PURPOSE:Previous studies have shown a rising incidence of early-onset symptomatic intracranial atherosclerosis (sICAS), which has brought a severe economic burden to social development. This study aimed to evaluate the molecular biomarkers associated with early-onset sICAS and to seek possible intervention strategies for early prevention.PATIENTS AND METHODS:We consecutively recruited patients with sICAS and divided them into two groups based on age: early-onset sICAS group as age ≤60 years old and late-onset sICAS group as age >60 years old. We collected and compared the demographic data and laboratory results of each group. A bivariate logistic regression model was applied to evaluate the independent molecular biomarkers of early-onset sICAS.RESULTS:A total of 1007 subjects with sICAS were enrolled in this study, comprising 519 patients in the early-onset sICAS group and 488 patients in the late-onset sICAS group. Bivariate logistic regression analysis demonstrated an increased level of white blood cell, platelet, albumin globulin ratio, free triiodothyronine, and a decreased level of total bile acid, urea nitrogen, high-density lipoprotein, homocysteine, and fibrinogen in the early-onset sICAS group when compared to the late-onset group.CONCLUSION:Our study showed the relevance between early sICAS and circulating levels of different molecular biomarkers. Detection of these related molecular biomarkers may provide a simple way for early sICAS preventions in the future.

Background: Neutrophil-to-lymphocyte ratio (NLR) is an indicator of poor prognosis in acute ischemic stroke (AIS), but associations between NLR with stroke severity and prognosis of intracranial atherosclerotic stenosis (ICAS)-related ischemic events have not been well-elucidated; therefore, we aimed to evaluate whether admission NLR levels correlate with the early stroke severity and short-term functional prognosis in patients with symptomatic intracranial atherosclerotic stenosis (sICAS). Methods: This retrospective study enrolled 899 consecutive patients with AIS attributed to ICAS at Xiangya Hospital stroke center between May 2016 and September 2020. The initial stroke severity was rated by the admission National Institutes of Health Stroke Scale (NIHSS) scores, and the short-term prognosis was evaluated using the 14-day modified Rankin Scale (mRS) scores after stroke onset. A severe stroke was defined as NIHSS >8; an unfavorable functional outcome was defined as mRS scores of 3–6. Admission NLR was determined based on circulating neutrophil and lymphocyte counts. Results: The median admission NLR of all patients was 2.80 [interquartile range (IQR), 2.00–4.00]. In univariate analysis, admission NLR was significantly elevated in patients with severe stroke and poor short-term prognosis. After multivariate adjustment, admission NLR levels were significantly correlated with severe stroke [odds ratio (OR), 1.132; 95% confidence interval (95% CI), 1.038–1.234; P = 0.005] and unfavorable short-term prognosis (OR, 1.102; 95% CI, 1.017–1.195; P = 0.018) in Model 1. In Model 2, the highest NLR tertile (≥3.533) remained an independent predictor of severe stroke (OR, 2.736; 95% CI, 1.590–4.708; P < 0.001) and unfavorable functional outcome (OR, 2.165; 95% CI, 1.416–3.311; P < 0.001) compared with the lowest NLR tertile (<2.231). The receiver operating characteristic (ROC) curves showed the predictability of NLR regarding the stroke severity [area under the curve (AUC), 0.659; 95% CI, 0.615–0.703; P < 0.001] and short-term prognosis (AUC, 0.613; 95% CI, 0.575–0.650; P < 0.001). The nomograms were constructed to create the predictive models of the severity and short-term outcome of sICAS. Conclusions: Elevated admission NLR levels were independently associated with the initial stroke severity and could be an early predictor of severity and poor short-term prognosis in AIS patients with ICAS, which might help us identify a target group timely for preventive therapies.

Background: Bilirubin plays a paradoxical role in the pathological mechanism of stroke. To date, few clinical studies have investigated the effect of serum bilirubin on symptomatic intracranial atherosclerotic stenosis (sICAS). This study aims to evaluate the connection between serum bilirubin and sICAS.Methods: From September 2015 to May 2020, 1,156 sICAS patients without hepatobiliary diseases admitted to our hospital were included. Patients were distributed into none-mild (0–49%), moderate (50–69%) and severe-occlusion sICAS groups (70–100%) by the degree of artery stenosis. Moderate and severe-occlusion sICAS patients were classified into three groups by the number of stenotic arteries (single-, two- and multiple-vessel stenosis). The relationship between serum bilirubin levels and sICAS was analyzed by logistic regression analysis.Results: In univariable analyses, sICAS patients with severe and multiple atherosclerotic stenoses had lower levels of total bilirubin (Tbil), direct bilirubin (Dbil), and indirect bilirubin (Ibil). In multinomial logistic regression analyses, when compared with the highest tertile of bilirubin, lower levels of Tbil, Dbil, and Ibil showed higher risks of severe-occlusion sICAS (95% CI: 2.018–6.075 in tertile 1 for Tbil; 2.380–7.410 in tertile 1 for Dbil; 1.758–5.641 in tertile 1 for Ibil). Moreover, the logistic regression analyses showed that lower levels of Tbil, Dbil, and Ibil were related to multiple (≥3) atherosclerotic stenoses (95% CI: 2.365–5.298 in tertile 1 and 2.312–5.208 in tertile 2 for Tbil; 1.743–3.835 in tertile 1 and 1.416–3.144 in tertile 2 for Dbil; 2.361–5.345 in tertile 1 and 1.604–3.545 in tertile 2 for Ibil) when compared with tertile 3.Conclusions: Our findings suggest that lower bilirubin levels may indicate severe and multiple intracranial atherosclerotic stenoses.

OBJECTIVE:To evaluate the status and influential factors for prenatal care and postpartum visit among pregnant women in Hunan Province from 2008 to 2013 based on the data from the First Health Service Survey in Hunan Province.
 Methods: Based on the data of prenatal care and postpartum visit among pregnant women from the First Health Service Survey of Hunan Province in 2013, proportion of pregnant women, who didn't meet the criteria for prenatal care and postpartum visit, were calculated (≥5 times for prenatal care and ≥2 times for postpartum visit, according to the National Basic Public Health Service program, 2009 Edition). Multivariable logistic regression models were used to identify the influencial factors.
 Results: A total of 1 035 eligible women were included in data analysis. The proportion of pregnant women who did not meet the criteria were 40.12% (95% CI 24.91%-55.33%) for prenatal care and 64.88% (95% CI 39.70%-90.06%) for postpartum visit. After adjusting other confounding factors, pregnant women with middle- and high-income had lower proportions of not meeting the criteria than those with low-income, with adjusted odds ratios of 0.41 and 0.39, respectively. Multiparae had higher proportion of not meeting the criteria than primiparas, with adjusted odds ratio of 1.54, and pregnant women with age 25-34 years and 35-64 years had lower proportions of not meeting the criteria than those with age 15-24 years. In term of postpartum visit, pregnant women with middle- to high-income had lower proportions of not meeting the criteria than those with low-income, with adjusted odds ratios of 0.50, 0.46 and 0.54, respectively; multiparae had higher proportion of not meeting the criteria than primiparas, with the adjusted odds ratio of 2.30.
 Conclusion: Proportions of pregnant women of not meeting the criteria are high in Hunan Province. Local government should strengthen the management to decrease the proportions of pregnant women who do not meet the standard in prenatal care and postpartum visit, especially for those mulparae with low family income and young age.

Objective The purpose of the study is to provide reference for training bases conducting graded professionalism education.Methods The method of the study is to conduct a self-evaluation and a instructor-evaluation about professionalism for 122 residents in rotation and 90 medical interns through the Questionnaire of Professionalism Evaluation on Residents/Medical Interns.Results The re sult of the study is that among 7 elements about professionalism evaluation,the self-evaluation score and the instructor-evaluation score of residents are higher than those of medical interns.This difference is statistically meaningful (P ＜ 0.05).As for self-evaluation,the scores of residents and medical interns are the highest in terms of “respect for other people” and the lowest in terms of “being responsible”;for the instructor-evaluation,the scores of residents and medical interns are the highest in terms of “respect for other people” and the lowest in terms of “leadership”.Moreover,among 29 indicators about professionalism evaluation,the self-evaluation scores and the instructor-evaluation scores of residents are higher than those of medical interns.The difference is statistically meaningful (P ＜ 0.05).Conclusions The conclusion of the study is that the professionalism of residents is better than that of medical interns.Based on this fact,the training bases can conduct different professionalism trainings to students in different stages.The graded professionalism education system can be called the pathway for medical interns to become residents in terms of professionalism.

目的 分析2013年湖南省居民两周患病与≥15岁居民半年慢性病患病的疾病构成及顺位.方法 采用多阶段随机抽样得到24 282人为调查对象,用Rao-Scott调整X2检验比较不同人口学特征间患病率差别、估算前10位疾病构成.结果 湖南省城乡居民两周患病率接近(23.03％和22.75％),但农村15～岁、35～岁居民两周患病率(5.52％和14.96％)均分别高于城市(2.18％和9.40％),差异均有统计学意义(均有P＜0.05).＜5岁、5～岁和15～岁年龄段居民两周患病以急性呼吸道疾病和伤害为主,≥35岁居民两周患病中慢病占较大比例.≥15岁城市居民半年内慢病患病率为32.97％,高于农村的27.68％,但差异无统计学意义(X2=1.34,P=0.247).≥35岁城乡居民慢病患病以高血压、糖尿病和椎间盘疾病最常见.结论 湖南省35岁以下居民两周患病以急性呼吸道传染性疾病和伤害为主,≥35岁居民中,随着年龄增加慢病所占比重增长迅速.≥15岁居民半年慢病患病率已达28.92％;高血压、糖尿病和椎间盘疾病成为≥35岁城乡居民最主要的慢性病.

目的 了解患慢性病与跌倒发生的关系.方法 应用多阶段随机抽样法,在长沙市开福区选取18岁及以上的居民为研究对象,采用自制调查表收集慢性病患病情况、跌倒发生情况等信息.结果 在3 078名调查对象中,近1年的跌倒人次发生率为2.76％,其中男、女性跌倒发生率分别为1.95％和3.33％.慢性病患病率为30.77％,其中高血压和糖尿病患病率最高,分别为19.69％和6.56％.调整性别、年龄、婚姻状况后,患1种慢性病的个体发生跌倒风险高于未患病个体(调整OR=2.32).结论 湖南省长沙市开福区社区18岁及以上居民跌倒发生率较高,患慢性病增加居民跌倒的发生风险,卫生部门在开展跌倒干预工作时应综合考虑慢性病患病的影响.

Surveillance of cause of death is an important part of public health work and is the base of rational health decision-making. Considering the fact that few domestic publications involved quality assessment indicators of surveillance data, current quality of global death surveillance data, and common verification methods of death surveillance data, we summarizes the research status of quality assessment standards, the quality assessment of global death surveillance data, and common validation methods of surveillance data, with the aim of providing the reference for improving the data quality of China’s death surveillance.

Injury surveillance is an important way to assess and understand the injury problem of a country or region. In the last few decades, oversea and domestic injury surveillance has made a big progress. This paper summarizes the development of international and domestic injury surveillance, and proposes suggestion to improve injury surveillance of China.

Objective To explore the clinical value of serum procalcitonin(PCT) in children with community acquired pneumonia(CAP) caused by gram-positive(G+) and gram-negative(G-) bacteria.Methods The data about the levels of PCT and hsCRP,WBC count,and blood bacterial culture results of all children with CAP hospitalized in the Children's Hospital of Hunan Province from January to August 2011 were collected.According to blood bacterial culture results,the children were divided into G+ group and G-group.The levels of PCT and hsCRP,WBC count were compared between the two groups.Results One hundred and twenty-two children were subjected in accordance with the selected standard,including 54 patients who were infected by G+ bacteria and 68 patients who were infected by G-bacteria.The serum PCT level of G-group was significantly higher than that of G+ group(P<0.001).No statistically significant difference was found in hsCRP level and WBC count between the two groups(P>0.05).Using a cut-off point of 7.65 ng/ml for PCT,the sensitivity and specificity for G-bacteria infection in children with CAP were 77.9% and 87.0%,respectively,the area under the ROC curve was 0.864(95%CI 0.776-0.917).Conclusions The PCT level has some clinical value in differentiating CAP children from gram-negative bacteria infection and gram-positive bacteria infection,which can provide the reference for physicians to rationally use antibiotics in early stage.

Objective: To observe the clinical therapeutic effect of Traditional Chinese and Western Medicine combination therapy in treating chronic nephritis.Methods: Eighty cases of chronic nephritis were randomly divided into treatment group(40 cases) and control group(40 cases) to evaluate the total therapeutic effect,24 hour urine protein,blood creatinine,the urea nitrogen and hemorheology two months later.Results: There was a remarkable difference(P0.05) between the treatment group and control group in the effect rate.In aspect of improving the 24 hour urine protein,blood creatinine,the urea nitrogen and hemorheology,the treatment group showed a better effect than control group(P0.05).Conclusion: The combination therapy can improve the progression of chronic nephritis,and clinical symptoms.Thereby it has a better efficacy than simple Western medicine treatment.

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