Pharmaceutical treatment status of patients with COPD in the community based on medical Internet of Things: a real-world study.

This study aimed to investigate the real-world standardisation and adherence of medical treatment regimens in patients with chronic obstructive pulmonary disease (COPD) in the community for making future management strategy. The follow-up data and treatment information of patients with COPD, which were collected through the Management Information Center of COPD (MICCOPD) in 21 community health service centres in Songjiang District, a countryside region of Shanghai. Concordance between the pharmaceutical treatment plan and recommendation of 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report during the follow-up management period, as well as the medication adherence by patients,were analysed. Out of the 2044 patients diagnosed with COPD, 814 patients (39.8%) who had an initial record of medication use were found to meet the inclusion criteria. The most common medication regimens were long-acting beta-agonist plus inhaled corticosteroids (35.9%) and oral bronchodilators (41.9%). Among these 814 patients, 45.7%, 38.0%, 31.6% and 14.6% adhered to the treatment after 6, 12, 18 and 24 months of follow-up, respectively. The concordance rate with the regimens recommended by the 2017 GOLD guidelines was 35.5% at baseline, 35.5% at 6 months, 32.7% at 12 months, 35.4% at 18 months and 37% at 24 months. The compliance and guideline consistency rates of patients with COPD in the community under the management of general practitioners need to be improved. Enhancing general practitioner proficiency in the prevention and management of COPD and increasing patient awareness of the condition, are crucial standardising and improving adherence to initial and follow-up COPD treatments.

Laparoscopic management or laparoscopy combined with transvaginal management of type II cesarean scar pregnancy.

OBJECTIVE: To evaluate the clinical effectiveness of laparoscopic management of cesarean scar pregnancy (CSP) by deep implantation. BACKGROUND: A pregnancy implanting within the scar from a previous cesarean delivery is a rare condition of ectopic pregnancy. There are two different types of CSPs. Type I is caused by implantation of the amniotic sac on the scar with progression toward either the cervicoisthmic space or the uterine cavity. Type II (CSP-II) is caused by deep implantation into a previous CS defect with infiltrating growth into the uterine myometrium and bulging from the uterine serosal surface, which may result in uterine rupture and severe bleeding during the first trimester of pregnancy. Thus, timely management with an early and accurate diagnosis of CSP-II is important. However, laparoscopic management in CSP-II has not yet been evaluated. METHODS: Eleven patients with CSP-II underwent conservative laparoscopic surgery or laparoscopy combined with transvaginal bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair to preserve the uterus from March 2008 to November 2011. Patients with CSP-II were diagnosed using color Doppler sonography, and the diagnosis was confirmed by laparoscopy. The operation time, the blood loss during surgery, the levels of ß-human chorionic gonadotropin (ß-hCG) before surgery, the time taken for serum ß-hCG levels to return to <100 mIU/mL postoperatively, and the time for the uterine body to revert to its original state were retrospectively analyzed. RESULTS: All 11 operations were successfully performed using laparoscopy with preservation of the uterus. One patient underwent a dilation and curettage after laparoscopic bilateral uterine artery ligation. Eight patients were treated solely by laparoscopic bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair. The remaining two patients underwent laparoscopic bilateral uterine artery ligation and transvaginal resection of the CS with gestational tissue and wound repair because of dense adhesions and heavy bleeding. The average operation time was 85.5 (±17.5) minutes, and the blood loss was 250.0 (±221.4) mL. The blood serum level of ß-hCG returned to <100 mIU/mL in 16.4 (±5.3) days postoperatively. Among the 10 patients who underwent resection of CS and wound repair, the time for the uterus to revert to its original state (judged by ultra-sonography) was 10.8 (±3.0) days postoperatively. CONCLUSIONS: Laparoscopy can remove ectopic gestational tissue and allow subsequent wound repair, as well as provide diagnostic confirmation. Being a minimally invasive procedure, laparoscopic or laparoscopy combined with transvaginal bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair can become an effective alternative for the treatment of CSP-II.

[Study on gasless-laparoscopic vaginoplasty using sigmoid colon segment].

OBJECTIVE: To study the clinical effect of gasless-laparoscopic vaginoplasty using sigmoid colon segment. METHODS: Clinical data of 119 cases undergoing laparoscopic or gasless-laparoscopic vaginoplasty using a vascularized pedicled sigmoid colon segment in Beijing Anzhen Hospital from January 2007 to December 2010 were reviewed retrospectively. Those patients were classified into 57 cases with laparoscopic sigmoid colon vaginoplasty and 62 cases with gasless-laparoscopic sigmoid colon vaginoplasty. The operation time, blood loss in operating, bowel movement after operation, postoperation hospital duration, side effect, and artificial vagina were compared between laparoscopic and gasless-laparoscopic group. RESULTS: The vaginoplasty were preformed successfully in 119 cases. The mean operation time of were (159 ± 18) min in laparoscopic group and (146 ± 17) min in gasless-laparoscopic group, respectively, which reached statistical difference (P < 0.01). The blood loss in operating were (83 ± 14) ml and (86 ± 13) ml, bowel movement after operation were (68 ± 8) hours and (68 ± 11) hours, and postoperation hospital duration were (11.1 ± 1.3) days and (11.4 ± 1.9) days respectively in laparoscopic group and gasless-laparoscopic group. No significant difference were found in the blood loss in operating, bowel movement after operation, and postoperation hospital duration between two groups (P > 0.05) .No intraoperative complication occurred. There were two cases with incomplete adhesive intestinal obstruction at 15-20 days postoperatively, which one was in laparoscopic group and one was in gas-less laparoscopic group. At 6-50 months of following up (median time 12 months), all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length. Vaginal discharges resembled a milky white water or mucus without odour. Eighty-five patients with sexual intercourse reported satisfactory feeling. One patients complained vaginal stenosis in laparoscopic group. CONCLUSION: Gasless-laparoscopic vaginoplasty using sigmoid colon segment is an alternative feasible and practical treatment.

Real-World COPD Management Over 3 Years at the Community Health Service Center of Shanghai During the COVID-19 Pandemic in China.

Objective: To evaluate the real-world situation for the management of chronic obstructive pulmonary disease (COPD) and poorly controlled disease risk factors in the Chinese community. Methods: This retrospective multicentre study analysed data from COPDMICand MICHC in Shanghai Songjiang District, Shanghai, China. The differences in COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) dyspnea scale, and the number of emergency cases, emergency visits, inpatient cases, and hospitalisations from January 2018 to December 2020 were analysed. The impact of coronavirus disease 2019 (COVID-19) on COPD management was also assessed. Results: For 2020 versus 2018, analysis of 468 COPD cases from COPDMIC matched with MICHC data showed significantly more patients with improved mMRC grades, significantly fewer emergency cases and emergency visits, and significantly fewer hospitalisation cases and hospitalisations. Differences in the number of emergency visits and hospitalisations per capita were statistically significant. Compared to GOLD 3-4, GOLD 1-2 patients showed significant improvements in CAT score, mMRC grade, the number of emergency visits and hospitalisations per capita. Treatment adherence from 2018 to 2020 was 25%, 29.1%, and 6.8%, and the proportion of medication regimens consistent with guidelines was 43.44%, 50.98%, and 71.87%, respectively. Higher treatment adherence resulted in significantly improved CAT scores and mMRC grades and fewer emergency department visits and hospitalisations per capita. Conclusion: Combined with remote management tools, patients with COPD achieved continuous improvement in symptoms and exacerbations over 3 years. In the context of COVID-19 prevention/control measures, improvements were significant for patients with GOLD 1-2 COPD but limited with GOLD 3-4. Pharmacologic treatment significantly improved clinical symptoms and reduced emergency visits and hospitalisations. Severe airflow limitation and poor adherence to pharmacologic treatment were important risk factors for lack of disease remission.

[Mechanism study of fluoride adsorption by hydrous metal oxides].

Hydrous oxides of cerium, aluminum, nickel and copper were prepared by alkaline precipitation method. Langmuir adsorption isotherm was studied and specific surface area was measured by BET method through N2 adsorption-desorption process. IR characterization of hydrous metal oxides before and after fluoride adsorption was also studied. Results show that different hydrous metal oxides have different specific surface areas and their pore size distributions also are not all the same. Adsorption capacity is not directly dependent on the specific surface area. Isotherm study indicates that the adsorption follows Langmuir model and shows the feature of monolayer adsorption. IR study before and after fluoride adsorption shows that different hydrous metal oxides have similar adsorption sites in the same IR region as well as adsorption sites in the different IR region. The comprehensive interaction of these adsorption sites with fluoride ions results in the different adsorption capacity of different hydrous metal oxides.

[Preparation and catalytic activity of surface-modification CNTs/TiO2 composite photocatalysts].

A novel kind of carbon nanotubes/titanium dioxide (CNTs/TiO2) composite photocatalyst was prepared by a modified sol-gel method in which the nanoscaled TiO2 particles were uniformly deposited on the CNTs modified with poly(vinyl pyrrolidone) (PVP). The composites were characterized by a range of analytical techniques including high resolution transmission electron microscopy (TEM), X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS). The results show the successful covering of the CNTs with PVP, forming core-shell structure. The nanoscaled TiO2 particles were uniformly deposited on the surface of CNTs reducing the bare CNTs which avoid losing the absorption and scattering of photons. The combination of CNTs and TiO2 particles imply the enhanced interactions between the CNTs and TiO2 interface which possibly becomes heterojunction. The composites become mesoporous crystalline TiO2 (anatase) clusters after annealing at 500 degrees C, and the surface area increases obviously. The photocatalytic activities of surface modification CNTs/TiO2 (smCNTs/TiO2) composites are extremely enhanced from the results of the photodegradation of methylene blue (MB).

[Removal of methyl orange from aqueous solution by magnetic carbon nanotubes].

Ferrocene was used as a catalyst, and xylene as carbon source. Chemical vapor deposition method was used to synthesize carbon nanotubes (CNTs). The CNTs were treated by oxidation method with concentrated nitric acid. Magnetic carbon nanotubes were prepared by using chemical co-precipitation. The products were characterized by field emission scanning electron microscope. This paper is concerned with the adsorption of methyl orange by magnetic carbon nanotubes. The best experimental conditions were found. Adsorbent solution was analyzed by UV-Vis adsorption spectra. At the same time, desorption and re-adsorption of methyl orange from magnetic CNTs were studied.

[Clinical study on laparoscopic technique for vaginoplasty using an ileum with long vascular pedicle].

OBJECTIVE: To study the operative methods and clinical outcome of laparoscopic ileal colpopoiesis with long vascular pedicle. METHODS: We reviewed 31 cases which had received ileal colpopoiesis, including 25 cases of congenital absence of vagina and 6 cases of male-to-female trans-sex. All cases were operated on by laparoscopic (8 cases) and laparoscopy assisted (23 cases) ileal colpopoiesis. The postoperative results were analyzed through physical examination and interview regarding the patient's functional status and satisfaction during sexual intercourse. RESULTS: Ileal colpopoiesis were preformed successfully on all 31 cases. Follow-ups of 3-13 months were done for all of them. Patients used vaginal mould for at least 8 months. All artificial vaginas had excellent cosmetic results, including adequate vaginal length, good lubrication, and appearance and physical functions similar to female natural vagina, and sexual function was reportedly satisfactory. One of the patients had an operative complication of an intestinal obstruction, which was cured by a second operation and other treatments. CONCLUSIONS: The laparoscopic and laparoscopy assisted ileal vaginoplasty is a feasible, safe and ideal method of current vaginoplasty due to its minor damage, excellent cosmetic results and similarity to normal vaginal features. However, vaginal mould should be used for a long period of time (at least 8 months) after an operation, to prevent vaginal orifice shrinkage.

[Women's postpartum sexuality and delivery types].

OBJECTIVE: To investigate the impact of delivery on the sexuality of primiparous women in China, and the association with delivery type. METHODS: We inquired 460 of primiparous women delivering of a live birth at the first affiliated hospital of Chongqing medical university from November 1, 2000 to July 31, 2001. It was a cross-sectional study using obstetric records and postal questionnaire survey by outpatients consultation six months after delivery. RESULTS: Ninety-four point seven percent had resumed sexual activity within six months of the birth. In the first three months after delivery, 70.6% of women experienced sexual problems, it declined to 34.2% at six months, but can not reaching the pre-pregnancy levels. There was no close relation between sexuality postpartum and delivery. (sexual satisfactory, desire, active rate, dyspareunia and pubococcygeal muscle intensity, P > 0.05). CONCLUSIONS: Postpartum sexuality was not significantly associated with delivery types. Sexual problems were very common after childbirth. More consultation and direction of postpartum sexuality recurrence is needed.