menopausal women. Conclusion:Snoring was associated positively with hypertension among adults. The effect of snoring on prevalent hypertension were obvious, especially among people, being female, being central obese, and being premenopausal.

Objective:To evaluate the effect of comprehensive intervention combined with clinical preventive services and lifestyle adjustment on high-risk populations of cardiovascular disease.Methods:In 2015, 4 towns (streets) in Tongxiang City, of Zhejiang Province including Heshan Town, Longxiang Street, Wutong Street, and Fengming Street, were selected by using the typical sampling. The towns (streets) were allocated to the intervention group (Heshan Town and Longxiang Street) and the control group (Wutong Street and Fengming Street) by using the cluster random sampling. In each town (street), hypertension patients aged 50 to 74 years old who were taking community medicine management and with a 10-year cardiovascular disease risk ≥10% were recruited as subjects. There were 1 823 subjects in the intervention group and 1 883 in the control group. The intervention group was given a 1-year comprehensive intervention combining clinical preventive services and lifestyle adjustment, while the control group received routine chronic disease management. After the intervention, the final questionnaire investigation was conducted and health physical examination data were obtained. The death, acute coronary heart disease events and stroke incidence were the primary outcomes, and cardiovascular disease-related knowledge and behavior, clinical preventive services utilization, physical changes, blood fat index and 10-year cardiovascular disease risk were the secondary outcomes. The difference-in-difference model was used to evaluate the effects of interventions.Results:The age of subjects in the intervention and control group was (68.76±3.75) and (67.90±4.56) years old, respectively. After 1-year intervention, the incidence of mortality, acute coronary events and stroke in intervention group was 1.65% (30 cases), 0.27% (5 cases) and 2.69% (49 cases), respectively, which showed no statistical difference compared to the control group [1.33% (25 cases), 0.32% (6 cases) and 2.07% (39 cases)]. After adjusting for the age, gender, education, marital status, self-assessed family income level and situation of taking antihypertensive drugs, the difference-in-difference model showed that the body mass index and diastolic blood pressure in the intervention group decreased by 0.33 kg/m 2 and 1.49 mmHg (1 mmHg=0.133 kPa). Compared with the control group, daily vegetable consumption proportion, the awareness rates of aspirin, stains, salt intake, and oil intake increased by 4.76%, 26.22%, 29.56%, 10.80%, and 15.17%, respectively ( P<0.05). Conclusion:After the 1-year comprehensive intervention, there was no significant change in primary outcomes among high-risk populations of cardiovascular disease. In secondary outcomes, body mass index and diastolic blood pressure declined and cardiovascular disease-related knowledge awareness increased.

Objective:To evaluate the effect of comprehensive intervention combined with clinical preventive services and lifestyle adjustment on high-risk populations of cardiovascular disease.Methods:In 2015, 4 towns (streets) in Tongxiang City, of Zhejiang Province including Heshan Town, Longxiang Street, Wutong Street, and Fengming Street, were selected by using the typical sampling. The towns (streets) were allocated to the intervention group (Heshan Town and Longxiang Street) and the control group (Wutong Street and Fengming Street) by using the cluster random sampling. In each town (street), hypertension patients aged 50 to 74 years old who were taking community medicine management and with a 10-year cardiovascular disease risk ≥10% were recruited as subjects. There were 1 823 subjects in the intervention group and 1 883 in the control group. The intervention group was given a 1-year comprehensive intervention combining clinical preventive services and lifestyle adjustment, while the control group received routine chronic disease management. After the intervention, the final questionnaire investigation was conducted and health physical examination data were obtained. The death, acute coronary heart disease events and stroke incidence were the primary outcomes, and cardiovascular disease-related knowledge and behavior, clinical preventive services utilization, physical changes, blood fat index and 10-year cardiovascular disease risk were the secondary outcomes. The difference-in-difference model was used to evaluate the effects of interventions.Results:The age of subjects in the intervention and control group was (68.76±3.75) and (67.90±4.56) years old, respectively. After 1-year intervention, the incidence of mortality, acute coronary events and stroke in intervention group was 1.65% (30 cases), 0.27% (5 cases) and 2.69% (49 cases), respectively, which showed no statistical difference compared to the control group [1.33% (25 cases), 0.32% (6 cases) and 2.07% (39 cases)]. After adjusting for the age, gender, education, marital status, self-assessed family income level and situation of taking antihypertensive drugs, the difference-in-difference model showed that the body mass index and diastolic blood pressure in the intervention group decreased by 0.33 kg/m 2 and 1.49 mmHg (1 mmHg=0.133 kPa). Compared with the control group, daily vegetable consumption proportion, the awareness rates of aspirin, stains, salt intake, and oil intake increased by 4.76%, 26.22%, 29.56%, 10.80%, and 15.17%, respectively ( P<0.05). Conclusion:After the 1-year comprehensive intervention, there was no significant change in primary outcomes among high-risk populations of cardiovascular disease. In secondary outcomes, body mass index and diastolic blood pressure declined and cardiovascular disease-related knowledge awareness increased.

Objective To investigate the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in Chinese patients with ischemic stroke . Methods In this multi‐center study ,2 310 continuously inpatients with ischemic stroke diagnosed in 20 stroke screening and prevention project base hospitals from June 2015 to M ay 2016 were enrolled . Carotid ultrasonography and transcranial color‐coded sonography or transcranial Doppler were performed in all patients to confirm the presence of cerebral artery stenosis or occlusion . According to the distribution of lesions ,the subjects were divided into 2 groups :the simple intracranial artery stenosis group and the simple extracranial artery stenosis group . T he difference of risk factors between the two groups was compared . Results Of the 2 310 patients with ischemic stroke ,1 516 ( 65 .6% ) had simple intracranial artery stenosis and 794 ( 34 .4% ) had simple extracranial artery stenosis . T he incidence of anterior circulation artery stenosis was higher in the group of intracranial artery stenosis than that in the extracranial artery stenosis group ( 68 .1% vs 48 .7% , P ＜0 .001) . Posterior circulation artery stenosis and combined anterior with posterior circulation artery stenosis were more common in patients with extracranial artery stenosis group than those in intracranial artery stenosis group ( 36 .4% vs 22 .1% ,14 .9% vs 9 .8% ;all P ＜0 .001) . Univariate analysis of risk factors for stroke showed that patients with intracranial arterial stenosis had a higher prevelence of hypertension , diabetes ,obesity ,and family history of stroke ,and their systolic blood pressure ,diastolic blood pressure , body mass index ( BM I) ,fasting blood‐glucose ,glycosylated hemoglobin ,triacylglycerol ,total cholesterol , and low‐density lipoprotein cholesterol were significantly higher than those in the extracranial arterial stenosis group ( all P ＜ 0 .05 ) . T he proportion of elderly ( ≥ 65 years old ) ,male and smokers in the extracranial arterial stenosis group was significantly higher than that in the intracranial arterial stenosis group ( all P ＜0 .05) . Multivariate logistic regression analysis showed that elderly ( ≥65 years old) ,male , and smoking history were independent risk factors for extracranial arterial stenosis ( OR＝ 2 .012 ,1 .637 , 1 .325 ,respectively ;all P ＜0 .05) . While hypertension ,diabetes ,less physical activity ,and high BM I levels were independent risk factors for simple intracranial arterial disease ( OR ＝ 1 .301 ,1 .252 ,1 .248 ,1 .030 , respectively ;all P ＜0 .05) . Conclusions There are significant differences in the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in patients with ischemic stroke in China .

Objective : To evaluate the risk of cardiovascular disease in hypertensive patients managed by communities in Tongxiang in the next 10 years,and to provide evidence for the development of cardiovascular disease prevention strategies. Methods: The information about hypertensive patients managed by communities was collected from Tongxiang resident health records management system. The risk of ischemic cardiovascular disease（ICVD）in the next 10 years was assessed by the Assessment Scale of 10-Year ICVD Risk in Chinese. Results: A total of 27 173 hypertensive patients managed by communities with complete data were recruited,including 11 868 males,accounting for 43.68%,and 15 305 females,accounting for 56.32%. The median（inter-quartile range）of the total scores of 10-year ICVD risk in hypertensive patients was 8.00（3.00）,with 9.00（2.00）in males and 8.00（2.00）in females. The total scores of 10-year ICVD risk in males was significantly higher than those in females（P<0.05）. A total of 8 764 patients had high 10-year ICVD risk,accounting for 32.25%. The proportion of high10-year ICVD risk in females with hypertension was higher than that in males（P<0.05）. The weights of ICVD risk factors in males were 54.58% in age,17.42% in systolic blood pressure,14.27% in smoking,7.77% in body mass index,4.51% in total cholesterol and 1.45% in diabetes;the ones in females were 63.57% in age,14.63% in systolic blood pressure,9.81% in body mass index,6.00% in total cholesterol,5.88% in diabetes and 0.11% in smoking. Conclusion The ICVD risk of hypertensive patients managed by communities in Tongxiang is higher in the next 10 years. Male patients should focus on the control of blood pressure and smoking,while female patients should focus on the control of blood pressure and body weight.

Objective To investigate the homology of methicillin-resistant Stphylococcusaureus(MRSA)from the neonatal intensive care unit(NICU)of a children's hospital,and evaluate routes and preventive strategies of MRSA healthcare-associated infection(HAI). Methods MRSA strains from neonates and environment of NICU between October and December 2014 were collected,and strains were identified by VITEK-2 microbial analysis system and cefoxitin Kirby-Bauer method,homology of MRSA was analyzed by pulsed-field gel electrophoresis (PFGE ). Results A total of 6 MRSA strains were isolated from NICU between October and December 2014,3 of which (bed-58,70,and 100)were detected MRSA from specimens,MRSA were isolated from neonatal incubator and nurse (nasal swabs and hands)who cared for neonate at bed 58. 5 of 6 MRSA strains were homology,antimicrobial susceptibility testing result showed that No. 1-5 strains were resistant to clindamycin and amoxicillin/clavulanic acid,No. 6 strain was slightly different from No. 1-5 strains,No. 6 strain was susceptible to both clindamycin and amoxicillin/clavulanic acid. PFGE results showed that No. 1-5 strains were of the same type,No. 6 strain was a different type. Conclusion The main route of this MRSA transmission is contact transmission,especially through the hands of health care workers,identification and analysis of epidemic strains by PFGE technique is an effective measures to prevent HAI outbreak and perform epidemiological study.