BACKGROUND: Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients. METHODS: Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes. RESULTS: Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality. CONCLUSION: Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients. CLINICAL TRIAL REGISTRATION Chinese Clinical Trail Registry, No. ChiCTR2100044625.
Humans ; Blood Pressure ; Pulmonary Disease, Chronic Obstructive/therapy* ; Cohort Studies ; Respiration, Artificial ; Inpatients ; Hospital Mortality

Objective:To evaluate the feasibility and clinical efficacy of deformed complex vertebral osteotomy (DCVO) technique on the treatment of angular kyphosis of cured spinal tuberculosis.Methods:A retrospective study was performed on patients with angular kyphosis of cured spinal tuberculosis who underwent the DCVO technique or posterior vertebral column resection (PVCR) technique from Jan, 2007 to Jan, 2019. 33 patients were included, 18 males and 15 females, the average age was 39.5±15.0 years old (ranged 9-78 years old). The vertebral deformity in thoracic vertebrae 14 cases, thoracolumbar vertebrae 16 cases, and lumbar vertebrae 3 cases. 20 cases underwent the DCVO technique, while 13 cases underwent PVCR technique. For DCVO group, the multiple malformed vertebrae were considered a malformed complex, and a larger range and angle wedge osteotomy was performed within the complex using the DCVO technique. PVCR technique would resect the whole deformed vertebrae, and subsequently brought the two separated spinal columns together with instruments and titanium mesh. The intro-operative blood loss, operating time and complications were recorded. The radiological measurements included preoperative and postoperative spinopelvic parameters, which including thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and segmental kyphosis. The recovery of neurological function was evaluated by Frankle classification.Results:All patients were followed up for 7-72 months. Comparing with the cases underwent PVCR technique, the DCVO group has a significantly lower blood loss (1315.00±462.57 ml), operating time (293.00±83.86 min) and complications rate (1.5%). At the time of preoperation, postoperation and last follow-up, the deformity angle of DCVO group was 96.80°±6.32°, 29.10°±6.96°and 29.05°±6.49°, which gained an average 69.9% correction rate. The statistical analysis suggested that deformity angle was enormously corrected. And there was an insignificant difference between DCVO group and PVCR group. Meanwhile, the preoperative, postoperative and follow-up TK of DCVO group was 96.96°±29.13°, 37.15°±4.88° and 37.00°±3.89°respectively, whosecorrection rate was 67.1%; LL was 66.70°±21.21°, 42.25°±5.53° and 41.90°±4.98°, which have a significant difference between pre-operation and post-operation/follow-up ( F=23.997, P<0.001) ; SVA was 75.95±18.63 mm, 16.30±6.88 mm and 16.55±7.30 mm. PI was 47.50°±6.12°, 47.35°±5.54°and 47.90°±5.93°, PT was 37.25°±9.63°, 18.50°±1.99° and 19.00°±1.65°; SS was 10.25°±8.27°, 29.15°±5.91° and 28.85°±5.77°. The sagittal and spinopelvic parameters of two groups improved significantly at postoperation and follow-up. No obviously difference of spinal parameters was found between two groups at preoperation and postoperation. Both groups have cases with dysneuria. And all of these cases achieved different degrees of recovery at follow-up. Conclusion:The use of DCVO technique for the treatment of post-tubercular angular kyphosis is safe and efficiency. DCVO leads a better clinical outcomes and lower complication rate than VCR technique.

Objective:To research the clinical effect of early comprehensive intervention for physical and intelligence development of premature infant (test-tube baby).Methods:One hundred and eleven premature infant in Dalian Municipal Women and Children′s Medical Center from June 2016 to June 2018 were enrolled. Study group (57 cases) received comprehensive intervention including health education, exercise training, nutrition guidance and rehabilitation therapy, and control group (54 cases) received health education. The weight, height, head circumference and CDCC score of two groups were analyzed in 3, 6 and 12 month.Results:Physical development: the weight [3 month: (4.72 ± 0.19) kg vs. (4.34 ± 0.29) kg; 6 month: (6.49 ± 0.37) kg vs. (6.25 ± 0.41) kg; 12 month: (9.58 ± 1.15) kg vs. (8.76 ± 0.92) kg] and height [3 month: (59.63 ± 5.51) cm vs. (56.29 ± 5.86) cm; 6 month: (65.09 ± 5.94) cm vs. (62.36 ± 6.20) cm] in 3, 6 and 12 month, and head circumference in 3 and 6 month [3 month: (37.71 ± 1.77) cm vs. (35.90 ± 1.48) cm; 6 month: (43.18 ± 1.96) cm vs. (41.82 ± 2.61) cm] of study group were higher than those in control group, and all difference had statistical significant ( P<0.05). Intelligence development: the MDI [3 month: (84.49 ± 9.78) scores vs. (80.58 ± 10.40) scores; 6 month: (89.65 ± 13.21) scores vs. (83.24 ± 17.66) scores; 12 month: (96.03 ± 15.43) scores vs. (89.71 ± 17.85) scores] and PDI score of study group was higher than that in control group in 3, 6 and 12 month [3 month: (82.68 ± 5.35) scores vs. (79.43 ± 7.21) scores; 6 month: (86.34 ± 8.33) scores vs. (82.51 ± 9.67) scores; 12 month: (94.86 ± 10.27) scores vs. (90.32 ± 11.65) scores] ( P<0.05). Conclusions:Early comprehensive intervention has a good clinical efficacy for physical and intelligence development of premature infant (test-tube baby) and is worthy of popularizing and applying.

Objective To explore the changes and significance of Klotho protein levels in different stages of chronic kidney disease (CKD). Methods From March 2015 to December 2017,176 patients with CKD admitted to nephrology department of Inner Mongolia People＇s Hospital were selected as the study object (CKD group), and 80 healthy patients in our hospital were selected as the control group in the same period. The serum Klotho levels of CKD patients and control group at different stages were detected by double antibody sandwich ELISA, and the differences between each group were compared. Results The serum Klotho level of CKD group (( 4. 84 ± 1. 87) μg／L) was significantly lower than that of the control group ((9. 11± 3. 14) μg／L) ( t＝ 13. 82, P＜0. 01) . One-way anova showed that estimated renal glomerular filtration rate (eGFR),serum albumin (ALB),hemoglobin ( Hb),blood calcium ( Ca) and serum Klotho were gradually decreased,while phosphorus (P) and creatinine (Cr) in serum were gradually increased,and the difference was statistically significant among the five stages( all P＜0. 01). Spearman correlation analysis showed that Klotho level was positively correlated with eGFR and Ca,and negatively correlated with CKD stage,Cr and P (r＝0. 369,0. 160,－0. 200,－0. 250,－0. 230,all P＜0. 05). The multiple linear regression equation showed that Klotho level was positively and independently correlated with eGFR ( t＝ 3. 89, P＜0. 001),and negatively correlated with CKD staging independently (t＝－4. 12,P＜0. 001). Conclusion The expression level of serum Klotho protein in patients with CKD is lower than that of healthy people,and it decreases with the increase of CKD stages,which is closely related to the deterioration of renal function. It can be used as a reference index to evaluate the incidence and severity of CKD.

Objective:To determine the effect of standardized patients in medical international students' graduation practice assessment.Methods:The students were divided into two groups ofstandardized patient assessment and traditional assessment,the theoretical and professional performance was compared and analyzed after the assessments.All the students were investigated using questionnaire.Result:The students assessed using standardized patients reported higher skill scores than those with traditional assessments,and the difference was statistically significant.However,no difference was observed in theoretical scores.Gorcltusion:The introduction of standardized patient to medical international students' graduation practice assessment alleviates the status that emphasizes theory but ignores practice due to the lack of clinical resources,eliminates the obstacles in the communication between students and patients,and is conducive to the cultivation of humanistic quality and adaptability of the students.It is worthy popularizing in international students' graduation practice assessment.

Objective: To discuss the conversion coefficient of morphine injection with continuous intravenous pump delivery or subcutaneous injection for the patients with advanced cancer pain demanding high dose of opioids.Methods: Using a retrospective survey, the patients with advanced cancer pain demanding high dose of opioids with poor efficacy were divided into 3∶1 group and 2.5∶1 group, and the conversion coefficient of 3∶1 or 2.5∶1 was used for the opioids equivalently conversed to intravenous or subcutaneous injection of morphine.After the conversion, the degree of pain relief, the analgesic efficiency in the conversion process, titration time, daily oral morphine equivalent amount at stable pain, morphine related adverse reactions and the other indicators were studied to evaluate the analgesic effect of morphine injection with different conversion coefficient.Results: There was no statistical significant difference between the two groups in the degree of pain relief, the effective rate of analgesia and the daily oral akministration amount of morphine at sable pain(P>0.05).The adjustment times for morphine in the two groups was (1.57±0.93) and (1.0±0.00), respectively, and the difference was statistically significant (P<0.05).The daily oral administration amount of morphine at stable pain in the two groups respectively was (226.67±69.74) mg and (258.67±101.34) mg;the morphine related adverse reactions were mainly constipation, and there was no significant difference in the incidence (P>0.05).Conclusion: Giving morphine injection to the patients with terminal cancer pain demanding high dose of opioids with poor effect, the use of PCA pump through intravenous or subcutaneous injection can effectively relieve pain.Using the conversion coefficient of 2.5:1 can quickly complete the titration process, and safely achieve the effective analgesia.

Objective To evaluate the clinical efficacy and feasibility of using the expanding pedicle subtraction osteotomy (E-PSO) technique for the treatment of congenital severe thoracic angular kyphotic deformity.Methods We retrospectively reviewed a cohort of 13patients with congenital severe kyphosis admitted to our hospital from January 2010 to June 2015 including 5 males and 8 females,the average age is (34.9±20.5) years old (ranged 15-55 years old).The vertebral deformity in T7～83 cases,T8～93 cases,T9～102 cases,T10～114 cases,T9～111 case.All cases were treated by E-PSO technique.The multi-malformed vertebrae are considered as a complexus.And the osteotomy was performed within the complexus.The superior and inferior endplate of the complexus were reserved.After the osteotomy was completed,alternately pressed tightly closed the upper and lower parts.Results All cases were followed up for 10-42 months,with an average of 32 months.At the time of preoperation,postoperation andthe last follow-up,the deformity angle was 107.0°±3.5°,23.5°± 1.5° and 23.5°±0.2°;TK was 98.1°±7.6°,28.9°±3.0° and 29.5°±0.1 °,LL was 94.1 °± 1.5°,43.7°± 1.3° and 44.1 °±5.3°;SVA was (-0.6±39) mm,(1.6±7.9) mm and (6±0.7) mm,respectively;PI was 28.9°±1.6°,31.7±12.3°and 31.9°±2.1°;PT was 17.7°±1.9°,13.4°±3.4°and 13.1°±4.2°,SS was 11.3°±0.4°,18.2°±1.1° and 18.7°±2.1°,respectively.The sagittal parameters and spinopelvic parameters except SVA were significantly improved in the post-operation and the last follow-up compared with the pre-operation according to the image data.No significant loss of correction occurred during the follow-up,and there was no statistical difference.The preoperative VAS score was (5.7± 1.4) points,ODI score was (19.8±12.7) points.The last follow-up VAS score was (1.9±0.7) points,the ODI score was (9.2±0.7) points.No case of nerve damage,infection and other complications,and no dissection,displacement and rupture of internal fixation were found during the follow-up.Conclusion The use of E-PSO technique for the treatment of congenital severe thoracic kyphotic kyphosis is feasible and can achieve better curative effect.

A survey was conducted on a sample of 67 general practitioners ( GPs ) receiving in-service training in Beijing in 2012.Hypertension knowledge mastering and training status were investigated through a self-administered questionnaire .Results showed that the accuracy rates of the 4 domainitems (basic knowledge and skill, lifestyle modification, drug therapy, health management ) were 42.3%(340/804), 48.0%(225/469), 27.8%(96/335) and 70.6%(473/670), respectively with an overall accuracy rate of 49.8%(1 134/2 278).Trainees from urban scored higher than those from rural areas (P<0.01).About one third of trainees indicated that the 3 main teaching sessions they took part in did not cover the content of hypertension management .The hypertension guideline ( primary care version 2009) was most frequently used for training GPs , but only 33.9%(21/62) accessed such training .The results indicate that hypertension knowledge level seems to be generally low among GPs on in-service training in Beijing and the current training situation need to be further improved , particularly for those from rural areas .

Objective To investigate the position competency of residents in the first year and to search for the standardizing training which aims at advancing position competencies. Method Twenty residents of the first year and 40 of superior doctors were taken as research targets. Question-naires including 8 aspects (basic ability, occupational spirit, communication skills, medical knowl-edge, team work, public health, information and management, and academic research) were con-ducted and were scored namelessly. The scores of items in one kind of ability were summed up to serve as the total score of this ability. The mean score of one kind of ability and the mean score of 8 kinds of abilities of residents and superior doctors was calculated. SPSS 17.0 was adopted to make statistical analysis. t-test was adopted to test the difference between the score from residents and superior doctors with P<0.05 representing statistics significance. Results The scores of 8 kinds of abilities were much lower than full scores. The scores of basic ability, occupational spirit, and team work from residents (78.5, 87.4, 41.9) were higher than those from superior doctors (72.6, 80.5, 39.5), with statistical significances (P=0.020, 0.013, 0.045). Conclusions Residents are lack of position competency and awareness, which demonstrates the gap between the training model and the demand of work. It is sug-gested that we should design the training system and evaluation methods based on doctors' compe-tences, add training for comprehensive ability and evaluate abilities of all aspects. An excellent hu-manity education should be built and quality cultivation should be taken attention to. Objective and measurable indices should be developed to increase residents' knowledge.

The current status and training requirements for general practitioner (GP) were surveyed with questionnaires in 84 trainees from the first Beijing GP retraining program.Results showed that three most demanded skills of health service in community were electrocardiogram (98.8％),clinical lab results reading (96.4％),dressing change (90.5％).The services not provided but should be provided in community were aerosol rebreathing method (23.8％),resection of small superficial lumps (22.6％) and reading X-ray films (20.2％).The reasons for services not provided were insufficient resources (41.7％),lack of skilled personnel (35.7％) and staffing shortage (20.2％).The most required training skills were reading X-ray films (64.3％),electrocardiogram (54.8％) and laboratory results reading (51.2％).There were some skills inadequately trained including cricothyroid membrane puncture,suprapubic bladder puncture and resection of superficial small lumps.The results indicate that the required skills in community health service and individual demands of general practitioners should be the priority of the future training programs.