OBJECTIVE To explore the influence of surgical history on chemotherapy -induced nausea and vomiting （CINV）. METHODS A retrospective case -control study was adopted ，with 824 patients undergoing chemotherapy as the object . A total of 27 items were collected ，including demographic data ，medical history data ，pre-chemotherapy data ，and chemotherapy treatment status. Logistic regression model was used to analyze the relationship between the history of surgery and the risk of CINV . The multiple models were constructed to correct potential confounding factors ，and subgroup analysis was performed on patients with surgical history . RESULTS The incidence of CINV was higher in patients with surgical history . The statistical result before adjustment was [OR＝1.72，95%CI（1.31，2.28），P＜0.001]；after adjusting potential confounding factors ，the statistical result was [OR＝1.78，95% CI（1.28，2.48），P＝0.001]. In the subgroup analysis ，the time between surgery and chemotherapy was different ， and the impact of surgical history on CINV was different ，and the results were statistically significant （P＝0.027）. The risk of CINV showed decreasing trend with the time ，and the results were statistically significant （P for trend ≤0.050）. Compared with patients who had not undergone surgery ，patients who had undergone surgery within one year had a higher risk of CINV [OR＝ 2.33，95%CI（1.52，3.59），P＜0.001]. CONCLUSIONS Patients with surgical history are more prone to CINV ，and the risk of CINV shows a downward trend in the length of time from surgery .

Objective:To analyze the status of secondary maternal and child health hospital accreditation in China and the impact of such accreditation on their service improvement.Methods:The paper used the propensity score matching method to match the accreditation group and the non-accreditation group in 1∶1 ratio, and compared the related indicators of service capability of maternal and child health hospitals between the two groups by non-parametric test and Chi-square test.Results:A total of 842 maternal and child health care hospitals were matched. A comparison was made between the accreditation group and the non-accreditation group, and the differences of the following indicators of individual services within the hospital were statistically significant( P<0.01). These indicators were annual emergency attendance, the number of types of health services for women and children, the utilization rate of beds, the average daily hospital bed of each practicing physician; the following indicators of service management within their coverage were statistically significant: namely the proportion of institutions carrying out health education evaluation within their coverage, that of institutions producing uniform " Mother and Child Health Handbook", that of institutions carrying out information quality control, as well as analysis and utilization.These indicators of the accreditation group were higher than those in the non-accreditation group( P<0.01). Conclusions:Given the role played by maternal and child health institution accreditation in promoting secondary maternal and child health hospital regarding better service content, quantity, efficiency and the quality of business management within their coverage, there is still room for improvement.

Objective: To understand the current status of follow up of people living with HIV/AIDS by health service at grass root in rural area of Jiangxi province and related factors, and provide references for the promotion of the follow up by grass root health service. Methods: People living HIV/AIDS aged ≥18 years and diagnosed before 31 December 2017 in 6 townships of Xinjian, Yushan counties and Guixi city were included in the study in Jiangxi province. They had been followed up for more than one time after the first epidemiologic survey. The information about their demographic characteristics and HIV infection status were collected by using self-designed questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify the factors that influencing the acceptance of follow up by grass root health service. Results: Of the 373 surveyed HIV infected subjects aged (53.06±16.15) years, 261 were males (70.0%, 261/373). Among the surveyed subjects, the illiteracy and people who received only primary school education accounted for 54.7% (204/373). The rate of follow up of the HIV infected subjects by grass root health service was 55.8% (208/373), and those through heterosexual contact were 58.5% (190/325). The multivariate regression analysis showed that the acceptance of follow up by grass root health service was higher in those who were farmers (OR=7.36, 95%CI: 2.52-21.45), had family support (OR=16.01, 95%CI: 2.25-49.73), didn’t worry about discrimination (OR=12.97, 95%CI: 4.75-35.42), trusted health care provider (OR=5.07, 95%CI: 2.19-11.76) and showed AIDS symptoms (OR=10.58, 95%CI: 2.25- 49.73). Conclusions The performance of follow up of people living with HIV/AIDS by grass root health service was well, suggesting it is a feasible management model. Being famer or not, family member supporting or not, worry about discrimination or not, trusting health care provider or not and showing AIDS symptoms or not were the main factors influencing the acceptance of follow up by grass root health service.

The HIV-infected people were investigated for their satisfactory situation towards the follow-up management of primary medical and health care institutions in Xinjian County, Yushan County and Guixi City of Jiangxi Province from January to July 2018 and related factors were also analyzed. The total score of the Infected Patients′ Follow-up Management Satisfaction Scale higher than 59 was defined as the satisfactory. 75.68% of 259 infected patients were satisfied with the follow-up management. Compared to farmers and other follow-up modes, non-farmers (OR=10.72, 95%CI: 2.07-55.63), and patients receiving follow-up service in responsible institutions (OR=6.44, 95%CI: 3.12-13.30) were more satisfied with follow-up management.

Objective To explore the safety and feasibility of laparoscopic hepatectomy combined with radiofrequency ablation for primary liver cancer difficult to manage.Methods A retrospective study was conducted to analyze the clinical data of 16 patients who underwent laparoscopic hepatectomy combined with radiofrequency ablation in the Zhejiang Provincial People's Hospital from Apr 2015 to Dec 2017.Results 2 more tumors were found by intraoperative laparoscopic ultrasound.All patients underwent laparoscopic hepatectomy combined with radiofrequency ablation successfully.There were 2 laparoscopic left hepatectomy combined with radiofrequency ablation,2 laparoscopic right hepatectomy combined with radiofrequency ablation,6 laparoscopic left lateral lobectomy combined with radiofrequency ablation,4 laparoscopic right postrior lobectomy combined with radiofrequency ablation and 2 irregular laparoscopic hepatectomy combined with radiofrequency ablation.The intraoperative blood loss ranged from 100-800 ml.The average operative time was (283 ± 112) min.The length of postoperative hospital stay ranged from 5 to 12 days.The tumor-free survival rate after operation is 100％ (16/16) on 6 to 38 months follow up.Conclusion It is safe and feasible to carry out laparoscopic hepatectomy combined with radiofrequency ablation in difficult to manage primary liver cancer.

The HIV?infected people were investigated for their satisfactory situation towards the follow?up management of primary medical and health care institutions in Xinjian County, Yushan County and Guixi City of Jiangxi Province from January to July 2018 and related factors were also analyzed. The total score of the Infected Patients′Follow?up Management Satisfaction Scale higher than 59 was defined as the satisfactory. 75.68% of 259 infected patients were satisfied with the follow?up management. Compared to farmers and other follow?up modes, non?farmers (OR=10.72, 95%CI: 2.07-55.63), and patients receiving follow?up service in responsible institutions ( OR=6.44, 95%CI : 3.12-13.30) were more satisfied with follow?up management.

The HIV?infected people were investigated for their satisfactory situation towards the follow?up management of primary medical and health care institutions in Xinjian County, Yushan County and Guixi City of Jiangxi Province from January to July 2018 and related factors were also analyzed. The total score of the Infected Patients′Follow?up Management Satisfaction Scale higher than 59 was defined as the satisfactory. 75.68% of 259 infected patients were satisfied with the follow?up management. Compared to farmers and other follow?up modes, non?farmers (OR=10.72, 95%CI: 2.07-55.63), and patients receiving follow?up service in responsible institutions ( OR=6.44, 95%CI : 3.12-13.30) were more satisfied with follow?up management.

Objective: To estimate the prevalence of anxiety and depression symptoms during pregnancy among women from six districts of China and to explore the determinants of anxiety and depression during pregnancy. Methods: A cross-sectional study of maternal health status was conducted using the probability proportionate to size sampling method among pregnant women from six counties/districts in six provinces of China (Hebei, Liaoning, Fujian, Hunan, Sichuan and Yunnan). A questionnaire was completed by each of the women included in the study from August to December 2014. Women were recruited from three medical and health institutions with the most obstetrics patients in each district. A total of 4 210 pregnant women were included in the investigation. The hospital anxiety and depression (HAD) scale was applied to measure the symptoms of anxiety and depression in the pregnant women. Trend chi square test was used to assess the differences of anxiety and depression symptom among three trimesters. The multivariate logistic regression model was used to investigate potential contributory factors. Results: The detection rates for anxiety symptoms and depression symptoms during pregnancy were 8.5% (357/4 210) and 12.5% (525/4 210), respectively. The prevalence of anxiety symptoms during the first, second and third trimesters were 7.9% (110/1 392), 8.8% (124/1 413) and 8.8% (123/1 405), respectively (χ^2trend=0.89, P= 0.419). The prevalence of depression symptoms during the first, second and third trimesters were 14.0% (195/1 392), 12.6% (178/1 413) and 10.8% (152/1 405), respectively (χ² _trend=6.52, P=0.011). Multivariate logistic regression analysis showed an increased risk of anxiety and depression in women with an educational background of middle school rather than a college degree (OR=1.94, 95% CI: 1.44-2.63; OR=3.80, 95% CI: 2.45- 5.91). Furthermore, compared with planned pregnancies, women with unplanned pregnancies had a higher risk of anxiety and depression (OR=1.33, 95% CI: 1.06- 1.66; OR=1.35, 95% CI: 1.07- 1.71). Pregnant women who felt they lived in crowded residential conditions were at an increased risk of anxiety compared with those living in spacious residential environments (OR=1.82, 95% CI: 1.15- 2.87). Pregnant women with a household income of less than 10 000 yuan were at a higher risk of depression than living in a household with an income of ≥100 000 yuan (OR=1.91, 95% CI: 1.05-3.49). Similarly, multiparous women (≥2) were at higher risk of depression compared with nulliparous women (OR=1.88, 95% CI: 1.04- 3.41). Conclusion The prevalence of anxiety and depression symptoms during pregnancy appears to be associated with several demographic factors, along with a women's obstetrical history. Lower educational background, unplanned pregnancy, the feeling of living under crowded residential conditions were all found to be risk factors for anxiety during pregnancy. Similarly, lower educational background, unplanned pregnancy, a lower household income (<10 000) and a greater number of previous deliveries were all risk factors for depression during pregnancy.

Objective To collect the demographic,lifestyle and clinical factors of patients with cerebrovascular disease,and analyze the vascular cognitive impairment(VCI) factors and set up high-risk factors model.methods 505 patients with cerebrovascular disease hospitalization in department of geriatrics and neurology in hospital from October 2014 to October 2016 were enrolled.According to the questionaire survey data of demographics,lifestyle and clinical factors,the patients were divided into training set (421 cases) and test set (84 cases),and training set were divided into the non-VCI set (225 cases) and VCI set (196 cases).Analyzed the influence factors of VCI in patients with cerebrovascular disease by decision tree algorithm,and compared it with the Logistic regression analysis and chi-square and established the decision tree model for risk factors of VCI.Result sAccording to the VCI decision tree model,cross validation model recognition accuracy was 73.63%,while test set prediction accuracy was 73.81%.Alcoholism,hobbies,education level,tea drinking,diabetes,hypertension,diet,age,sleep and physical exercise were classification of node variables,while drinking was the root.The probability of VCI had significant difference (P<0.05) in the crowds with different risk factors.According to Result s of Logistic regression analysis,education level,drinking,exercise and diabetes were independent risk factors for VCI,while the model prediction accuracy was 66.98%,and test set prediction accuracy was 53.57%.According to the ROC curve of the decision tree model and the Logistic regression model,the decision tree model AUC was 0.737 (95%CI 0.688 to 0.786),and the Logistic regression model AUC was 0.664 (95%CI 0.612 to 0.717).Conclusion It is suggested that the decision tree model might be superior to logistic regression model in the prediction accuracy for VCI of patients with cerebrovascular disease.The alcoholism,diabetes,high blood pressure,high fat diet and insomnia are risk factors of VCI,while hobbies,high level of education,physical exercise and drinking tea can be the protective factors of the VCI.

Objective Comparison of the levator ani muscles in three-dimensional (3D) MRI-based models in women with and without pelvic organ prolapse at rest to analyze the morphological characteristics of levator ani muscles in women with POP. Methods Twenty-five women with POP and 22 women with normal pelvic support were selected from Nanfang Hospital of Southern Medical University. Axial, sagittal, and coronal T2-weighted pelvic magnetic resonance scans were obtained with the women in the supine position.The 3D models were reconstructed from the source images. Morphological changes was compared within the two groups of levator ani muscles, and the 3D models were measured to determine the levator ani muscle volume (LVOL), levator plate angle (LPA), levator hiatus width (LH-W) and length (LH-L), distance between symphysis and levator sling muscle (LSG). Results There were no puborectalis avulsions in control, in POP, 3 cases of avulsions just in left, 3 cases of avulsions just in right, 7 cases in bilateral. The shape of iliococcygeus were all dome-shaped in control, 11 cases were U-shaped and 14 cases were dome-shaped in POP. The shape of levator hiatus were 7 cases of U-shape, 12 cases of V-shape, 3 cases of irregular in control; 5 cases of U-shape, 4 cases of V-shape, 16 cases of irregular in POP. POP versus control: LH-L: (68.0 ± 8.9) versus (61.6 ± 7.2) mm (P<0.05); LH-W: (41.4 ± 3.9) versus (38.0 ± 3.2) mm (P<0.05); LSG-L: (29.6 ± 7.4) versus (24.6 ± 3.7) mm (P<0.05); LSG-R: (28.4 ± 6.8) versus (23.9 ± 3.2) mm (P<0.05); LPA: (51.0 ± 11.3)° versus (40.6 ± 6.3)° (P<0.05); LVOL: (23.7 ± 5.8) versus (24.6 ± 5.0) cm3 (P>0.05). Conclusions It is possible to assess the morphologic changes of levator ani by using 3D MRI models objectively, our 3D data demonstrate larger in LVOL, LPA, LH-W, LH-L, LSG, and the changes in shape. It is helpful to diagnose and assess the specific situation of patients POP in clinic.