Guidelines for prevention and treatment of colorectal adenoma with integrated Chinese and western medicine / 中国中药杂志

The Guidelines for prevention and treatment of colorectal adenoma with integrated Chinese and western medicine are put forward by Nanjing University of Chinese Medicine and approved by China Association of Chinese Medicine. According to the formulation processes and methods of relevant clinical practice guidelines, the experts in clinical medicine and methodology were organized to discuss the key problems to be addressed in the clinical prevention and treatment of colorectal adenoma(CRA) and provided answers following the evidence-based medicine method, so as to provide guidance for clinical decision-making. CRA is the major precancerous disease of colorectal cancer. Although the prevention and treatment with integrated Chinese and western medicine have been applied to the clinical practice of CRA, there is still a lack of high-quality guidelines. Four basic questions, 15 clinical questions, and 10 outcome indicators were determined by literature research and Delphi questionnaire. The relevant randomized controlled trial(RCT) was retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, Web of Science, and 2 clinical trial registries, and finally several RCTs meeting the inclusion criteria were included. The data extracted from the RCT was imported into RevMan 5.3 for evidence synthesis, and the evidence was evaluated based on the Grading of Recommendations, Assessment, Development, and Evaluations(GRADE). The final recommendations were formed by the nominal group method based on the evidence summary table. The guidelines involve the diagnosis, screening, treatment with integrated Chinese and western medicine, prevention, and follow-up of colorectal adenoma, providing options for the clinical prevention and treatment of CRA.

Establishment of biological reference interval for reverse triiodothyronine by indirect method / 中华核医学与分子影像杂志

Objective:To establish reverse triiodothyronine (rT 3) biological reference interval suitable for laboratory by indirect method. Methods:From April to September 2019, 797 cases (332 males, 465 females, age: 12-95 years) underwent thyroid function, thyroid related antibody and rT 3 tests from hospitalized population in Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine were retrospectively analyzed. The reference individuals with normal thyroid hormone, antibody and without thyroid nodule or goiter were screened as inclusion criteria, and the factors such as acute and chronic diseases or drugs that might affect the values of rT 3 were excluded. Independent sample t test, one-way analysis of variance and least significant difference t test were used to analyze data. The rT 3 reference interval was established by non-parametric sequencing method, and 2.5% and 97.5% percentile values of data distribution were selected as the upper and the lower reference limits. In order to verify the rT 3 reference interval, 20 healthy individuals and 20 inpatients who met the inclusion and exclusion criteria were selected to test rT 3 with a simple random sampling method. Results:A total of 159 reference individuals (66 males, 93 females, age: 23-87 years) were enrolled. The rT 3 values of 23-29( n=4), 30-39( n=18), 40-49( n=29), 50-59( n=43), 60-69( n=40), 70-79( n=19) and over 80( n=6) years old groups were (0.62±0.16), (0.63±0.12), (0.64±0.11), (0.61±0.11), (0.65±0.14), (0.65±0.11) and (0.79±0.10) μg/L, respectively. There was a statistically significant difference in the rT 3 test results among different age groups ( F=2.17, P=0.049). There were statistically significant differences of rT 3 between the individuals over 80 years old and other age groups (all P<0.05), while there were no statistically significant differences among the other groups (all P>0.05). The rT 3 of males and females under 80 years old were (0.62±0.11) and (0.64±0.12) μg/L, respectively, with no significant difference between them ( t=-0.81, P=0.420). The newly established rT 3 reference interval suitable for people above 20 years old and below 80 years old was 0.47-0.92 μg/L, and the lower limit was significantly higher than that of the reference interval in the reagent specification (0.20-0.95 μg/L). The rT 3 range of 20 healthy individuals was 0.57-0.82 μg/L and that of 20 inpatients was 0.48-0.77 μg/L, which were all within the new reference interval. Conclusion:The rT 3 biological reference interval established here has clinical application value, but its applicable range of age still needs to be further improved.

Application of 3D visualization and 3D printing in individualized precision surgery for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma / 南方医科大学学报

OBJECTIVE@#To explore the application of 3D visualization and 3D printing in individualized precision surgical treatment of Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma.@*METHODS@#We retrospectively analyzed the data of 10 patients with hilar cholangiocarcinoma undergoing surgeries under the guidance of 3D visualization and 3D printing in the Department of Hepatobiliary Surgery, Zhujiang Hospital from May 2016 to March 2019. Thin-section CT data of the patients were collected for 3D reconstruction and 3D printing, and the 3D printed models were used for observing the 3D relationship of tumor with the intrahepatic bile duct, hepatic artery, portal vein and hepatic vein system and for performing preoperative simulated surgery and surgical planning. The 3D printed models were subsequently used for real-time intraoperative navigation to guide surgeries in the operating room.@*RESULTS@#3D visualization models were successfully reconstructed for all the 10 patients and printed into 3D models. The 3D visualization types in Bismuth-Corlette classification included type Ⅲa (4 cases), type Ⅲb (4 cases), and type Ⅳ (2 cases); 4 patients showed portal vein variation, 3 had hepatic artery variation, and 2 had both portal vein and hepatic artery variations. Two patients were found to have trifurcation type of portal vein variation, one had "I-shaped" variation, and one showed the absence of the right anterior branch of the portal vein; 3 patients had hepatic artery variations with the left hepatic artery originating from the left gastric artery (1 case) and the right hepatic artery originating from the superior mesenteric artery (2 cases). Four patients with type Ⅲb underwent left hepatectomy; 4 with type Ⅲa received right hepatectomy; 1 patient with of type Ⅳ received peripheral hepatic resection and another underwent left hepatectomy. The results of preoperative 3D reconstruction, 3D printed model and preoperative planning were consistent with the intraoperative findings. The operative time was 452±75.12 min with a mean intraoperative blood loss of 356±62.35 mL and a mean hospital stay of 15 ± 4.61 days in these cases. One patient had bile leakage and 3 patients had pleural effusion postoperatively, and they were discharged after drainage and medications. No liver failure or death occurred in these cases perioperatively.@*CONCLUSIONS@#3D visualization and 3D printing can facilitate accurate preoperative assessment, surgical planning and surgical procedure optimization for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma to improve surgical safety and reduce surgical risks especially in cases of intrahepatic vascular variations.

The applications of enhanced recovery after surgery in laparoscopic hepatectomy: a retrospective cohort study / 中华普通外科杂志

Objective To investigate the safety and effectiveness during perioperative period in patients undergoing laparoscopic hepatectomy under ERAS program.Methods A retrospective study was carried out,in 40 patients under ERAS programs from Sep 2016 to Aug 2017 compared with 40 patients in control group from Sep 2015 to Aug 2016 in intraoperative central vein pressure,blood loss,postoperative stress indicators,the incidence of moderate to severe pain,exhaust time,oral feeding time,ambulation time,complications,hospital stays and costs and patient satisfaction.Results Compared with control group,the intraoperative blood loss was decreased by controlling central venous pressure (t =2.556,P =0.013),earlier exhaust,oral intake of food and ambulation (P ＜0.001),lower incidence rate of moderate to severe pain (x2 =11.314,P ＜ 0.001),and higher patient satisfaction (t =6.816,P ＜ 0.001) in ERAS group,though there were no significant differences in extubation time (t =0.336,P =0.738).The average hospital stays were 2.8 days shorter (16.6 ± 3.0 vs.19.4 ± 6.4,t =2.514,P =0.015),and hospital expenses were (￥)6 000 less than control group (5.4 ±0.7 vs.6.0± 1.5,t =2.338,P =0.023).Conclusion ERAS programs applied to patients undergoing laparoscopic hepatectomy can safely and effectively accelerate patient recovery.

Discussion on the Construction of Continuous Education Mode of Doctor - patient Communication for Medical Students / 中国医学伦理学

By analyzing the different characteristics of continuous education mode of doctor - patient communi-cation at every stages and the main point of integrating this into the clinical reform teaching, this paper finally pointed that it should make continuous education mode of doctor - patient communication run through the whole pe-riod of university and continuously explore and practice the new teaching theory and method, thus to provide some practical and effective reference comments for constructing a set of complete continuous education mode of doctor -patient communication integrated into clinical practical teaching method.

Effect of health service and its influence factors in flood disaster areas / 中南大学学报(医学版)

OBJECTIVE@#To explore the effect of health service and its influential factors in flood disaster areas.@*METHODS@#Fifty-five towns were sampled randomly from Dongting Lake area suffering from flood in 1998. The health service level, effect, and its influence factors were investigated retrospectively.@*RESULTS@#The incidence rate of notifiable infectious diseases was 11.7 per thousand, prevalence rate of chronic disease was 51.2 per thousand, infant mortality rate was 43.1 per thousand, neonatal mortality rate was 10.2 per thousand, and the total mortality rate was 554.3/100,000 in Dongting Lake area. The health investment level was significantly associated with the incidence rate of notifiable infectious diseases, the infant mortality rate, and total mortality rate. Duration of flood and income per capita were important factors for the effect of health investment.@*CONCLUSION@#Increasing health investment and residents' income in the flood disaster area, shortening the duration of flood would play positive role in residents' health in the flood disaster area.

Study on index of osteoporosis with height-shortening value for self-examination in middle-aged and elderly population / 中华流行病学杂志

<p><b>OBJECTIVE</b>To probe into the application value of the height shortening value as the self-examination index of the middle-aged and aged group's osteoporosis or reduced bone mineral density in communities.</p><p><b>METHODS</b>Four communities were selected by cluster sampling at random in Changsha city to be the objects of study, among which women were 45 years old or older and men were 60 years old. Difference and the percentage proportion of the height shortening between the height of the research objects which was measured at their youth and the height measured at this study, were calculated. Mineral density of the anteroposterior lumber spine L2-L4, the left femur neck of each object of study with the DPX-IQ dual energy X-ray (DEXA) were both examined. Results examined by DEXA were recognized as "Golden Standards" and different absolute and relative height shortening values were taken as positive cutoff points. Sensitivity, specificity and Youden's index were calculated to draw the receiver operator characteristic curve in order to get the positive cutoff which was most suitable to both sensitivity and specificity, and to calculate the predicative values of that self-examination method among different groups.</p><p><b>RESULTS</b>3 cm of height shortened seemed to be the positive cutoff of the self-examination of osteoporosis, and its sensitivity, specificity and Youden's index were 75.4%, 76.7% and 0.521 respectively. 2 cm of height shortened was suggested as the positive cutoff of the self-examination method of reduced bone mineral density, while its sensitivity, specificity and Youden's index were 81.7%, 75.6% and 0.573 respectively. In this self-examination method, positive predicative value was the highest (76.4%; 88.7%) among the women group aged over 65.</p><p><b>CONCLUSION</b>Certain height-shortening value could be used as the rough index of screening osteoporosis of reduced bone mineral density, which set a simple and easy way of self-examination for the middle-aged and elderly population.</p>

Years of potential life of residents among different flood areas in Hunan province / 中南大学学报(医学版)

OBJECTIVE@#To determine the damage of different types of floods on the residents health.@*METHODS@#The methods of standard mortality rate (SMR) and years of potential life lost (YPLL) were used to analyze the death of sample residents from flood areas in Dongting Lake in Hunan province.@*RESULTS@#The order of death causes in the soaked area, the collapsed area and the non-flood area was the same. But the mortality rates of residents injury, poisoning and malignant neoplasm diseases in the soaked area and the collapsed area were higher than those of non-flood area. The resident standard rates of years of potential life lost (SYPLL) in the soaked area and the collapsed area were higher than that of the controls, especially in the age group of 30 to 45. The flood-attributed SYPLL in the male was higher than that of the female.@*CONCLUSION@#Flood actually affected the health of residents. The more serious the flood is, the worse the effect is. It is very important to decrease the resident mortality rate of the injury, poisoning and malignant neoplasm, and to pay attention to protect people of 30 to 45 years old in flood areas.

A study on the health status of residents affected by flood disasters / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the immediate and long-term effects of disasters caused by floods on residents health status.</p><p><b>METHODS</b>Stratified sampling by ranks of flood disaster occurred in 1996 and 1998, flood disaster areas and control areas were carried out. A retrospective study was also carried out to study all diseases involved during 1996 - 1999.</p><p><b>RESULTS</b>The incident rates of acute infectious disease in flooding areas in 1996 and 1998 were both higher than those of non-flooding areas (863.181/100 000 and 736.591/100 000, respectively). But there was no different between the incident rate of the first years in flooding areas and that of non-flooding areas. The prevalence rates of 8 kinds of chronic diseases related to circulatory system, nervous system, digestive system, injury and poisonous diseases in flooding areas were also higher than that in the non-flooding areas. The highest incidence rates of most diseases were in the mountainous flooding areas, followed by areas collapsed by flooding, and the lowest were seen in soakedareas by floods. The incidence rates of intestinal infectious diseases and respiratory infectious diseases were lower in areas where prevention and control measures were weak.</p><p><b>CONCLUSION</b>Flood could lead to the increase of incidence rates both on acute infectious diseases and non-infectious diseases. Interventions on non-infectious diseases should also be enforced to stop the epidemics when preventing and controlling acute infectious disease.</p>

A research on the public health index related to the comprehensive assessment on floods / 中华流行病学杂志

<p><b>OBJECTIVE</b>To develop a public health index related to the comprehensive assessment on the impact caused by floods.</p><p><b>METHODS</b>A Analytic hierarchy process (AHP) theory was used to establish the initial evaluation system on the impact of floods. Modified-Delphi process was used to screen and determine the indicators and their weights while synthetical scored method was used to establish the comprehensive assessment model. Percentile was used to differentiate the degree of floods. Finally, analysis of variance (ANOVA) and correlation analysis were used to test the differentiability of the model for different degree of floods and the independence of these indicators.</p><p><b>RESULTS</b>The model of comprehensive assessment on the impact of floods was set up, including six first-ranking indicators and twenty-four sub-indicators. The values of comprehensive assessment were divided into five grades by the percentiles. Verified results indicated that there were significant difference among the five grades (F = 76.11, P < 0.01) and all indicators were independent.</p><p><b>CONCLUSION</b>An index of comprehensive assessment on the impact of floods was established, which could be used to evaluate the impact of floods and to differentiate the degree of flood, which seemed to have the characteristic of reliability, comprehensiveness and practicability.</p>

Study on hospitalization expenses of flood disaster areas' residents of Dongting Lake in Hunan province in 1998 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the expenses of hospitalization among the population in the flood disaster areas of Dongting Lake in Hunan province in 1998.</p><p><b>METHODS</b>Descriptive epidemiologic study were conducted to analyze hospitalization expenses of the residents of 55 villages in flood disaster areas in 1998; single factors analysis and logarithmic linear regression analysis were carried out to explore influencing factors about hospitalization expenses of the residents.</p><p><b>RESULTS</b>The hospitalization rate was 4.59% with an average hospitalization expenses of 667.42 Yuan in the flood disaster areas' residents of Dongting Lake in 1998. Compared with populations without suffering from flood, hospitalization rate and the average hospitalization expenses of flood disaster Areas' residents of Dongting Lake in 1998 were higher and had significant difference. The average hospitalization expenses in 1998 was affected by flood types, family income, gender, age, literacy, occupation, outcome after leaving the hospital and hospital ranks.</p><p><b>CONCLUSION</b>These results implied that the flood disease aggravated inhabitants' burden of disease in Dongting Lake areas; the factors influencing the average hospitalization expenses were multiple, and synthetic measures should be taken in the prevention and control of flood disaster.</p>