Research progress on the role and mechanism of endothelial dysfunction in hyperhomocysteine-induced atherosclerosis / 生理学报

Hyperhomocysteinemia (HHcy) is considered to be an independent risk factor for cardiovascular diseases, but the molecular mechanisms underlying its pathogenesis are not fully understood. Endothelial dysfunction is a key initiating factor in the pathogenesis of atherosclerosis, which is commonly observed in almost all HHcy-induced vascular diseases. HHcy promotes oxidative stress, inhibits nitric oxide production, suppresses hydrogen sulfide signaling pathway, promotes endothelial mesenchymal transition, activates coagulation pathways, and promotes protein N-homocysteination and cellular hypomethylation, all of which can cause endothelial dysfunction. This article reviews the specific links between HHcy and endothelial dysfunction, and highlights recent evidence that endothelial mesenchymal transition contributes to HHcy-induced vascular damage, with a hope to provide new ideas for the clinical treatment of HHcy-related vascular diseases.

Report content and prenatal diagnosis of non-invasive prenatal testing for sex chromosome aneuploidy / 中华妇产科杂志

Objective: To analyze the report content, the methods and results of prenatal diagnosis of high risk of sex chromosome aneuploidy (SCA) in non-invasive prenatal testing (NIPT). Methods: A total of 227 single pregnancy pregnant women who received genetic counseling and invasive prenatal diagnosis at Drum Tower Hospital Affiliated to the Medical School of Nanjing University from January 2015 to April 2022 due to the high risk of SCA suggested by NIPT were collected. The methods and results of prenatal diagnosis were retrospectively analyzed, and the results of chromosome karyotype analysis and chromosome microarray analysis (CMA) were compared. The relationship between NIPT screening and invasive prenatal diagnosis was analyzed. Results: (1) Prenatal diagnosis methods for 277 SCA high risk pregnant women included 73 cases of karyotyping, 41 cases of CMA and 163 cases of karyotyping combined with CMA, of which one case conducted amniocentesis secondly for further fluorescence in situ hybridization (FISH) testing. Results of invasive prenatal diagnosis were normal in 166 cases (59.9%, 166/277), and the abnormal results including one case of 45,X (0.4%, 1/277), 18 cases of 47,XXX (6.5%, 18/277), 36 cases of 47,XXY (13.0%, 36/277), 20 cases of 47,XYY (7.2%, 20/277), 1 case of 48,XXXX (0.4%, 1/277), 20 cases of mosaic SCA (7.2%, 20/277), 5 cases of sex chromosome structural abnormality or large segment abnormality (1.8%, 5/277), and 10 cases of other abnormalities [3.6%, 10/277; including 9 cases of copy number variation (CNV) and 1 case of balanced translocation]. Positive predictive value (PPV) for SCA screening by NIPT was 34.7% (96/277). (2) Among the 163 cases tested by karyotyping combined with CMA, 11 cases (6.7%, 11/163) showed inconsistent results by both methods, including 5 cases of mosaic SCA, 1 case of additional balanced translocation detected by karyotyping and 5 cases of additional CNV detected by CMA. (3) NIPT screening reports included 149 cases of "sex chromosome aneuploidy"(53.8%, 149/277), 54 cases of "number of sex chromosome increased" (19.5%, 54/277), and 74 cases of "number of sex chromosome or X chromosome decreased" (26.7%, 74/277). The PPV of "number of sex chromosome increased" and "number of sex chromosome or X chromosome decreased" were 72.2% (39/54) and 18.9% (14/74), respectively, and the difference was statistically significant (χ2=34.56, P<0.01). Conclusions: NIPT could be served as an important prenatal screening technique of SCA, especially for trisomy and mosaicism, but the PPV is comparatively low. More information of NIPT such as the specific SCA or maternal SCA might help improving the confidence of genetic counseling and thus guide clinic management. Multi technology platforms including karyotyping, CMA and FISH could be considered in the diagnosis of high risk of SCA by NIPT.

Preliminary study on the mechanism underlying the ecological isolation of Oncomelania hupensis populations in Changde City / 中国血吸虫病防治杂志

Objective To investigate ecological isolation between Oncomelania hupensis snail populations in hilly regions and marshland and lake regions in Yuanjiang valley, Changde City, Hunan Province, and to unravel its underlying mechanisms. Methods Taoyuan County, Shimen County, Linli County and Lixian County in Changde City were selected as snail sampling sites in hilly regions, and Lixian County, Jinshi City, West Lake Administration District, Hanshou County and Dingcheng District were selected as snail sampling sites in marshland and lake areas. Cytochrome C oxidase 1 (cox 1) gene was amplified in snail samples and sequenced. The genetic sequences of O. hupensis snails were aligned using the software MEGA 11, and the haplotypes of O. hupensis snails were determined using the software DNASP 5.10.01. The phylogenetic tree was generated using Bayesian inference with the software MrBayes 3.2, and analysis of molecular variance (AMOVA) was performed to analyze the source of genetic divergence and estimate the genetic divergence index (FST) among snail populations with the software Arlequin 3.5.2.2. The genetic barrier among 11 O. hupensis snail populations was estimated using the Monmonier algorithm of adegenet toolkit in R package. The settings with “land in winter and water in summer” in the Yuanjian River section were divided into two categories according to the upstream and downstream, and the areas with “land in winter and water in summer” in the upstream and downstream were transformed into raster data, and then loaded into the software Fragstats 4 for analysis of landscape indicators. The trends in changes of digital elevation were extracted from the Yuanjiang River section based on the digital elevation model, and made three-dimensional visualization using the R package. Results The mitochondrial cox 1 gene were amplified in 165 O. hupensis snais from 11 sampling sites and sequenced, and a total of 152 valid gene sequences were obtained, with 46 haplotypes or 9 populations determined. No haplotype was shared in snails between Taoyuan County and Dingcheng District and Hanshou County along the downstream of the Yuanjiang River. The total area of settings with “land in winter and water in summer” was 617.66 hm2 in the upsteram of the Yuanjiang River, which consisted of 473 patches, with each patch measuring 1.31 hm2, the largest area index of 0.735 2, the landscape division index of 0.999 9, and the landscape shape index of 45.293 7. The total area of settings with “land in winter and water in summer” was 9 956.92 hm2 in the downstream of the Yuanjiang River, which consisted of 771 patches, with each patch measuring 12.91 hm2, the largest area index of 97.839 9, the landscape division index of 0.042 7, and the landscape shape index of 7.249 6. The area of settings with “land in winter and water in summer” was much larger in the downstream than that in the upstream of the Yuanjiang River, and the stronger landscape connectivity and non-remarkable alteration of riverbed elevation provided suitable habitats for snail breeding. Conclusion The hydrological and environmental characteristics of the upstream of the Yuanjiang River restrain the breeding and spread of O. hupensis, resulting in ecological isolation between Oncomelania hupensis in Taoyuan County and those in the downstream of Yuanjiang River.

Application of PBL teaching combined with flipped classroom in standardized residency training of orthopedics / 中华医学教育探索杂志

Objective:To explore the application of self-teaching model based on PBL teaching combined with flipped classroom in standardized residency training of orthopedics.Methods:There were 102 cases of residents who received standardized residency training from March 2017 to February 2018 in orthopedics department of Yueyang Hospital of Traditional Chinese and Western Medicine, among whom 55 were randomized into the observation group and 47 were divided into the control group. Traditional teaching was applied in the control group and self-teaching model was applied additionally in the observation group. At the end of the month, the teaching effect was evaluated by the department graduation examinations and questionnaire survey. SPSS 19.0 was used for t test. Results:The ability of history inquiry, diagnosis and physical examination of the residents in the observation group were higher than those in the control group. The self-study and data access ability, confidence in presenting, and satisfaction with teaching in the observation group were better than those in the control group.Conclusion:The self-teaching mode can arouse the learning initiative of residents, and increase residents' literature retrieval ability and their learning satisfaction.

Study on the hospitalization cost and its influencing factors of imported malaria patients in Guangxi Zhuang Autonomous Region and Yunnan Province / 中国血吸虫病防治杂志

Objective To analyze the hospitalization cost and its influencing factors of imported malaria patients in Guangxi Zhuang Autonomous Region and Yunnan Province, so as to provide insights into the evaluation of the economic burden due to imported malaria, and the guiding of malaria control and the rational allocation of medical resources. Methods The data pertaining to the hospitalization costs of imported malaria patients admitted to Shanglin County People’s Hospital in Guangxi Zhuang Autonomous Region during the period from January 1 through December 31, 2019, and Tengchong Municipal People’s Hospital in Yunnan Province from January 1, 2015 to December 31, 2019, were collected, and the epidemiological data of these imported malaria patients were extracted from the Information Management System for Parasitic Diseases Control and Prevention, China. The composition of the hospitalization expenses was analyzed using a descriptive method. In addition, the factors affecting the hospitalization expenses of imported malaria patients were identified using a univariate analysis and a recursive system model. Results A total of 206 imported malaria patients were included in this study, including 194 men (94.17%) and 12 women (5.83%). The mean length of hospital stay was 5.00 days per patient and the median hospitalization expenses were 2 813.07 Yuan per time, in which the expenses for laboratory examinations were the highest (45.31%, 1 274.62/2 813.07). Univariate analysis showed that hospital (z = 5.43, P < 0.01), type of malaria (χ2 = 34.86, P < 0.01) and type of payment (χ2 = 7.72, P < 0.05) were factors affecting the hospitalization expenses of imported malaria patients. Recursion system modeling revealed that the total effects on hospitalization expenses of imported malaria patients included length of hospital stay (0.78), selection of hospital (0.34), basic medical insurance for urban and rural residents (0.19), new rural cooperative medical care (0.17), Plasmodium falciparum malaria (0.15), gender (0.11) and P. vivax malaria (0.09). Conclusions The hospitalization expenses of imported malaria patients are affected by multiple factors in Guangxi Zhuang Autonomous Region and Yunnan Province, in which the length of hospital stay is the most predominant influencing factor. A reduction in the length of hospital stay is effective to decrease the hospitalization expenses of imported malaria patients.

A systematic review on the association between meteorological factors with traffic accident injury / 中华疾病控制杂志

In recent years, the impact of meteorological factors on health and injury has been paid more and more attention. Severe weather events were considered to be an important risk factor for traffic accident injuries. Evidence from a large number of epidemiological studies suggests that meteorological factors, including high temperatures, rainfall, snowfall, wind and visibility, might be related to the occurrence of traffic accidents. This systematic review attempts to summarize the current research status of meteorological factors on traffic accident injury, systematically review the relationship between meteorological factors and traffic accident injury, and discuss how to further carry out related research.

A study of factors related to aspirin-induced early phase gastric mucosal injury in elderly people / 中华老年医学杂志

Objective:To study clinical and genetic factors for early phase gastric mucosal injury due to long-term aspirin use in elderly people treated with angiotensin-converting enzyme inhibitors(AVCEI)/angiotensin II AT-1 receptor blockers(ARB)or statins.Methods:Four hundred and sixty-seven elderly persons taking 100 mg aspirin per day for a long time combined with ACEI/ARB or statins in our hospital were enrolled and retrospectively analyzed.According to endoscopy results, patients were divided into the normal gastric mucosa group(n=125), chronic gastritis group(n=199)and gastric mucosal erosion group(n=143). Clinical features and SLCO1B1 genetic polymorphisms affecting the absorption of ACEI/ARB and statins were statistically analyzed.Results:Compared with the normal gastric mucosa group, reduced glomerular filtration rate(GFR)was a risk factor for chronic gastritis and gastric mucosal erosion[(66.5±24.4) ml·min·1.73 m -2vs.(70.9±18.5) ml·min·1.73 m -2, OR=5.06, 95% CI: 2.14-11.51, P<0.01]. Advanced age[(78.5±10.1) years old vs.(71.5±9.6) years old, OR=1.33, 95% CI: 1.04-2.87, P<0.05], history of peptic ulcer[14.0% or 20/143 vs.5.6% or 7/125, OR=2.41, 95% CI: 1.08-5.01, P<0.05], no prescription of proton pump inhibitor[18.2% or 26/143 vs.50.4% or 63/125, OR=0.18, 95% CI: 0.11-0.31, P<0.01], lower GFR[(55.8±23.1) ml·min·1.73 m -2vs.(70.9±18.5) ml·min·1.73 m -2, OR=8.04, 95% CI: 3.02-22.6, P<0.01]and SLCO1B1*1b diplotype[42.0% or 60/143 vs.24.0% or 30/125, OR=2.64, 95% CI: 1.59-4.17, P<0.05]were risk factors for gastric mucosal erosion. Conclusions:The SLCO1B1*1b diplotype may increase the risk of gastric mucosal erosion induced by aspirin via weakening the protective effects of ACEI/ARB and statins on the gastric mucosa.Advanced age, a history of peptic ulcer, no prescription of proton pump inhibitors and renal function decline are risk factors for gastric mucosal injury.

Effectiveness of vaginal high uterosacral ligament suspension for treatment of recurrent pelvic organ prolapse / 中华妇产科杂志

Objective To evaluate the indications and clinic outcomes of vaginal high uterosacral ligament suspension (HUS) for treatment of recurrent advanced pelvic organ prolapse (POP). Methods This retrospective study analyzed 42 women with recurrent advanced POP who were referred to Fourth Medical Center of PLA General Hospital and underwent transvaginal HUS between November 2005 and January 2018. Primary surgeries included 30 vaginal colporrhaphy, 5 Manchester operation, 5 transvaginal mesh repair,2 sacrospinous ligament fixation.The median time for recurrence from primary pelvic floor repair surgery was 9 months, including 14 cases (33%, 14/42)≤3 months (median time was 2 months) and 25 cases (67%, 28/42) longer than 3 months (median time was 18 months).The rate of recurrent prolapse in stageⅢorⅣ was 79% (33 cases), 45% (19 cases) and 17%(7 cases) in anterior, apical and posterior compartment respectively. Results Transvaginal high bilateral uterosacral ligaments were identified and used for successful vaginal vault suspension after vaginal hysterectomy and residual cervical resection in all 42 consecutive patients. The cases of transvaginal mesh used in anterior wall and posterior wall were 25 (60%, 25/42) and 3 (7%, 3/42) respectively. There was no major intra-and postoperative complications,such as ureter and other pelvic organ injury. The median time of follow-up was 5.3 years after transvaginal HUS. The points of pelvic organ prolapse quantification system reduced significantly and point C improved from+0.3 cm to-8.2 cm after reoperation (P<0.01). The objective cure rate were 100% (42/42) both in apex and posterior compartment,while 93% (39/42) in anterior compartment. None had reoperation or pessary usage for recurrence of prolapse. Conclusion Transvaginal HUS with vaginal wall repair could be as a safety, cost-effective, minimal traumatic and durable procedure for recurrent POP in the most of cases.

Clinical Value of Extravascular Lung Water Monitoring for Rapid Recovery in Pediatric Patients After Complete Repair of Tetralogy of Fallot / 中国循环杂志

Objective: To explore the clinical value of extravascular lung water monitoring for rapid recovery in pediatric patients after complete repair of tetralogy of Fallot (TOF). Methods: A total of 43 pediatric patients received complete repair of TOF were studied. The pulse contour cardiac index (PCCI), global end diastolic volume index (GEDI), stroke volume variation (SVV), systemic vascular resistance index (SVRI), global ejection fraction (GEF), maximum of pressure increase in aorta (dPmax), extravascular lung water index (EVWI) and pulmonary vascular permeability index (PVPI) were recorded by pulse-indicated continuous cardiac output (PICCO) monitoring at immediately enter pediatric ICU (PICU) and 6h, 12h, 18h, 24h post-operation. Meanwhile, the heart rate, blood pressure, central venous pressure (CVP), left atrium pressure (LAP) and balance of liquid were monitored; mechanical ventilation time, PICU stay time, re-intubation,re-occlusion of major aortopulmonary collateral arteries (MAPCAs) and other complications were recorded. Based on post-operative mechanical ventilation time, the patients were divided into 2 groups: Rapid recovery (R) group, patients with mechanical ventilation≤24h, n=29 and Delayed recovery (D) group, patients with mechanical ventilation>24h, n=14. Results: Compared with group D, group R had the shorter mechanical ventilation time (14.2±8.0) h vs (86.3±44.5) h and PICU stay time (2.5±1.7) days vs (5.3±3.6) days, both P<0.05; decreased PVPI at immediately enter PICU and 6h, 12h, 18h, 24h post-operation as (4.9±1.3 vs 6.4±1.5),(5.1±1.8 vs 6.5±1.3),(4.8±2.0 vs 6.5±1.6),(4.4±1.1vs 6.9±1.8), (4.4±2.5 vs 6.5±2.2) respectively, all P<0.05; Lower ELWI at 12h and 18h post-operation as(20.9±6.1) ml/kg vs (26.8±5.7) ml/kg and(19.1±5.5) ml/kg vs (26.7±5.5)ml/kg, both P<0.05. Group R had no patient received re-occlusion of MAPCAs after operation, while Group D had 3. No death, no catheter-related complication occurred in either group. Conclusion: MAPCAs may increase extravascular lung water, pulmonary vascular permeability and cause lung perfusion, therefore affect the early recovery of complete repair of pediatric TOF. PICCO monitoring may conduct bedside quantitative observation of lung perfusion, combining with ELWI and PVPI, clinicians may identify and manage MAPCAs as necessity for rapid recovery in relevant patients.

Clinical management of 110 cases of polypropylene mesh and sling exposure after reconstructive pelvic floor surgery / 中华妇产科杂志

Objective To explore the clinical management and outcomes of polypropylene mesh and sling exposure after reconstructive pelvic surgery(RPS). Methods A total of 110 cases of mesh and sling exposure after RPS were analyzed, who admitted between Jan. 2002 and Oct. 2017 in First Affiliated Hospital of PLA General Hospital, in which 3 cases were referred from other hospitals. Mesh and sling exposures were identified in the outpatient clinic and categorized and managed according to International Continence Society and International Urogynecology Association(ICS-IUGA)classification about category, time and site(CTS)of mesh complication. Outpatient management included observation, topical estrogen use and mesh removal. Management in hospital included surgical removal of exposed mesh and repair of the resulting defects under the anesthesia. Seventy-four cases were managed in the outpatient setting, and 36 cases required inpatient management. Follow-up was consecutively performed from 1 month to 10 years. Objective outcome included the surgeon′s assessment of the healing state of the vaginal mucosa. Subjective outcome was evaluated with patient global impression of improvement questionnaire(PGI-I). Results One hundred and ten patients with mesh exposure were classified according to the different RPS underwent. There were 95 cases from transvaginal mesh surgery, 5 cases from anti-stress urinary incontinence sling surgery, and 10 cases from sacrocolpopxy. The outpatient group healed at an average of(3.0 ± 1.8)months. Of the 36 patients who required inpatient management, 21 cases healed completely at an average of 7 days after one surgery. The remaining 8 cases required either two or three times surgeries or conservative management. In the outpatient group, the PGI-I scale very much better was found in 65 cases(87.8％)and much better in 9 cases(12.2％). In the inpatient surgery group, the scale was very much better in 30 cases (83.3％), and much better in 6 cases(16.7％). Conclusions Among patients with mesh exposure after mesh-augmented RPS, 2/3 of patients with a CTS classification 1-3 could be managed in the office,and remaining 1/3 with CTS classification 4-6 need operation under anesthesia in hospital. If the mesh and sling exposure could be scientifically classified, according to the size, site and accompany symptoms, as well as pain, most of the mesh complications after explosure could be resolved. Using the pelvic floor repair and polypropylene mesh sling, the majority of the patients could get a better outcome, without affecting the effect of the original operation.

Observation of clinical effects of percutaneous vertebroplasty in the treatment of vertebral compression fractures complicated with intravertebral clefts / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of percutaneous vertebroplasty(PVP)in the treatment of osteoporotic vertebral compression fractures complicated with intravertebral clefts.</p><p><b>METHODS</b>The clinical data of 176 patients with osteoporotic vertebral compression fractures underwent treatment from January 2013 to May 2016 were retrospectively analyzed. All the patients were treated by unilateral PVP procedure, 37 patients with intravertebral clefts. Seven cases were excluded according to the standard and 30 patients were internalized in the study. There were 14 males and 16 females, aged from 60 to 93 years old with an average of (77.73±9.33) years. The mean bone mineral density was (-3.16±0.48) SD (ranged from -2.3 to -4.1 SD). The Oswestry Disability Index(ODI), visual analogue scale (VAS) were analyzed before operation and 1 day, 3 months, 1 year after operation. The compression ratio of injured vertebrae was measured by X-ray before operation and 3 days, 3 months after operation.</p><p><b>RESULTS</b>All the operations were successful and all the patients were followed up more than 1 year. Postoperative at 1 d, 3 months, 1 year, VAS scores were obviously released (2.93±0.83, 2.07±0.58, 1.57±0.68, respectively) than preoperative 7.00±1.41(<0.01);and ODI scores were obviously improved (36.2±4.1, 22.9±6.7, 18.8±5.9, respectively) than preoperative 40.5±3.9(<0.01). Postoperative at 3 days, 3 months, vertebral height percent of injured vertebrae were (79.26±8.57)% , (77.68±8.96)% , respectively, which had obviously improvement compared to preoperative (72.00±12.14)% (<0.05).</p><p><b>CONCLUSIONS</b>PVP is an effective and reliable method in the treatment of osteoporotic vertebral compression fractures complicated with intravertebral clefts. It can effectively restore the height of the vertebral body, obviously improve the patient's pain and functional status.</p>

The first concurrent diagnosis of acute symptomatic Babesiosis and chronic myeloid leukemia in a healthy young adult

No abstract available.

Survey of relationship among psychological capital,social support and job burnout in nurses / 中国职业医学

OBJECTIVE: To study the relationship among nurses' mental capital,social support and job burnout. METHODS: One hundred and sixty-one clinical nurses were selected as the study objects from 2 Grade 3A hospitals and 2 Grade 2A hospitals of Luohe City using stratified random sampling method. The questionnaires of Psychological Capital,Social Support Revalued Scale and Maslach Burnout Inventory were answered and analyzed. RESULTS: The scores of self-efficacy dimension in the nurses who were older than 41 years old and working age more than 21 years were higher than other age groups and other working age groups respectively( P < 0. 05). The scores of subjective support and objective support of married group were higher than the unmarried group( P < 0. 01). Subjective support of the undergraduate nurse group had higher scores than junior college group( P < 0. 05). The self-efficacy,hope,toughness and optimism dimensions of psychological capital of nurses were negatively correlated with the emotional exhaustion,depersonalization and diminished personal accomplishment dimensions of job burnout respectively( P < 0. 01). The psychological capital could and predict the degree of social support( P < 0. 05). Social support had a buffering effect to the occurrence of job burnout. Selfefficacy,hope,objective support and subjective support could predict emotional exhaustion( P < 0. 05). Hope and optimism could predict depersonalization( P < 0. 01). Utilization of social support and subjective support could predict diminished personal accomplishment( P < 0. 05). CONCLUSION: Nurses psychological capital,social support and job burnout varied with age,length of service,marital status and educational level. Psychological capital and social support had the combined effect of job burnout.

Study on the medical services monitoring under the concept of big data / 中国卫生政策研究

Medical service utilization monitoring of county areas residents is one of the important contents of health policy management and research.Traditional service utilization monitoring, such as National Health Services Survey (NHSS), residents healthcare treatment (clinical) data from medical insurance, had problems of high cost, large deviation, slowly updating monitoring indicators, out of time in health management decisions.The data convergence and re-architecture of multi-source data provide a new idea for the monitoring of residents'' service utilization.Different linking data-sources would come true with the tools of Microsoft Access database administration and Excel programming techniques.At the same time, a new database would be accessed with the indices of residents'' annual medical service utilization, preference in medical services, unconscionable service utilization, and lead to the promotion of medical service utilization monitoring research development.

Long-term effectiveness of transvaginal high uterosacral ligament suspension / 中华妇产科杂志

Objective To assess the long-term effectiveness of the transvaginal high uterosacral ligament suspension (HUS) in women suffering from advanced pelvic organ prolapse (POP).Methods A retrospective review of records identified 118 women who underwent transvaginal HUS with or without additional concomitant anterior and (or) posterior repairs from June 2003 to August 2009 in the First Affiliated Hospital,General Hospital of People's Liberation Army.Of 118 women,104 women completed the follow-up during study period;these 104 women were analysed.Follow-up visits were performed 2,6 and 12 months after surgery and then annually.Anatomic results of POP was established by pelvic examination using pelvic organ prolapse quantitation system (POP-Q) staging.Funtional results were obtained by patient global impression of improvement (PGI-I),pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7).Surgical success required the fulfillment of all 3 criteria:(1) prolapse leading edge of 0 cm or less and apex of 1/2 total vaginal length or less;(2) the absence of pelvic organ prolapse symptoms as reported on the PFDI-20 question No.3 (Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?);and (3) no prolapse reoperations or pessary use during the study period.Results The mean follow-up time was (9.1 ± 1.5) years.The overall surgery success rate was 91.3％ (95/104) according to above all 3 criteria.Prolapse recurrence rates were isolated anterior 6.7％ (7/104),isolated apical 0,isolated posterior 2.9％ (3/104) and multiple compartments 1.0％ (1/104).Five women (4.8％,5/104) developed bothersome vaginal bulge symptoms.None of recurrent women underwent retreatment,including either surgery or use of a pessary at last follow-up.The subjective satisfaction rate was 90.4％ (94/104).PFDI-20 and PFIQ-7 scores showed a statistically significant improvement from preoperative 72 and 65 points to postoperative 17 and 9 points respectively (all P＜0.01).There was a 2.9％ (3/104) rate of intraoperative ureteral kinking and 3.8％ (4/104) rate of postoperative morbidity.Conclusions The transvaginal HUS for vault prolapse offers good long-term anatomical results with excellent vault suspension.With additional concomitant anterior and (or) posterior repairs,it will be a reconstructive surgery for the majority of advanced POP.It is minimal traumatic and appropriate for different type of POP,especially for the eldly patients.It is worthy of being popularized for clinical application.

Validity analysis of readmissions at seven townships and counties of China / 中华医院管理杂志

Objective To learn the suitability and validity of readmission service at counties and townships in rural China.Methods Seven pilot counties were randomly selected from the eastern,middle and western areas of China,and five diseases of the respiratory infection and cerebral system were set as the targets,while 600 target inpatient readmitted who had any of the five target diseases from 2012 to 2013 in such counties were selected from the NRCMS database.With expert consultation and empirical evaluation,the fitness of the days of stay at township hospital and necessity of hospitalization at county hospitals were evaluated for such target inpatients.Results 64.7％ of the target inpatients were found with unfit days of stay at township hospitals,mostly too short;59.0％ of the target inpatients' hospitalization at county hospitals were found with serious risk factors during their hospitalization;18.5％ of the inpatients were found with unnecessary hospitalization.Conclusions Hierarchical medical system can enhance the efficiency of the heahhcare system,but the current validity of readmission is poor,so is the fitness of days of stay at township hospitals,and the quality of the referral pattern.These problems mostly result from poor medical competence at township hospitals and high autonomy of patients in seeking medical service anywhere in the country.

The Expositions of Dai Sigong’s Treatments to Diarrhea / 浙江中医药大学学报

Objective]Analysis about how Dai Sigong expounded and treated diarrhea. [Methods]Look up relevant literature,list Dai Sigong ’s expositions about diarrhea’ pathogenesis and treatments, and summarize how Dai Sigong treated diarrhea. [Results] Dai Sigong generalized some methods about diarrhea treatment, such“diaphoresis”“purgative method”“emesis method”“tonifying method”“harmonyzing method”“invigorating spleen for diuresis”“invigorating qi for ascending”“eliminating”dampness”“clearing interior heat”and so on.[Conclusion]Depanding on predecessors’ discourse analysis, Dai Sigong inherited Zhu Danxi’s academic thought, summariied diarrhea’ pathogenesis and treatments, made a breakthrough to a thought that“It’s noneffective not using diuresis to eliminate dampness”and put forword that“there are many ways to cure diarrhea by eliminating dampness”. It provided more means to therapy diarrhea for descendants and had great meanings to consult.

The nationwide impact of injury-related deaths on average life expectancy in China / 生物医学与环境科学（英文）

To expand the evidence base to inform future public policy aimed at accident prevention, we investigated the impact of different categories of injury on average life expectancy in China. We used data from the National Death Cause Registration Information System and National Maternity and Children Health Surveillance databases, as well as 2010 population data from the National Bureau of Statistics. We then calculated the average life expectancy of the Chinese population, in addition to life expectancy after eliminating injury-related mortality. The average life expectancy of the Chinese population in 2010 was 74.93 years. After eliminating deaths due to injuries, the fourth leading cause of mortality in China, average life expectancy increased by 1.36 years. When this was broken down by population sub-groups, these gains were 1.76 and 0.79 years in men and women, 0.94 and 1.56 years in urban and rural residents, and 1.11, 1.30, and 1.67 years for residents in the Eastern, Central and Western regions respectively. After eliminating all categories of injury, the average life expectancy of the Chinese population was found to increase by 1.36 years. This figure was higher for males and residents of rural areas and Western China.

Mutation analysis and prenatal diagnosis of families affected with Duchenne and Becker muscular dystrophy / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To detect potential mutations for probands from families affected with Duchenne/Becker muscular dystrophy (DMD/BMD), and to carry out prenatal diagnosis through identification of female carriers.</p><p><b>METHODS</b>A total of 43 DMD/BMD families were recruited. Multiplex PCR was used to analyze 18 exons within hotspots for DMD gene deletions. Multiplex ligation-dependent probe amplification (MLPA) was used to detect potential deletions and duplications of DMD gene for 43 patients and 36 females from 32 families. Prenatal diagnosis was performed for 27 families.</p><p><b>RESULTS</b>Deletional mutations were detected in 26 patients with multiplex PCR. In addition, MLPA has detected 3 deletions and 6 duplicational mutations, and the ranges of mutations were all determined. Among 36 female members, 18 were determined as carriers of deletional mutations, 10 were excluded as mutation carriers. The status of remaining 8 could not be determined. For prenatal diagnosis, 3 out of 18 male fetuses were diagnosed as patients and 1 female fetus was identified as carrier.</p><p><b>CONCLUSION</b>MLPA is an accurate and reliable method for detecting deletional/duplicational mutations of DMD gene as well as for prenatal diagnosis and detection of female carriers.</p>

Analysis of risk factor of acute kidney injury after craniocerebral injury / 中华肾脏病杂志

Objective To investigate the incidence and risk factors of acute kidney injury (AKI) after craniocerebral injury.Methods A single cohort of 791 patients who suffered from craniocerebral injury from January 2008 to January 2010 in the Second Hospital of Lanzhou University were prospectively analyzed.Craniocerebral injury was defined according to definite medical history of craniocerebral injury,the verification of CT and Glasgow coma scale (GCS) score.AKI was defined as a relative 50％ increase or an absolute increment of 26.4 μmol/L in Scr within 48 hours and/or urine volume ＜0.5 ml·kg-1·h-1 up to 6 h.Multivariate Logistic regression analysis was used to evaluate possible risk factors associated with post-craniocerebral injury AKI.Results Of the 791 patients,the incidence of AKI was 39.4％.In hospital mortality of AKI patients was 27.9％,which was 5.065 times of non-AKI patients (P＜0.01).The incidence of AKI in patients with lower GCS score (≤8 score,heavy group)was 69.7％,which was significantly higher as compared to moderate and mild groups (P＜0.01).Unconditional multivariate Logistic regression analysis revealed that lower GCS score (≤ 8 score),hypotension (systolic pressure＜90 mm Hg),elderly and male were the independent predictors of AKI episodes,the corresponding OR values were 2.932,2.176,1.789,1.544 respectively.Conclusions AKI is a common complication after craniocerebral injury.Lower GCS score,hypotension,elderly and male are the independent risk factors of AKI in patients after craniocerebral injury.