Health and Family Planning Commission of Hubei Province

INTRODUCTION: In China, the severity of medical disputes has greatly increased during the past two decades, which has caused various adverse outcomes for health professionals. Previous research on violence in healthcare settings has primarily examined the occurrence of patient-initiated violence and its effects on physicians, but few studies have focused on the impact of the extent of physicians' exposure to violence. This study examined the different frequency levels of specific types of violence and their relationships to physicians' psychological wellbeing, including emotional exhaustion (EE), job satisfaction (JS), and intention to leave (IL). METHODS: Using a stratified random sampling method, the participants were drawn from 123 public hospitals in Shanghai, Hubei Province, and Gansu Province in China, and 1,656 completed questionnaires were collected. Chi-square test, analysis of variance, and mixed linear model were employed in the analysis. RESULTS: The results showed that the rate of exposure to verbal abuse (VA) was the highest (92.75%), followed by threats of assault (TA, 88.10%) and physical assaults (PA, 81.04%). Physicians' reported high-frequency exposure to VA, TA, and PA was 35.14%, 27.72%, and 19.32%, respectively. The results indicated that exposure to violence significantly affected EE, JS, and IL, and the intensity of the harm of high-frequency exposure was several times stronger than that of low-frequency exposure. Interestingly, we found that VA produced a greater adverse impact on physicians' EE and satisfaction with work (JS-1) than did TA or PA. This finding may be attributed to the fact that physicians are more likely to be exposed to a high frequency of VA, and the effect of high-frequency exposure is much stronger. CONCLUSION: The results indicated that decreasing violent incidents and creating a safer work environment for physicians should be a top priority for both government and society.

BACKGROUND: Public health emergencies have challenged the public health emergency management systems (PHEMSs) of many countries critically and frequently since this century. As the world's most populated country and the second biggest economy in the world, China used to have a fragile PHEMS; however, the government took forceful actions to build PHEMS after the 2003 SARS outbreak. After more than one decade's efforts, we tried to assess the improvements and problems of China's PHEMS between 2002 and 2012. METHODS: We conducted two rounds of national surveys and collected the data of the year 2002 and 2012, including all 32 provincial, 139 municipal, and 489 county CDCs. The municipal and county CDCs were selected by systematic random sampling. Twenty-one indicators of four stages (preparation, readiness, response and recovery) from the National Assessment Criteria for CDC Performance were chosen to assess the ten-year trends. RESULTS: At the preparation stage, organization, mechanisms, workforce, and stockpile across all levels and regions were significantly improved after one decade's efforts. At the readiness stage, the capability for formulating an emergency plan was also significantly improved during the same period. At the response stage, internet-based direct reporting was 98.8%, and coping scores were nearly full points of ten in 2012. At the recovery stage, the capabilities were generally lower than expected. CONCLUSIONS: Due to forceful leadership, sounder regulations, and intensive resources, China's PHEMS has been improved at the preparation, readiness, and response stages; however, the recovery stage was still weak and could not meet the requirements of crisis management and preventive governance. In addition, CDCs in the Western region and counties lagged behind in performance on most indicators. Future priorities should include developing the recovery stage, establishing a closed feedback loop, and strengthening the capabilities of CDCs in Western region and counties.

Nuclear factor I/B (NFIB) is a widely studied transcription factor that participates in tumor progression; nevertheless, studies on NFIB in colorectal cancer (CRC) are limited. In our study, Western blot and RT-PCR analyses showed that NFIB was overexpressed in CRC tissues and cell lines, which was consistent with our bioinformatic analysis results. Furthermore, NFIB expression was closely related to the TNM stage of CRC. NFIB promoted cell proliferation and migration and inhibited cell apoptosis in vitro. Meanwhile, we discovered that NFIB accelerated xenograft tumor growth in vivo. In addition, NFIB weakened the sensitivity of CRC cells to 5-fluorouracil (5-FU). NFIB induced epithelial-mesenchymal transition (EMT) by upregulating snail expression, which was accompanied by decreased E-cadherin and Zo-1 expression and increasedd Vimentin expression. Because the Akt pathway plays an important role in CRC progression, we examined whether there was a correlation between NFIB and the Akt pathway in cell proliferation and migration. Our results showed that NFIB promoted cell proliferation and increased 5-FU resistance by activating the Akt pathway. In summary, our findings suggested that NFIB induced EMT of CRC cells via upregulating snail expression and promoted cell proliferation and 5-FU resistance by activating the Akt pathway.

OBJECTIVE: The association between 25-hydroxyvitamin D (25(OH)D) and maternal depression (MD) is deemed to be inconclusive. The current analysis aimed to quantify the relationship between 25(OH)D serum concentrations, the main indicator of vitamin D nutritional status, and MD. DESIGN: Dose-response meta-analysis. SETTING: A systematic search in PubMed, Embase and Web of Science from inception to June 2019. PARTICIPANTS: Relevant observational studies reporting risk estimates and 95 % CI of random effects for 25(OH)D concentration on MD were identified. RESULTS: Twelve observational studies with thirteen independent reports involving 10 317 pregnant women were included. Compared with the lowest category of 25(OH)D, the pooled OR for the highest category of MD was 0·49 (95 % CI 0·35, 0·63); a high heterogeneity was observed (P = 0·001, I2 = 82·1 %). A non-linear association between 25(OH)D and MD was found (P for non-linearity = 0·001); the dose-response analysis indicated that the lowest pooled OR was at blood 25(OH)D concentrations of 90-110 nmol/l. Subgroup analyses suggested a stronger association between 25(OH)D and MD in summer time (OR 0·25, 95 % CI 0·08, 0·43) than in other seasons (OR 0·68, 95 % CI 0·52, 0·83) (P for interaction = 0·008). A visual inspection of funnel plot and Begg's and Egger's tests did not indicate any evidence of publication bias. CONCLUSIONS: Low circulating 25(OH)D is associated with MD, and our analysis suggests that they influence each other. Further randomised controlled trials would be needed to determine the direction of causation.

OBJECTIVE: This study analysed differences in the perceived patient safety climate among different working departments and job types in public general hospitals in China. DESIGN: Cross-sectional survey. SETTING: Eighteen tertiary hospitals and 36 secondary hospitals from 10 areas in Shanghai, Hubei Province and Gansu Province, China. PARTICIPANTS: Overall, 4753 staff, including physicians, nurses, medical technicians and managers, were recruited from March to June 2015. MAIN OUTCOME MEASURE: The Patient Safety Climate in Healthcare Organisations (PSCHO) tool and the percentages of 'problematic responses' (PPRs) were used as outcome measures. Multivariable two-level random intercept models were applied in the analysis. RESULTS: A total of 4121 valid questionnaires were collected. Perceptions regarding the patient safety climate varied among departments and job types. Physicians responded with relatively more negative evaluations of 'organisational resources for safety', 'unit recognition and support for safety efforts', 'psychological safety', 'problem responsiveness' and overall safety climate. Paediatrics departments, intensive care units, emergency departments and clinical auxiliary departments require more attention. The PPRs for 'fear of blame and punishment' were universally significantly high, and the PPRs for 'fear of shame' and 'provision of safe care' were remarkably high, especially in some departments. Departmental differences across all dimensions and the overall safety climate primarily depended on job type. CONCLUSIONS: The differences suggest that strategies and measures for improving the patient safety climate should be tailored by working department and job type.

INTRODUCTION: Substantial resources have been expended on clinical pathways (CPs), but the reported effects of CPs on medical care vary considerably. This study sought to determine the effects of CPs on medical care in Chinese hospitals, including the perceived effects of CPs on medical care and the objectively measured patient outcomes. METHODS: Study data were obtained from 54 public hospitals in three provinces of China in 2015. Hospital questionnaires, employee surveys, and chart reviews were used to collect data related to hospital characteristics, the implementation of CPs and compliance status, perceived effects of CPs, and objectively measured patient outcomes. Logistic regression models and linear regression models were adopted in this study. RESULTS: The effects of CPs were not highly perceived by the hospitals or by the managers and physicians in China. The relatively low involvement in the implementation of and adherence to CPs resulted in CPs having no significant effects on hospital medical care as a whole. However, a chart review of 5 conditions in Chinese hospitals demonstrated that compliance with national CPs reduced the length of stay (LOS) and inpatient medical costs. CONCLUSIONS: CPs should be implemented widely and followed closely to improve hospital medical care as a whole, and further studies should be conducted to identify the key elements of the effects of CPs on patient clinical outcomes.

MicroRNA-125a (miR-125a) is related to the occurrence, development, and prognosis of various cancers according to relevant reports. However, its function role and mechanism in non-small cell lung cancer (NSCLC) is yet to be explored. Herein, we investigated the role and preliminary mechanism of miR-125a in NSCLC. First, miR-125a was noticeably downregulated in NSCLC tissues in contrast to adjacent normal tissues through the real-time quantitative polymerase chain reaction (RT-qPCR) assay. The inverted result was observed on the STAT3 and HAS1 expressions. Moreover, miR-125a was expressed at highest level in A549 among four human NSCLC cell lines. Second, functional studies indicated miR-125a restrained proliferation, invasion, migration, metastasis, and advocated apoptosis of NSCLC cells, but had no obvious effect on cell cycle. Next, results indicated that a target of miR-125a was STAT3 on the basis of prediction and confirmation by the dual-luciferase reporter assay. RT-qPCR and Western blot assays displayed that miR-125a overexpression conspicuously constrained STAT3 expression at messenger RNA and protein levels. Finally, the binding between HAS1 promoter region and STAT3 was predicted by PROMO database analysis and verified by chromatin immunoprecipitation assay, suggesting that STAT3 was bound with the HAS1 promoter regions. STAT3 overexpression exerted positive effects on HAS1 expression at protein and mRNA levels. Additionally, HAS1-related functional studies illustrated HAS1 pronouncedly suppressed the proliferative, invasive, and migratory potential of NSCLC cells in vitro. Collectively, our findings demonstrated that miR-125a prohibited the proliferation, invasion, and migration of NSCLC cells by HAS1 expression reduction as a result of inhibiting STAT3 expression in NSCLC. This study indicated that miR-125a might be of potential or value for NSCLC treatment.

We recently showed that ticagrelor reduced myocardial ischemia-reperfusion injury (IRI) and downregulated galectin-3 in the ischemic myocardium. This study tested the hypothesis that ticagrelor could reduce IRI through the NF-κB pathway. Rats were randomly divided into sham-operated group, placebo group (gastric administration of saline after IRI), ticagrelor group (gastric administration of ticagrelor after left anterior descending artery ligation), dextran sodium sulfate (DSS) group (DSS was added to drinking water 7 days before IRI), and DSS + ticagrelor group (DSS was added to drinking water 7 days before IRI and gastric administration of ticagrelor after left anterior descending artery ligation). Ticagrelor significantly reduced the infarct size and plasma cTnI at 3 and 7 days after IRI, significantly downregulated protein and mRNA expressions of NF-κB and galectin-3, and mRNA expressions of IL-6 and TNF-α in the ischemic area at 24 hours, 3 and 7 days after IRI. Ticagrelor also significantly decreased plasma high-sensitivity C-reactive protein and NT-proBNP levels at 24 hours and 3 days after IRI. Furthermore, pretreatment with DSS blocked the beneficial effects of ticagrelor. Our study indicates that the cardioprotective effect of ticagrelor might be partly mediated by inhibiting the NF-κB pathway in this rat model of IRI.

Aim: The aim of the study was to provide evidence for the prevention and reduction of falls in the elderly living in rural areas by analyzing epidemiological data of falls among the rural older people (>65 years old) and identifying the risk and protective factors. Methods: This study analyzed the sociodemographic characteristics, living environment, lifestyle, chronic disease condition, mental health, activities of daily living (ADL), and detailed information of falls of 3752 rural elderly. Rank tests, chi-square tests, and binary logistic regression were used for data analysis. Results: The prevalence of falls was 30.0%, and the 75-84-years age group had the highest fall rate (18.8%). According to the binary logistic regression analysis, six variables, including roughage intake frequency, age, gender, cane use, floor tiles, and IADL, were involved in the fall patterns. Low roughage intake (OR = 2.48, 95% CI 1.24-4.97), female gender (OR = 2.12, 95% CI 1.48-3.05), the use of a cane (OR = 2.11, 95% CI 1.08-4.10), and medium IADL (OR = 2.02, 95% CI 1.89-2.32) were the top four risk factors. Conclusion: The fall in the rural elderly was mainly due to the poor living and working conditions. Routine fall assessment could address several preventable risk factors to reduce the prevalence and mitigate the harm of falls.

OBJECTIVE: This study aimed to analyze the potential difference in patient safety climate by region (Shanghai vs Hubei Province vs Gansu Province) and general public hospital level (tertiary vs secondary) in China. METHODS: Using a stratified sampling method, employees from 54 public general hospitals in Shanghai, Hubei Province, and Gansu Province in China were surveyed in 2015. The Patient Safety Climate in Health Care Organizations tool and the percentage of "problematic responses" (PPRs) were used to measure and analyze the patient safety climate. A χ2 test and hierarchical linear modeling were applied for the analysis. RESULTS: In the study, 4121 valid questionnaires were collected. The psychometric analysis supported the validity and reliability of our Chinese version of the Patient Safety Climate in Health Care Organizations. The overall patient safety climate was relatively good and exhibited no significant differences among the surveyed hospitals by various regions (Shanghai vs Hubei Province vs Gansu Province) and diverse hospital levels (tertiary vs secondary) using hierarchical linear models. "Fear of blame and punishment" and "fear of shame" had the highest PPRs and were prevalent in various types of hospitals. "Provision of safe care" and "organizational resources for safety" also had notably high PPRs. There were 4 dimensions varied by region and hospital level in this survey. CONCLUSIONS: Fear of shame and fear of blame are the most important barriers to the improvement of patient safety in the hospitals of China. Facility characteristics contributed somewhat to hospital patient safety climate in some dimensions. The initiatives to improve hospital patient safety climate are necessary and its implementation strategies needs to be shared.

RATIONALE: Vaginal cuff dehiscence and evisceration constitute a rare but potentially life-threatening event that usually occurs in postmenopausal patients who have undergone hysterectomy. This is a valuable case of spontaneous transvaginal evisceration without pelvic surgery history. PATIENT CONCERNS: A 74-year-old postmenopausal woman with an obstetric history of 7 full term vaginal deliveries, experienced sudden evisceration when she attempted to defecate. DIAGNOSES: Spontaneous vaginal cuff dehiscence and multiorgan evisceration. INTERVENTIONS: After physical examination and fluid resuscitation, the patient had underwent the Hartmann's procedure, total hysterosalpingo-oophorectomy, sacrocolpopexy, and posterior colporrhaphy. OUTCOMES: The patient recovered well and the constipation symptoms have significantly improved. One-year follow-ups examination revealed complete healing of the vaginal cuff, and there was no evidence of prolapse. LESSONS: We report a case of spontaneous vaginal cuff evisceration without pelvic surgery history but with constipation and redundant sigmoid colon. After resecting the necrotic sigmoid colon, the patient's constipation symptoms significantly improved. It is reasonable to speculate that the etiology was related to severe sigmoidocoele.

YMSM who had engaged in casual sex, practicing unprotected sex or having multiple sexual partners, were recognized as high risk population. Targeted intervention programs are needed to decrease the one-night-stand behavior. Internet intervention strategy seemed an important method to serve the purpose.

Background: In November 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated their definition of hypertension from 140/90 mm Hg to 130/80 mm Hg. Objectives: We sought to assess the situation of hypertension and the impact of applying the new threshold to a geographically and ethnically diverse population. Methods: We analyzed selected data on 237,142 participants aged ≥40 who had blood pressure taken for the 2014 China National Stroke Screening and Prevention Project. Choropleth maps and logistic regression analyses were performed to estimate the prevalence, geographical distribution and risk factors of hypertension using both 2017 ACC/AHA guidelines and 2014 evidence-based guidelines. Results: The present cross-sectional study showed the age- and sex-standardized prevalence of hypertension was 37.08% and 58.52%, respectively, according to 2014 evidence-based guidelines and 2017 ACC/AHA guidelines. The distribution of hypertension and risk factors changed little between guidelines, with data showing a high prevalence of hypertension around Bohai Gulf and in south central coastal areas using either definition. The age- and sex-standardized prevalence of newly labeled as hypertensive was 21.44%. Interestingly, the high prevalence region of newly labeled as hypertensive was found in the north China. Conclusion: The prevalence of hypertension increased significantly on 2017 ACC/AHA guidelines compared to the prevalence when using 2014 evidence-based guidelines, with high prevalence areas of newly labeled as hypertensive now seen mainly in north China. There need to be correspondingly robust efforts to improve health education, health management, and behavioral and lifestyle interventions in the north.

OBJECTIVE: This work aims to collect and summarize the outcomes on free preconceptual screening examination in rural areas of Hubei Province in 2012. Moreover, this review promotes further understanding of the status of this activity to provide the Family Planning Commission valid scientific data upon which to construct effective policies. METHODS: Couples, who complied with the family planning policy and were the residents in agricultural areas or lived in a local rural area for more than six months, were encouraged to participate in the free preconceptual screening examination service provided by the Hubei Provincial Population and Family Planning Commission. This service included 19 screening tests. All the data, including forms, manuals, and test results, were collected from 1 January 2012 to 31 December 2012 in rural areas in Hubei Province. RESULTS: A total of 497,860 individuals participated in the free preconceptual screening examination service, with a coverage rate of 97.1%. 4.0% and 4.8% of the participants exhibited with abnormal blood levels of ALT and creatinine, respectively; 0.36% of the participants tested positive for syphilis; 0.44% and 3.6% of the female participants tested positive for Neisseria gonorrhoeae and Chlamydia trachomatis, respectively; and 0.84% and 1.8% of the female participants tested positive for cytomegalovirus (IgM) and Toxoplasma gondii (IgM), respectively. After risk assessment, 59,935 participants might have high-risk of adverse pregnancy outcomes. In 2012, the prevalence of birth defects among the parturient who participated in the preconceptual screening examination service was 0.04%, while the prevalence was 0.08% among those who did not participate in the service. CONCLUSION: Preconceptual screening examination service may help to address the risk factors that can lead to adverse pregnancy outcome. More studies on the relationship between preconceptual screening examination service and prevalence of birth defect or other adverse pregnancy outcomes should be conducted.

INTRODUCTION Since computed tomography (CT) was invented and used clinically or in research, it is currently widely used in the diagnosis, staging, assessment of disease response to treatment, with clearer image quality and shorter scanning time. There are many diseases which are not easily found at an early stage with noticeable symptoms, unknowingly spread the infection to others and are easily missed. When clinical symptoms appear, the disease may have been on late stage, its therapeutic efficacy and prognosis will be significantly worse. CT can be used for screening of asymptomatic population and individual health assessment (IHA), improving the detection rate of diseases, achieving early diagnosis and early treatment of diseases, thus improving the survival rate of patients. Radiation production is inevitable during CT scans, despite protective measures are improving continuously. Among the radiation doses of which the examinees received, the proportion of CT examination as a source of radiation is increasing. How to use CT rationally for IHA in asymptomatic population and to reduce the radiation dose of CT has become a research hotspot. In 2014, WHO held an international summit on “the reasonable application of CT in the IHA of asymptomatic population” in Munich, Germany, and reached a consensus. At present, the European and American countries have more studies on the usage of CT for IHA in an asymptomatic population with lung cancer, colorectal cancer, and coronary heart disease and have established a relevant strategy. This paper summarizes and analyses the utilization of CT and associated radiation-dose reduction in asymptomatic population in China. FEASIBILITY AND NECESSITY OF THE USE OF COMPUTED TOMOGRAPHY FOR INDIVIDUAL HEALTH ASSESSMENT IN ASYMPTOMATIC POPULATION IN CHINA CT is currently developing very rapidly within the last decade. Up-to-dated technologies are emerging. The sophisticated CT which has been launched since 2008 is called as “after 64 row CT”.[1] High-tech CT with its associated hardware and software are progressing. The problem of CT scanning dose has been one of the main factors restricting the development of CT and attracted wide attention. The effective methods to reduce CT radiation dose to patients includes the use of a prospective electrocardiogram (ECG) triggering of the scan, dual source CT (DSCT) and higher helical pitch, and “projection space denoising” technique.[2] Radiation dose has been significantly reduced. Currently, there are more than 10,000 CT scanners in hospitals in China. Rural community hospitals have one or more CT scanners. The capacity of having CT scanners is 8.6 per million populations.[3] The price of CT examination is relatively cheap in China, such as 15–32 € per plain CT head examination. The amount of CT examination is rising progressively. According to the United Nations Scientific Committee on the Effects of Atomic Radiation, the medical use radiation-dosage accounts for 98.2% of all man-made radiation dose, whereas among the medical diagnostic modalities, CT as a source of radiation has the highest proportion.[4] International Commission on Radiological Protection (ICRP) proposed that X-ray radiation dose of 1 mSv received will increase the incidence of malignant tumors of 5/100,000.[5] CT may cause higher collective medical radiation-dose received by examinees, while for same diagnostic tests in different hospitals, their radiation-dose received by patients is somewhat different. There are two reasons: (1) the equipment and technique parameter are different among hospitals, (2) there are no consensus guidelines for CT scanning parameters in China. CT technologists in some hospitals have no enough awareness of low-dose scanning. Clinically, asymptomatic population fails to show noticeable symptoms in the early stage of disease, and few of them receive treatment. Thus, the rational use of CT for IHA in an asymptomatic population is feasible and necessary in China. COMPUTED TOMOGRAPHY RADIATION-DOSE INDEX The common indicators of the CT radiation-dose measurement are volume CT dose index (CTDIvol), dose length product (DLP), and effective dose (ED). CT radiation dose was positively correlated with these three indices.[6] CTDIvol refers to the ratio of total radiation-dose absorbed by patient to X-ray beam width (mGy) during a CT examination. CTDIvol reflects the physical quantity of radiation-dose received by the subject. In general, the greater the CTDIvol, the more severe the biological effects caused by the radiation, and the more serious the damage to the body. DLP refers to CTDIvol × scan length. DLP is positively proportional to scan length, so that DLP implies the total radiation-dose received by patient during CT examination, and can be evaluated as random effects of radiation hazard index. ED = DLP × k (mSv), which does not refer to an ED but rather accumulative exposure to the risk of ionizing radiation, such as inducing cancer, can fully evaluate radiation to different tissues and organs, which unit is mSv. RATIONAL USE OF COMPUTED TOMOGRAPHY FOR INDIVIDUAL HEALTH ASSESSMENT IN ASYMPTOMATIC POPULATION IN CHINA The rational use of low-dose CT (LDCT) for IHA in the asymptomatic population may improve lesion-detection performance. In 1977, ICRP[7] proposed three principles of medical radiation protection including the legitimate practice, optimization of medical radiation protection, and limitation of an individual dose. Its main purpose is to optimize radiological diagnosis through the protection and implementation of quality assurance programs, so that good image quality can be obtained while radiation dose of patients can be reduced.[8] In 1990, after Naidich et al.[9] first proposed the concept of LDCT, while either CT manufacturers, physicists, or medical staff engaged in dose-radiation protection are doing the research constantly on LDCT scanning parameters settings and related technologies. The study of LDCT in foreign countries has started earlier, the research scope and the level of the research are more comprehensive and in-depth. The authors have sorted the relevant literature on the use of CT for IHA in an asymptomatic population in China and conducted the analysis and summary. Chest Based on the latest foreign guidelines of lung cancer screening, in 2015, a cardiothoracic group of Chinese Society of Radiology (CSR) launched the latest Chinese Experts’ Consensus[10] on low-dose spiral CT for lung cancer screening in 2015. They recommended LDCT screening for lung cancer in the high-risk Chinese population of lung cancer, and suggested that the high risk patients are defined as: 50–75 years of age; and at least one of the following risk factors: (1) smoking ≥20 pack/year, including those with past smoking history, but <15 years of smoking cessation; (2) passive smokers; (3) occupational exposure history (asbestos, beryllium, uranium, radon, etc.); (4) with a history of malignancy or a family history of lung cancer; and (5) with chronic obstructive pulmonary disease or diffuse pulmonary fibrotic disease. The LDCT scanning technology requirements including CT of above 16 rows for lung cancer screening is recommended. The scanning range is from the apex to the costophrenic angle level. For helical scanning mode, the pitch setting is ≤1, gantry rotation time is ≤1.0 s, scanning matrix set is not <512 × 512 (specific technical parameters are set based on different models), with large visual field (field of view = L); those with no iterative reconstruction technique can use the scanning parameters of 120 kV, 30–50 mAs, whereas those with new generation of iterative reconstruction technique can use 100–120 kV, <30 mAs as scanning parameters; if the reconstruction slice thickness is ≤0.625 mm, gapless reconstruction can be performed, if reconstruction slice thickness ranged from 0.625 to 1.25 mm, reconstruction interval should be ≤80% of slice thickness; reconstruction is performed by using standard algorithm, or pulmonary algorithm with standard algorithm. During the procedure, it is recommended to activate the “dose report” function, so that automatically generated dose report by the device will be stored for routine storage. Lung cancer screening is still controversial worldwide. While assuring the important significance of screening for lung cancer for detection of early lesions and reduction of the mortality of lung cancer, it still has many problems which need to improve. The main problems include a choice of screening tools, screening team quality, appropriate screening object, and establishing a sound screening program and guidelines. Munich conference expert consensus: (1) IHA CT for lung cancer detection should not be provided to the people under 55 years of age; (2) IHA CT detection of lung cancer should not be provided to population with no smoking history, or daily smoking history of one pack but <20 years and no other risk factors; and (3) personal risk prediction model should be used to select those who have lung cancer risk. IHA CT can be provided to the asymptomatic population equivalent to 5% of the risk of lung cancer in 5 years. If the risk is low, IHA CT can also be provided, but the assessment of risks versus benefits is needed. Annual or biannual screening can be provided to the population of 55–74 years of age; (4) IHA CT should be provided by radiologists and physicians of respiratory medicine; (5) the relevant information and knowledge of risk and benefit of CT IHA should be explained in detail to nonprofessionals. Currently, most IHA focus on the detection of early stage lung cancer and lung damage of asymptomatic smokers in China.[11] LDCT for lung IHA has a high sensitivity in early detection of asymptomatic lung cancer.[11] Patients only need to receive fewer radiation dose and similar images as produced by conventional dose can be obtained, thus the radiation dose can be minimized and diagnosis can be made. LDCT for IHA in asymptomatic population detects early-stage lung cancer more as compared to conventional X-ray examination.[12] Li et al.[13] compared radiation dose of lung LDCT and that of conventional-dose examination. 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OBJECTIVE: To understand the HIV infection status in middle aged and old men and the association between HIV infection and female sex workers in a city in Hubei province and provide evidence for the targeted prevention and control of HIV infection. METHODS: Ten communities/villages were selected through stratified cluster sampling from the suburban and rural areas of the city. A total of 634 men aged ≥50 years were surveyed by using self-designed questionnaire in December, 2014. RESULTS: The awareness rate of HIV/AIDS related knowledge was 13.3%(68/513). Among the men surveyed, 63.2%(371/587)thought they couldn't be infected with HIV, 9.1%(52/573)believed that extramarital sex is acceptable, and 32.4%(189/583)considered that commercial sexual behavior is just as well. Among the surveyed men reporting sexual behavior in the past 6 months, 6.6%(15/228)had sex with regular sexual partners, in which 63.6%(7/11)never used condoms, 21.8%(128/586)reported that some friends had commercial sexual behaviors. Among 601 men receiving HIV testing, 7 were HIV positive(1.2%). The HIV detection rates among the men living at 3 communities near red light district were 4.2%(5/119), 1.1%(1/95)and 0.5%(1/192)respectively; while no HIV infections were found in the men living at 2 towns far away from red light district. Seventy seven of 581 men surveyed(13.2%)reported to meet visiting female sex workers and they had higher HIV positive rate(5.2%, 4/77)than those without such experiences(0.6%, 3/504)(P=0.007). CONCLUSION: The middle aged and old men in this city had low awareness of HIV/AIDs related knowledge, and high-risk sexual behaviors existed among them. HIV positive rate was relatively high in this population, and HIV infection might be associated with sex service.

OBJECTIVE: To investigate the effect of α-lipoic acid on the oxidative stress of wound tissues and diabetic wound healing in mice with diabetic feet. METHODS: TU), respectively, with the treatment of α-lipoic acid. The wound healing was observed and wound area was measured at 7 and 14 days. The wound tissues were harvested to detect the levels of superoxide dismutase (SOD) and glutathione (GSH) using xanthine oxidase method and 5, 5-dithiobis-2-nitrobenzoic acid staining method at 14 days. At the same day, 7, and 14 days after modeling, the relative miR-29b expression in wound tissues from control and α-lipoic acid-treated model groups was detected by real-time fluorescence quantitative PCR. RESULTS: <0.05). CONCLUSIONS: α-lipoic acid could inhibit oxidative stress and promote diabetic wound healing by suppressing expression of miR-29b in mice.

OBJECTIVE: To explore the association between sexual sensation seeking and risk sexual behaviors among young men who have sex with men (YMSM) who were under 25 years old. METHODS: 403 YMSM were recruited through online publicity, organization of outdoor activities together with HIV voluntary counseling and testing services from May to November in 2013. A total number of 375 (93.05%) valid questionnaires were received. RESULTS: Data showed that, among the 375 YMSM, 37.9% had sex with men for the first time without using a condom, 55.7% had multiple sexual partners, 51.7% had one-night stand, and 5.6% engaged in group sex activities. Results from correlation analysis showed that sexual sensation seeking was positively correlated with four risk sexual behaviors (r = 0.247, 0.218, 0.296 and 0.252, respectively). Data from the Unconditional logistic regression analysis showed that YMSM with high sexual sensation seeking were more likely to engage in risk sexual behaviors. CONCLUSION: Sexual sensation seeking was associated with risk sexual behaviors among YMSM. More knowledge and behavior education based on the sexual sensation seeking should be emphasized, as well as increasing the awareness on HIV-related risk sexual behaviors.

Objective To study the compliance of medical care with corresponding national clinical pathways for inpatients of cholecystectomy for cholecystolithiasis with acute cholecystitis at public hospitals of China. Methods Thirty medical records of the inpatients with cholecystectomy admitted in 2014 were randomly sampled from 18 public hospitals in Shanghai, Hubei province and Gansu province, for assessment on their compliance with corresponding national clinical pathways. Results The average compliance rate of inpatient care of cholecystectomy at public hospitals was 67.7%. The study found low compliance rates in both severity assessment and timely examinations/diagnosis within two days after admission (5.8% and 35.3%, respectively). Conclusions Public hospitals in China should strengthen their supervision over the medical care process for inpatients of cholecystectomy with acute cholecystitis, and the clinical pathways in question should be updated and improved in time. Key words: Clinical pathway; Medical quality; Process assessment; Public hospital; Cholecystectomy

Background: Coronavirus disease (COVID-19) remains one of the most significant factors threatening public health security worldwide. The COVID-19 pandemic has been ongoing for more than 3 years; however, there are few studies on the clinical characteristics and mortality risk factors in patients with COVID-19 based on comprehensive data from multiple centers. Methods: A total of 53,030 patients with confirmed COVID-19 from 138 hospitals in Hubei Province were included in this study. We compared the clinical characteristics between survivors and non-survivors and analyzed the risk factors for in-hospital mortality. Results: Among the 53,030 patients with COVID-19, 49,320 (93.0 %) were discharged, and 3,710 (7.0 %) died during hospitalization. Cardiovascular disease was the most common comorbidity, followed by endocrine and digestive diseases. Male sex, >65-year-old, and high diastolic blood pressure, a series of abnormal laboratory test indicators and hyponatremia, hypokalemia, acute respiratory distress syndrome, shock, solid tumor, hematological tumor, and insulin use were independent risk factors for in-hospital mortality of patients with COVID-19. In addition, male sex, older age, and higher disease severity were associated with increased mortality in patients with COVID-19. Conclusion: Patients with early COVID-19 in Hubei Province had high mortality and a high proportion of severe cases and initial comorbidities. Cardiovascular disease was the most common comorbidity in patients with COVID-19. Male sex, older age, comorbidities, and abnormal laboratory data have been identified as independent risk factors for in-hospital mortality in patients with COVID-19. Therefore, there should be an increased focus on patients with COVID-19 with these risk factors.