Influencing factors of visits of residents to contracted family doctors in a Beijing community / 中华全科医师杂志

Objective:To analyze the influencing factors related to visiting rate of residents to contracted family doctors in a community health service center in Beijing.Methods:One thousand patients with contracted family doctor services who visited our center from January 2019 to December 2019 were selected for retrospective analysis. According to the corresponding visiting rate of contracted family doctors,patients were divided into low corresponding visiting rate, medium corresponding visiting rate and high corresponding visiting rate, and the influencing factors were analyzed.Results:Among the 1 000 patients, 481 (48.1%) were in the high corresponding visiting rate group, 342 (34.2%) in the middle corresponding visiting rate group, and 177 (17.7%) in the low corresponding visiting rate group. Univariate analysis showed that the corresponding visit rate was significantly associated with the age, marital status and educational level of patients, history of hypertension, the number of family doctor visits, the total visiting time and the consultation time per year (χ 2=12.55, 12.42, 7.69, 21.69, 253.97, 49.54, 9.07, all P<0.05). Multivariate logistic regression analysis showed that compared with the high corresponding visiting rate group, fewer of family doctor visits ( OR=0.68, 95 %CI: 0.58-0.78), lower education level( OR=0.65, 95 %CI: 0.46-0.92), history of hypertension ( OR=0.09, 95 %CI: 0.02-0.49), and 18-65 years old( OR=1.80, 95 %CI: 1.27-2.55) were the influencing factors for the low corresponding family doctor visiting rate(all P<0.05); while fewer of family doctor visits( OR=0.91, 95 %CI: 0.83-0.99),lower education level ( OR=0.74, 95 %CI: 0.55-0.98)and history of hypertension( OR=0.09, 95 %CI: 0.02-0.44)were the related factors of the medium corresponding visiting rate(all P<0.05). Conclusions:The visiting rate of patients to the contracted family doctor needs to be improved. The number of consultations of the contracted family doctor, educational background, history of hypertension, and age are the influencing factors of the corresponding visiting rate.

Analysis of consecutive patient visits in a community health service station in Beijing / 中华全科医师杂志

Objective:To analyze consecutive patients visits in a community health service station in Beijing.Methods:The basic information and behavior of the patients who visited Sanliheerqu Health Service Station in Beijing Xicheng district from January 1, 2015 to December 31, 2019 were retrieved from the electronic health records. The visiting situation, the stratification of the number of visits, and the correlation between the basic information and the consecutive visit was analyzed.Results:A total of 4 696 patients visited 202 560 times during 2015 to 2019, of whom 1 162 were consecutive patients (24.7%) with a total of 100 083 visits (49.4%).The annual number of visits, the total number of visits and the number of consecutive visits all showed an upward trend during the five years.The top 5 reasons for consecutive visit were all chronic diseases (hypertension, type 2 diabetes, dyslipidemia, coronary heart disease, and stroke) with median annual visits of 11 to 18, and it was increasing with the year. The rates of incidental visits (1-3/year, 66/1 162, 5.7%) and continuous visits (4-26/year, 1 020/1 162, 87.8%) in 2015 were higher than those in other years; while the rates of frequent visits (27-52/year, 71/1 162, 6.1%) and very frequent visits (>52/year, 5/1 162, 0.4%) were lower. The rates of frequent visits (181/1 162, 15.6%) and very frequent visits (78/1 162, 6.7%) in 2019 were higher than those in other years (χ 2=182.40, P<0.001).Compared with the non-consecutive visit group, the proportion of women (38.1%,735/1 930) and overweight/obesity (39.6%, 777/1 960) in the consecutive visit group was higher (χ 2=36.09, 69.69, P <0.001). Conclusion:The consecutive visit rate of residents in this institution needs to be improved. The utilization rate of primary medical resources for patients with consecutive visit is high and the number of medical visits is on the rise. Gender and BMI of patients may be related to consecutive visit.

Status of comorbidity among hypertensive patients with contracted family doctor service / 中华全科医师杂志

Objective:To investigate the coexistence status of common chronic diseases among hypertensive patients with contracted family doctor service in the community.Methods:Clinical data of 7 910 hypertensive patients with contracted family doctor service in Yuetan Community Health Service Center and its affiliated service stations were collected. The status of comorbidities and related factors were analyzed.Results:Among 7 910 hypertensive patients, there were 2 959 cases(37.4%) with 2 chronic diseases, 1 747 cases (22.1%) with 3 chronic diseases and 2 289 cases(28.9%) with simple hypertension. There was significant difference in comorbidity status among hypertensive patients in different age groups (χ 2=25.269, P<0.05). The top 3 comorbid chronic diseases were type 2 diabetes (2 979 cases, 37.7%), dyslipidemia (2 227 cases, 28.2%), and coronary heart disease (1 945 cases, 24.6%). Univariate analysis showed that the comorbidity of hypertensive patients was significantly related to age, smoking, marital status,employ status and education level (χ 2=9.697, 19.539, 33.343, 8.986, 7.923; P<0.05). Conclusion:There is a phenomenon of coexistence of multiple diseases in hypertensive patients with contracted family doctor service in Yuetan community.

Effects of N-methyl-N-cis-styryl-cinnamamide on Penicillin-induced Epileptiform Discharges in Rats / 中山大学学报(医学科学版)

[Objective]To investigate the effects of the seed extract of Clausena lansium,N-methyl-N-cis-styryl-cinnamamide,on the penicillin-induced epilepsy in rats.[Methods]Thirty-two Sprague-Dawely rata were randomly divided into four groups with 8 rats in each group:normal control(20 mL/L Tween 80+Normal Saline),model control(20 mL/L Tween 80+Penicillin),low dose treatment(Cinnamamide 75 mg/kg+Penicillin),hish dose treatment(Cinnamamide 150 mg/kg+Penicillin).The epilepsy rat model was established by localized intracortical injections of penicillin.The effects of pretreatments of the rats with N-methyl-N-cis-styryl-cinnamamide(intraperitoneal injection,ip)on the penicillin-induced seizure activities and the epileptiform discharges recorded by electrocorticogram(ECoG)were observed.[Results]The penicillin-induced seizure was significantly lightened in both the pretreatment groups(75 and 150 mg/kg N-methyl-N-cis-styryl-cinnamamide),compared with the model group.N-methyl-N-cis-styryl-cinnamamide(75 and 150 mg/kg)could significantly prolonged the latency of epileptiform activities,shorten the duration of epileptiform discharges and decreased the mean spike frequency in the late stage(P＜0.05 or P＜0.01).However,there was no significant difference in the highest value or the lowest value of the epileptiform waves between the model and cinnamamide treatment groups.[Conclusion]The seed extract of Clansena lansium,N-methyl-N-cis-styryl-cinnamamide,can significantly inhibit the seizure and epileptiform discharges caused by penicillin-localized injections in the cortex of rats,suggesting that the natural substance has an anticonvulsive function.

Perioperative anticoagulation or antiplatelet therapy in cases of carotid endoarterectomy / 中华普通外科杂志

Objective To evaluate the efficacy and safety of perioperative anticoagulation and antiplatelet therapy of carotid endoarterectomy (CEA). Methods A retrospective study on 110 cases (122 CEAs) of carotid stenosis between Jan 2004 and Dec 2008 was undertaken. 122 cases were divided into anticoagulation group and antiplatelet group according to the perioperative medical treatment. Postoperative results of stroke/death and wound hemotoma were compared between the two groups and statistically analyzed. Results 45 CEAs were given perioperative combination of anticoagulation and antiplatelet treatment. This comprised the anticoagulation group. The antiplatelet group consisted of the other 77 CEAs which were treated with antiplatelet solely. Perioperative stroke/death rates were equivalent (2.2% anticoagulation vs. 2.6% antiplatelet, P =0.897). Wound hemotoma rates were found with statistical significant difference between the two groups (13.3% anticoagulation group vs. 1.3% antiplatelet group, P = 0. 006 ). Conclusion Our results suggest that perioperative antiplatelet therapy in perioperative carotid endoarterectomy does not increase perioperative stroke/death risk, while perioperative anticoagulation increases the risk of wound hematoma.

Revascularization of lower limb artery ischemia for elder patients / 中华普通外科杂志

Objective To evaluate the result of revascularization for lower limb artery ischemia in elder patients. Method During Jan 2006 to Nov 2008, 262 elder patients (60 years old and up), underwent artery revascularization for lower limb arterial ischemia. Mortality, morbidity, primary patency, secondary patency and limb salvage were analyzed. Result There were a total of 323 ischemia limbs in those 262 elder patients undergoing revascalarization, among those 102 limbs underwent artery bypass, 98 limbs underwent endoluminal angioplasty with or without stenting, 67 limbs underwent embolectomy or endarterectomy, 56 limbs underwent open surgery combined with endoluminal treatment due to multiple segment lesions. Operation success rate was 94.7%. Two patients died within 30 days. Perioperative morbidity developed in 15 cases. 245 patients (93.5%) were followed-up from 1 month to 35 months. Mortality was 6.1% (15 cases), primary patency was 80.5%, secondary patency was 92.7% and limb salvage rate was 95.2%. Risk factors analysis showed that history of cardiac disease and elder ages were associated with higher mortality. Diabetes mellitus, critical ischemia and multiple segment lesions were associated with poor long term patency and limb salvage. Conclusion Lower limb ischemia is severe disease related to elder patients' death and amputation. Careful patient selection, detailed pre-operation work-up, meticulous operative technique play crucial roles for a successful arterial reconstruction.

Management of cerebral ischemia due to Takayasu's arteritis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To explore the management of cerebral ischemia caused by Takayasu's arteritis.</p><p><b>METHODS</b>Ninety-three cases treated from June 1984 to September 1999 at the General Post & Telecom Hospital, the Sir Run Run Shaw Hospital, the First Affiliated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hospital, including 10 men and 83 women, were reviewed. Of the 93 cases, bypasses from the ascending aorta to the axillary or subclavian artery and from graft to the carotid artery were performed in 47 cases. Subclavian to carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in five cases and stenting in one.</p><p><b>RESULTS</b>Marked improvement was achieved in 30.3%, fair in 34.9%, improvement in 21.2%, unchanged in 4.6%, and death in 9.0% before discharge; 30.6%, 38.8%, 16.3%, 4.1%, and 2.0% respectively during a mean follow-up of 48 months, and recurrence requiring revision in 8.2%.</p><p><b>CONCLUSION</b>Patients with occlusive lesions of all four cervical arteries always have severe cerebral ischemia and their distal runoff is always unvisualised by angiography. However, we found by exploration that the internal carotid artery is patent in all but one patient. Therefore, an ascending aorta to carotid bypass is feasible in most instances, and this can and should be done when the cerebral perfusion is jeopardized at a time when the patient is in a stable or relatively stable condition. Unfortunately, the cerebral re-perfusion syndrome is still a serious and not completely solved problem.</p>

Surgical management of carotid aneurysms / 中国普通外科杂志

Objective To explore the surgical methods in the treatment of carotid aneurysms. Methods A retros-pective analysis was made on the operations and results in 21 cases with 24 carotid aneurysms. Of the 24 carotid aneurysms, 18 were true and 6 false aneurysms. Nineteen cases underwent various operations including emergency operation in 3 cases. Carotid shunting device was used in 3 cases during operation. Results 2 cases were re-operated because of the recurrence of aneurysm,and 17 cases had satisfactory outcome without complications.None died in this series in perioperative period. Conclusions For carotid aneurysms,the first choice of treatment is syrgery.Surgical treatment is relatively safe and effective.

Significance of indirect portal venography in the diagnosis and management of prehepatic type portal hypertension / 中国普通外科杂志

ObjectiveTo explore the clinical significance of arterial portography in the diagnosis an d management of prehepatic type portal hypertension(PHPHT). Met hodsBetween 2000 to 2002, all the 11 patients with PHPHT were dia gnosed by angiography and B type ultrasounography. Different operations were par formed including mesocaval shunt in 5 patients,portal-vena cava shunt in 1, splenorenal shunt in 2,and portoazygos venous disconection in 1. Two patien ts were not operated. Results Nine cases undergoing surgical operations had satisfactory outcome. Conclusions PHPHT can be correctly diagnosed by indirect portal venography which is important for the choice of operation.

Minimally invasive endoscopic treatment for complications of PAHG injection for augmentation mammaplasty / 重庆医科大学学报

Objective:To search for a safe,effective and convenient treatment for the complications after polyacrylamide hydrogel(PAHG)injection for augmentation mammaplasty.Methods:47 patients with complications after PAHG injection for augmentation mammaplasty were included.B type ultrasound detection was performed Preoperatively in order to find out the distribution of PAHG.After local anesthesia,a 10 mm incision was made at submammary fold of each patients.Under the guidance of endoscope,PAHG was rinsed by tumescent technique at low pressure and aspirated out for several times,until the capsule wall of PAHG was clean and the rinse solution was clear.The infiltrative tissue was excised.Negative pressure drainage tube and antibiotics were used postoperatively and the patients were followed for 5～20 weeks.Results:All incisions were primarily healed,leaving no hematoma or infection.All patients were satisfied with disappearance of pain in the breasts,soft mammary tissue without any noeud and no PAHG remains which was detected by B type ultrasound.Conclusion:Minimally Invasive endoscopic treatment for complications of PAHG injection for augmentation mammaplasty was characterized by its micro-incision,accurate operation,high PAHG clearance,minimal trauma of tissue and reliable hemostasis,worth to be widely used.

Selective cholangiography during laparoscopic cholecystectomy,clinical analgsis of 155 cases / 重庆医科大学学报

Objective:To discuss the value of selective cholangiography during laparoscopic cholecystectomy(LC).Methods:Retrospective analysis was made on the clinical data of 155 patients who underwent intraoperative cholangiography(IOC) during LC from 2000 to 2006.Results:Among all the 155 patients,38 had residual bile stones;6 had cystic duct excess or variation and 3 had bile duct injury.All these abnormalities were cured during LC.Conclusions:The IOC during LC is easy to perform.It can not only reduce the incidence of residual bile stones and bile duct injury but also improve the therapeutic effect of LC.