Objective To analyze the current situation of unplanned reoperation in cardiac surgery and to discuss the management measures of unplanned reoperation.Methods The information of patients undergoing cardiac surgery in a class A tertiary comprehensive hospital during 2018-2022 was collected to analyze the incidence of unplanned reoperation,major ca uses,disease types,surgica l moda lities and Complications.Results A tota l of 3902 patients underwent surgery,of whom 73(1.87%)underwent unplanned reoperation.The main cause of unplanned reoperation was bleeding(50%).The disease types with the highest unplanned reoperation composition ratio were coronary heart disease(38.4%),and the disease types with the highest incidence were dilated cardiomyopathy(11.1%).The average hospitalization cost,the average length of hospitalization,mortality rate and medical dispute rate of patients who had unplanned reoperation were significantly higher than those who did not have unplanned reoperation,the difference was statistically significant(P=0.001).Conclusion The hospital should strengthen the perioperative management of cardiac surgery,focus on supervising disease types and surgical modalities with high incidence of unplanned reoperation,and strictly implement the system of operation classification and the system of reporting unplanned reoperation to ensure the quality of patient surgery.

Objective To analyze the characteristics of blood lipid metabolism in patients with Wilson's disease(WD)and understand the influencing factors of abnormal blood lipid.Methods The clinical data of 170 patients with WD and 59 healthy people were collected from June 2021 to March 2023,the blood lipids of the two groups were compared.To compare the characteristics of blood lipid metabolism in WD patients with different gender,age,body mass index(BMI)and disease types.According to whether the blood lipid was abnormal or not,WD patients were divided into normal blood lipid group and abnormal blood lipid group,and the biochemical indexes of the two groups were compared.The general situation and biochemical indicators were included in the single factor regression analysis,and the related factors that might affect blood lipid metabolism were screened out.The related factors of single factor screening were included in multivariate Logistic regression analysis to determine the abnormal factors affecting blood lipid.Results The triglyceride(TG)level of WD patients was lower than that of healthy controls,the difference was statistically significant(P<0.05).The rate of dyslipidemia in WD patients was 40.59%.Low density liporotein cholestrol in female WD patients was significantly lower than that in male WD patients(P<0.05).The values of BMI,alanine aminotransferase(ALT)and uric acid(UA)in dyslipidemia group of WD patients were significantly higher than those in normal group(all P<0.05).Multivariate Logistic regression analysis showed that BMI 24～28(OR=4.526,P<0.05),BMI>28(OR=6.360,P<0.05),UA(OR=1.006,P<0.01)and hyaluronic acid(HA)(OR=1.003,P<0.01)were associated with the high risk of dyslipidemia,with statistical significance.Conclusions WD patients have a high incidence of abnormal lipid metabolism,mainly with low high density liporotein cholestrol and high TG.The dyslipidemia in WD patients is affected by many factors.BMI,UA and HA are independent risk factors for dyslipidemia in WD patients.

Aceruloplasminemia(ACP)is a rare,adult-onset autosomal recessive disorder characterized by ceruloplasmin(CP)deficiency and iron metabolism disorders,with typical clinical manifestations of the triad of"neurological symptoms,diabetes,and retinopathy".Cranial MRI shows widely symmetrical T2-weighted imaging(T2WI)hypointensity in the basal ganglia,thalamus,dentate nucleus,and cortex.The diagnosis of ACP depends on genetic testing.Iron chelators were the main treatment,and some patients had unsatisfactory improvement in neurological symptoms.Clinicians should improve the recognition of ACP.Early diagnosis and treatment are helpful for the recovery of the disease.

Objective:To evaluate the impact of colonoscopy on the incidence of colorectal cancer (CRC).Methods:This study was based on the Screening Project of Early Diagnosis and Treatment of CRC in Jiashan county, Zhejiang province. After excluding participants with incomplete information, these with individual history of CRC, those with CRC, enteritis or ulcer, noticed through colonoscopy exam at baseline, a total of 25 894 participants were finally included. Cox proportional hazards regression model was used to analyze the association between colonoscopy and the incidence of CRC.Results:This study was followed up for 160 113 person-years with a median of 5.67 years. During the follow-up period, 127 of them developed the CRC. The incidence rates of CRC in participants, were 202.35 per 100 000 person-years, 40.93 per 100 000 person-years and 63.62 per 100 000 person-years, respectively among the following three groups: who did not take the colonoscopy, without colorectal lesions or with benign colorectal lesions noticed by the colonoscopy and the differences were statistically significant ( P<0.05). After adjusting for potential confounding factors, the HRs(95 %CI) of CRC were 0.24 (0.16-0.36) and 0.29 (0.17-0.49), among those who did not have or had colorectal lesions in the participants who underwent the colonoscopy. Stratified by anatomic site, age and sex, results showed that the associations among the aforementioned groups were relatively stable. Conclusion:Colonoscopy could effectively contribute to the reduction of CRC incidence in the high-risk population.

Objective: To explore the correlation between obesity and the risk of colorectal adenoma, so as to provide theoretic evidence for the intervention of the high-risk population for colorectal cancer. Methods: Based on the Screen Project of Early Diagnosis and Treatment of Colorectal Cancer in Jiashan County, from August 2012 to March 2018, the results of colonoscopy and body measurement information of the high-risk population for colorectal cancer were collected. According to the results of colonoscopy, 3 895 patients with colorectal adenoma and 11 232 healthy controls were enrolled. Multivariate logistic regression was used to analyze the correlation between overweight (body mass index (BMI) 24.0 to 27.9 kg/m²), obesity (BMI≥28.0 kg/m²) and the risk of colorectal adenoma. Results: After adjusting for gender and age, compared with that of individuals with normal weight (BMI 18.5 to 23.9 kg/m²), the risk of colorectal adenoma of obese patients increased by 36% (odds ratio (OR)=1.36, 95% confidence interval (CI) 1.18 to 1.56). After stratifing by gender, compared with that of individuals with normal weight, the risk of colorectal adenoma of obese males increased by 30% (OR=1.30, 95%CI 1.07 to 1.59), the risk of colorectal adenoma of overweight females and obese females increased by 15% (OR=1.15, 95%CI 1.01 to 1.31) and 40% (OR=1.40, 95%CI 1.14 to 1.71), respectively. After stratifing by age, compared with that of individuals with normal weight, the risk of colorectal adenoma of obese patients aged between 40 and 59 years increased by 31% (OR=1.31, 95%CI 1.07 to 1.61), and the risk of colorectal adenoma of overweight and obese patients aged between 60 and 74 years increased by 13% (OR=1.13, 95%CI 1.01 to 1.27) and 39% (OR=1.39, 95%CI 1.15 to 1.70), respectively. The results of subgroup analysis according to pathological types indicated that the risk of non-advanced adenoma and advanced adenoma of obese patients increased by 35% (OR=1.35, 95%CI 1.16 to 1.57) and 39% (OR=1.39, 95%CI 1.06 to 1.83), respectively. Conclusions Obesity is correlated with colorectal adenoma, which is more significant in women, individuals aged between 60 and 74 years and advanced adenoma. The intervention of high-risk population for colorectal cancer should include body mass control.

OBJECTIVE: To investigate the pre-pregnancy body mass index(BMI), gestational weight gain(GWG)and gestational outcomes in women with high normotension during pregnancy. METHODS: The clinical data of 1500 pregnant women who recieved antenatal care and delivered in Songjiang District Maternal and Child Hospital, Shanghai from 2015 to 2017 were retrospectively analyzed. The women were divided into high normotension group, normotension group and hypertensive disorder of pregnancy (HDP) group with 500 cases in each group. The general information, pre-pregnancy body mass index, gestational weight gain and gestational outcomes were analyzed. RESULTS: There were significant differences in pre-pregnancy BMI and GWG between the high normotension group and the normotension group (all <0.017), and there was significant difference in pre-pregnancy BMI between the high normotension group and HDP group (<0.017). In terms of adverse pregnancy outcomes, the incidence of oligohydramnios, placental abruption, postpartum hemorrhage, fetal distress and small for gestational age infant were higher in the high normotension group than those in the normotension group, but the differences were not of statistical significance (all >0.017); the incidence of oligohydramnios, placental abruption, cesarean section, postpartum hemorrhage, premature delivery and small for gestational age infant in HDP group were higher than those in high normotension group (all <0.01). In high normotension women with adverse gestational outcomes, the proportion of low GWG or too much GWG was higher and the proportion of normal GWG was lower than those in high normotension women without adverse gestational outcomes (all <0.01). CONCLUSIONS Pre-pregnancy BMI and GWG are correlated with pregnancy blood pressure and gestational outcomes. Reasonable intervention to gestational weight gain of pregnant women with high normotension is of significance to improve the gestational outcomes.
Blood Pressure ; Body Weight ; Cesarean Section ; Child ; China ; Female ; Humans ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

Objective To explore the relationship between quality of life and acceptance of disability of colostomy patients.Methods Using convenience sampling method to investigate 111 colostomy patients.General information questionnaire,QLQ-C30 scale,QLQ-CR38 scale and Acceptance of Disability Scale were used to investigate patients' general condition,quality of life and acceptance of disability.Data was analyzed by SPSS 17.0.Results The general health condition of colostomy patients was better than reference value and the score of ADS was at an average level.There was a relationship between general health condition,functioning dimensions,symptom dimensions and acceptance of disability.Conclusions There was a close relationship between quality of life and acceptance of disability.The acceptance of disability should be improved to help patients to obtain better quality of life.

Objective To investigate the immunization effect of influenza A/H1N1 vaccine in health care workers (HCW) in Inner Mongolia Greater Khingan Mountains area. Methods Five hundred and five HCW who received A/H1N1 influenza vaccination (immunized group) and 129 staffs who didn't receive the vaccination (unimmunized group) were randomly sampled for semiquantitative testing of serum H1N1 antibody (IgG) levels by enzyme-linked immunosorbent assay (ELISA).Results were analyzed and stratified by age, sex, occupation and the time interval between the time of vaccination and serum sample collection. The antibody positive rates of the two groups were compared by x2test. Results There were 401 (79. 4%) HCW whose H1N1 antibody were positive and 50 (9.9%) whose antibody were weak positive among 505 immunized HCW. While among 129 unimmunized HCW, there were 59 (45.7%) whose antibody were positive and 15 (11.6%) whose antibody were weak positive. The seroconversion rates of specific antibody were not significantly different among the different age groups after receiving A/H1N1 influenza vaccine (P＞ 0.05).However, there were statistical differences of the seroconversion rates among different sex groups (men 95.7% vs women 87.4% in immunized group, x2=6.40, P＜0.05; and men 73.3% vs women 52.5% in unimmunized group, x2 =4.07, P＜0.05) and different occupation groups (doctor 86.0% vs nurse 94.5% in immunized group, x2 = 9. 16, P＜0.01; and doctor 43. 8% vs nurse 75.0% in unimmunized group, x2=12.61, P＜0.01 ). The seroconversion rate was 81.5% after 80 to 89 days of vaccination, which was significantly lower than those after 30 to 39, 50 to 59 days and 60 to 69 days of vaccination, which was 100.0%, 94.7% and 93.6%, respectively (x2 =3.96, P ＜0.05; x2=7.15, P ＜0. 01; x2 = 9. 98, P＜0. 01). Conclusions A/H1N1 influenza vaccination can induce effective immune response in HCW in Greater Khingan Mountains area of Inner Mongolia. However,the level of specific antibody significantly reduces after 80 to 89 days of vaccination.

Teaching method is important to carry through the content of the course and guarantee the teaching quality.We have proceeded some reforms and research in the Obstetrics and Gynecology teaching and have obtained the good result by intergroting teaching conteut and teaching resoures,selecting high-level teaching team,case teaching,PBL teaching and multi-media teaching.