Objective:The principal components (PC) of venous-to-arterial carbon dioxide content diference [C(v-a)CO 2] were extraceted in septic shock patients, in orter to compare the contribution of the principal components to C(v-a)CO 2. Methods:Septic shock patients monitored by Swan Ganz floating catheter in the Medical Intensive Care Unit of Peking Union Medical College Hospital were included in the retrospective study. All pairs of arterial and mixed-venous blood gases within 1 h before and after a flood challenge were included in the analyses. The principal component method was used to extract the components of C(v-a)CO 2. Spearman correlation analysis was used to evaluate the correlation between the components and C(v-a)CO 2, and the correlation between the components and cardiac output. The differences of the components beween the 28-day survival group and 28-day death group were analyzed by univariate analysis. Results:A total of 504 pairs of blood gases in 104 septic shock patients were included in the analyses. The median age of patients was 62 years ( IQR, 48 to 71), and 59.6% (62/104) were men. Four principal components were extracted and the components account for 77.7% of variance. PC1 included PaO 2, PvO 2, SaO 2 and SvO 2. PC2 included pHa and pHv. PC3 included Hb and Hct. PC4 included PaCO 2 and PvCO 2. There was a significant difference in PC4 between the two group. PC4 could weakly predict the 28-day death (AUROC 0.634, 95% CI 0.527-0.741, P=0.015). Conclusions:In patients with infectious shock, arteriovenous [C(v-a)CO 2] consists of principal components of four dimensions: oxygenation, pH, Hb, and CO 2 partial pressure difference.Arterial CO 2 partial pressure difference [P(v-a)CO2] weakly predicts 28-d morbidity and mortality.

OBJECTIVES: The International Federation of Gynecology and Obstetrics (FIGO) 2000 scoring system classifies gestational trophoblastic neoplasia (GTN) patients into low- and high-risk groups, so that single- or multi-agent chemotherapy can be administered accordingly. However, a number of FIGO-defined low-risk patients still exhibit resistance to single-agent regimens, and the risk factors currently adopted in the FIGO scoring system possess inequable values for predicting single-agent chemoresistance. The purpose of this study is therefore to evaluate the efficacy of risk factors in predicting single-agent chemoresistance and explore the feasibility of simplifying the FIGO 2000 scoring system for GTN. METHODS: The clinical data of 578 GTN patients who received chemotherapy between January 2000 and December 2018 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were carried out to identify risk factors associated with single-agent chemoresistance in low-risk GTN patients. Then, simplified models were built and compared with the original FIGO 2000 scoring system. RESULTS: Among the eight FIGO risk factors, the univariate and multivariate analyses identified that pretreatment serum human chorionic gonadotropin (hCG) level and interval from antecedent pregnancy were consistently independent predictors for both first-line and subsequent single-agent chemoresistance. The simplified model with two independent factors showed a better performance in predicting single-agent chemoresistance than the model with the other four non-independent factors. However, the addition of other co-factors did improve the efficiency. Overall, simplified models can achieve favorable performance, but the original FIGO 2000 prognostic system still features the highest discrimination. CONCLUSIONS Pretreatment serum hCG level and interval from antecedent pregnancy were independent predictors for both first-line and subsequent single-agent chemoresistance, and they had greater weight than other non-independent factors in predicting single-agent chemoresistance. The simplified model composed of certain selected factors is a promising alternative to the original FIGO 2000 prognostic system, and it shows comparable performance.
Female ; Gestational Trophoblastic Disease/drug therapy* ; Humans ; Multivariate Analysis ; Pregnancy ; Retrospective Studies ; Risk Factors

Objective:To analyze the career development path and related problems of general practitioners (GPs)in the community.Methods:In October 2019, general practitioners with different positions working in Malu Town Community Health Service Center of Shanghai Jiading district were selected by typical sampling to participate in a focus group interview. Based on the saturation principle, 5 general practitioners were invited for in-depth interviews on their career development and related issues. The original data were analyzed with Colaizzi′s seven-step analysis method.Results:The career development of the general practitioners working in the community was divided into three stages: start stage, experience-accumulation stage and career-differentiation stage. In the start stage (the first 0-24 months), the GPs mainly got familiar with the community health service center through community rotation. In the experience-accumulation stage (1-5 years after entering the community health service center), GPs accumulated clinical experience from outpatient clinic, ward, and being family doctor, etc; at the same time, they accumulated management experience through part-time public health management, research and education management, secondment in district health committee. In the professional differentiation stage (5 years or more after entering the community health service center), GPs may take a position of full-time management, or department head. The three respondents had confusion in certain career development stages, including confusion in clinical skills upgrading and balance between clinical and management duties.Conclusions:The study suggests that general practitioners in the entry stage need to be given timely clinical rotation as well as research and teaching training; in the career differentiation stage, it is necessary to incorporate upgrading clinical service and management capability with policy development directions and institutional development needs to promote the successful career differentiation of general practitioners.

Objective:To report pediatric endoscopic retrograde cholangiopancreatography (ERCP) intubation techniques and to analyze the influencing factors of pediatric ERCP in China.Methods:Retrospective analysis was performed on 90 cases of pediatric and adult ERCP operations respectively at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to June 2020. The anatomic data, intubation time, and endoscopic intubation measures were reviewed. The anatomic differences in duodenal papilla between the children and adults were analyzed to find the factors affecting ERCP intubation time in children.Results:There were 88 cases of successful infantile intubation with the success rate of 97.8%, and 90 cases of successful adult intubation with the success rate of 100.0%. The intubation time in the pediatric group was 187±67 s, and that in the adult group was 247±86 s with significant difference ( t=5.220, P<0.001). The duodenal diameter of pediatric patients was 3.38±1.57 cm, and that of adult patients was 5.94±1.87 cm with significant difference ( t=9.832, P<0.001). The horizontal distance from the duodenal bulb to the papilla in pediatric patients was 2.44±1.15 cm, which was significantly shorter than 4.22±1.43 cm in adult patients ( t=9.077, P<0.001). Most duodenal papillae in children were hemispherical [flat 26.1% (23/88), hemispherical 51.1% (45/88), cylindrical 22.7% (20/88)], while most of those in the adult patients were cylindrical [flat 9.1% (8/88), hemispherical 23.9% (21/88), cylindrical 67.0% (59/88)]. The factors influencing the intubation time of ERCP in children by univariate analysis included the shape of duodenal papilla, duodenal papilla hardness, visual region, distance from junction of duodenal bulb and descending part to duodenal papilla, distance from duodenal papilla to endoscope, and degree of incising. Conclusion:Shorter and stiffer duodenal papillae in children with normal papilla orientation are associated with shorter intubation time. These indicators are favorable factors for intubation.

This study is to evaluate the application of the comprehensive capacity assessment system based on post competence in competitive recruitment of family doctors. Thirty five general practitioners participating in the family doctor post competition in 2019—2020 were graded and ranked by both the post competition method and the comprehensive capacity assessment system of family doctors. The top 32 candidates in terms of total scores were selected as the successful candidates for the family doctor job competition. Kappa test was used to assess the consistency of competition results between the two methods. Among 32 candidates who were qualified according to the 2019—2020 family doctors post competition method, 31 (96.9%) were also qualified for the family doctor′s comprehensive capacity assessment system ( Kappa=0.635, P<0.01). The results indicate that the comprehensive capacity assessment system for family doctors based on post competency is rational and objective, and can be used for competitive recruitment of family doctors in community health service center.

Objective:To develop a comprehensive ability evaluation system for general practice management post in community health service institutions.Methods:Based on the previous studies and literature search on competency of general practitioners in various clinical posts, the first draft of the comprehensive ability indicator system for general management posts was designed. From November 2019 to January 2020, the comprehensive ability indicator system, classification and scoring method and evaluation method for general management posts were determined through three rounds of Delphi consultation.Results:Seventeen experts with administrative management experiences were invited for consultation, including 3 directors in charge and 14 general practice managers. The response rate of valid questionnaires in the three rounds of consultation were all 17/17, the authority of experts were all>0.7, and the coordination coefficients of expert opinions were 0.142, 0.212, and 0.532 (all P<0.01). The 11 evaluation indexes of the comprehensive ability of community general management posts were: achievement orientation, initiative, interpersonal understanding, service consciousness, influence, organization, training others, teamwork, team leadership, professional skills and confidence. Methods suitable for evaluation the ability of psychological test indicators were achievement orientation, interpersonal understanding, service consciousness and self-confident;appropriate indicators for no-leader group discussion were initiation, influence, team work, team leadership;appropriate indicators for in-tray test ability were organized cognition, professional skills;and the appropriate indicator for the ability of the structured interview was training others. Conclusions:The comprehensive ability evaluation system for community general management posts established in this study is scientific and practical, which may provide objective standard basis for the ability evaluation of community health management talents.

Objective:To explore the relationship between semi-quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and long-term prognosis of locally advanced nasopharyngeal carcinoma, and to find prognostic indicators from non-invasive images of locally advanced nasopharyngeal carcinoma.Methods:Data were collected from January 2011 to January 2012 via a prospective clinical trial with locally advanced nasopharyngeal carcinoma. Clinical information was from 71 patients who completed the treatment plan with long-term follow-ups and UICC 2010 stage Ⅲ, Ⅳ A, Ⅳ B. The patients received three cycles of Taxotere-Platinol-Fluorouracil (TPF) regimen chrono-chemotherapy, followed by two cycles of concurrent paclitaxel chemotherapy with intensity-modulated radiotherapy (IMRT). DCE-MRI examination was performed before induction chemotherapy to obtain DCE-MRI related semi-quantitative parameters. Correlation analysis was conducted between DCE-MRI related semi-quantitative parameters and short-term efficacy of nasopharyngeal lesions after concurrent radiotherapy and chemotherapy. Results:Of all 77 patients, 71 completed treatment and were followed up from 9 to 86 months, with a median follow-up of 77 months, with 80.2% and 67.6% in 3- and 5-year OS, 73.2% and 60.5% in 3- and 5-year PFS, respectively. Evaluation of short-term efficacy of nasopharyngeal lesions after concurrent chemoradiotherapy: the difference in tissue arrival time of contrast agent between complete response (CR) group and partial response (PR) group was statistically significant ( t=0.537, P<0.05). Univariate survival analysis found that OS ( χ2=3.982, P<0.05) and PFS ( χ2=4.019, P<0.05) in the group with short contrast arrival time were significantly higher than those in the group with long contrast arrival time. OS ( χ2=7.593, P<0.05) and PFS ( χ2=5.624, P<0.05) of patients aged over 45 years were significantly lower than those aged less than 45 years. Cox multivariate regression model showed that advanced clinical stage (stage Ⅳ A, Ⅳ B) ( P=0.048) and age≥45 years ( P=0.031) were independent prognostic factors of OS in patients with nasopharyngeal carcinoma. Long arrival time of contrast agent ( P=0.018), age≥45 years ( P=0.004), advanced N(2-3) stage ( P=0.032) and enhancement peak<3 000 ( P=0.005) were independent prognostic factors of PFS in patients with nasopharyngeal carcinoma. Conclusions:The arrival time of the contrast agent in DCE-MRI may be a reliable prognostic factor for locally advanced nasopharyngeal carcinoma.

Objective: To evaluate the efficacy and safety of high-dose fluconazole alone or combined with flucytosine as initial therapy for cryptococcal meningitis (CM) in non-human immunodeficiency virus (HIV)-related patients. Methods: Twenty-five non-HIV-infected patients with CM from June 2015 to September 2018 in Huashan Hospital, Fudan University, who were initially treated with high-dose fluconazole with or without flucytosine for at least seven days were retrospectively reviewed.Clinical features and antifungal (600-800 mg/d) regimens were recorded, clinical responses and drug-related adverse events were evaluated. Mann-Whitney test and Fisher′s exact probabilities test were applied to compare variables between groups. Results: Of the 25 patients enrolled in this study, 15 had predisposing factors. Headache (25 cases), fever (21 cases), vomiting (13 cases) and neck stiffness (13 cases) were common manifestations. Abnormalities of cranial computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were found in 22 cases.Nineteen patients were treated with high-dose fluconazole plus flucytosine for initial therapy, and six patients were treated with high-dose fluconazole alone. The course of initial regimens with high-dose fluconazole was 42 (29, 120) days. At the end of initial therapy, partial response in 20 patients, stable response in three patients and death in two patients were observed, and the overall effective rate was 80%(20/25). In treatment failure group of initial treatment, the proportion of patients with baseline cerebrospinal fluid opening pressure over 300 mmH₂O (1 mmH₂O=0.009 8 kPa) and with altered mental status were both significantly higher compared with those in treatment success group. Fluconazole related adverse drug events were observed including elevated transaminases (one case), gastrointestinal symptoms combined with hypokalemia (two cases), and systemic rash (three cases). Except for three patients with rash reduced the dosage of fluconazole, no other patients were given dosage adjustment. Conclusion High-dose fluconazole alone or combined with flucytosine is effective and safe for the initial therapy of non-HIV-related CM patients.

Objective? To expLore the effects of Home FaLL Hazards Assessment (HFHA) on the incidence rate of home faLLs and recovery of hip function in patients receiving totaL hip arthropLasty (THA). Methods? TotaLLy 423 patients who received uniLateraL THA for the first time in the Department of Orthopedics, Nanjing Drum Tower HospitaL admitted from JuLy 2015 to JuLy 2017 were seLected by convenient sampLing and divided into the controL group (n=203) and the treatment group (n=220). Patients in the controL group received conventionaL postoperative nursing care and discharge guidance, whiLe the home faLL hazards of patients in the treatment group were evaLuated by HFHA in addition to conventionaL postoperative nursing care and discharge guidance. Nursing care was provided to them based on the assessment resuLts. The joint function score at discharge and 3 months after discharge, the incidence rate of faLLs over the past one year and the severity of injury caused by faLLs were compared between the two groups. ResuLts? There was no statisticaL difference in Harris index and BartheL index scores between the two groups at discharge (P＞ 0.05). Harris index and BartheL index scores 3 months after discharge were statisticaL differences in both groups (P＜0.05). 55 faLLs occurred over the past one year in the controL group, 7 of them with moderate or above injuries, whiLe 35 faLLs occurred over the past one year in the treatment group, 1 of them with moderate or above injuries. There were statisticaL differences in the incidence rate of faLLs and injury degrees between the two groups (P＜0.05). ConcLusions? HFHA, when used to assess the home faLL hazards, enabLes THA patients to know and note the high-risk hazards contributing to faLLs in their environment of rehabiLitation and effectiveLy reduces the patients home faLLs by improving the home environment.

Objective To compare the parameters of bilateral tubal ligation by LESS and multi-incision laparoscopy and their prognosis of IVF-ET. Methods From Jun. 2016 to Dec. 2017,32 patients underwent LESS bilateral tubal ligation and 60 patients under-went multi-incision laparoscopic bilateral tubal ligation were enrolled. The demographic data ,operative parameters ,and postoperative prognosis of IVF- ET in the two groups were summarized and compared. Results The mean operating time in LESS group was prolonged and its operative hospital stay was significantly decreased compared to multi-incision laparoscopic group. No significant difference was observed in the intraoperative blood loss in two groups. Moreover,no significant differences were found in the AFC,AMH,Gn stimulation days,total Gn dosage,Ovum number,good quality embryo rate,embryo implantion rate,clinical pregnancy rate and early spontaneous abortion rate in two groups. Conclusions For experienced laparoscopic surgeons,LESS is a safe and feasible procedure with similar perioperative outcomes to multi-incision laparoscopic surgery.