Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai Integration Model (SIM) / 医学前沿

This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai, China. A total of 173 235 patients with type 2 diabetes in 2017 were included in the analysis. Profiles of risk factors and intermediate outcomes were determined. The patients had a mean age of 66.43 ± 8.12 (standard deviation (SD)) years and a mean diabetes duration of 7.95 ± 5.53 (SD) years. The percentage of patients who achieved the target level for HbA1c (< 7.0%) was 48.6%. Patients who achieved the target levels for blood pressure (BP) < 130/80 mmHg and low-density lipoprotein-cholesterol (LDL-c) < 2.6 mmol/L reached 17.5% and 34.0%, respectively. A total of 3.8% achieved all three target levels, and the value increased to 6.8% with an adaptation of the BP target level (< 140/90 mmHg) for those over 65 years. Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels: male, young age, short diabetes duration, low body mass index, macrovascular complications, no microvascular complications, prescribed with lipid-lowering medication, and no prescription of antihypertensive medication. In conclusion, nearly 50% and one-third of the patients with diabetes met the target levels for HbA1c and LDL-c, respectively, with a low percentage achieving the BP target level. The percentage of patients who achieved all three target levels needs significant improvement.

Research on an integrated community-based chronic disease management model driven by massive databases / 上海预防医学

China’s chronic disease management suffers from problems such as unclear institutional function， insufficient information technology application， and weak regulation support. On the basis of current chronic disease management condition in China， this paper proposes to apply the concept of “people-centered” integrated health management to community chronic disease management and discusses the content and procedure of establishing an integrated community-based chronic disease management model driven by massive databases. The model innovatively combines technology integration， data integration and service integration， and can accurately and efficiently realize the "people-centered" full-course health management of various chronic diseases. Shanghai has provided integrated community-based chronic disease management service for 1.98 million citizens through applying this model. The model warrants further effectiveness and economic evaluation. This study provides precious experience for the development of chronic disease prevention and treatment in China.

miR-424-5p improves radiation sensitivity of cervical cancer by targeted inhibition of HMGA1 expression / 中华放射肿瘤学杂志

Objective:To investigate the effect of miR-424-5p on radiosensitivity and its mechanism in cervical cancer patients.Methods:The expression levels of miR-424-5p in the cervical cancer tissues and Hela cells were detected by RT-qPCR. The apoptosis rate of Hela cells was determined by flow cytometry. The proliferation activity of Hela cells was detected by CCK-8 assay. The protein expression levels in Hela cells were measured by Western blot.Results:Compared with normal tissues and cells, the expression level of miR-424-5p was significantly down-regulated in the cervical cancer tissues and Hela cells (1.03 vs. 0.88, P<0.01; 1.00 vs. 0.75, P<0.01). Overexpression of miR-424-5p significantly inhibited the proliferation activity of Hela cells after radiation treatment ( P<0.01), and significantly increased the apoptosis rate of Hela cells after radiation treatment (24.82% vs. 49.94%, P<0.001). Overexpression of miR-424-5p inhibited HMGA1 expression (1.01 vs. 0.63, P<0.01). miR-424-5p directly affected HMGA1, thereby impacting the radiosensitivity of cervical cancer radiotherapy. Conclusion:miR-424-5p can improve the radiosensitivity of cervical cancer radiotherapy by directly targeting HMGA1.

Chemical constituents from the marine sponge Theonella swinhoei / 药学实践杂志

Objective To investigate the chemical constituents of the marine sponge Theonella swinhoei collected from the Xisha Islands in the South China Sea .Methods The petroleum ether and dichloromethane extract of the marine sponge T . swinhoei were purified by solvent extraction and chromatographic methods including vacuum liquid chromatography (VLC) , medium pressureliquidchromatography(MPLC),thinlayerchromatography(TLC)onsilicagel,highperformanceliquidchro-matography(HPLC) ,and Sephadex LH-20 .The chemical structures were determined by spectroscopic analysis and comparison with the reported data .Results Eight compounds were isolated and their structures were determined as cholest-7-ene-3β,5α, 6β-triol (1) ,ergosta-7 ,22-diene-3β,5α,6β-triol (2) ,25-norcycloartane-3β,6α,16β,24-tetraol (3) ,sinuflexibilin D (4) ,14-de-oxycrassin (5) ,N-(2-phenylethyl)-(9Z)-tetradecanamide(6) ,N-(2-phenylethyl)-tetradecanamide (7) ,7 ,8-dimethyl-isoallox-azine (8) .Conclusion Compounds 1～ 7 were isolated from the sponge of genus Theonella for the first time .

Prevalence and risk factors for chronic kidney disease among patients with type 2 diabetes mellitus managed in community health centers in Shanghai / 中华内分泌代谢杂志

Objective To estimate the prevalence of chronic kidney disease and to identify influencing factors among patients enrolled in diabetes management by the community health centers in Shanghai. Methods A questionnaire survey and physical examination were conducted in patients with type 2 diabetes through a random sampling method. Eligible date of 1 618 subjects were enrolled in the study. Estimated glomerular filtration rate was calculated according to equation of the Modification of Diet in Renal Disease Study for serum creatinine. Logistic regression was performed to examine the association between risk factors and chronic kidney disease. Results The prevalence of chronic kidney disease was 43.4%, of which 16.1%were in Stage 1, 14.8%in Stage 2, 11.6%in Stage 3, and 1.0%in Stage 4/5 in the total of 1 618 patients, but only 3.6% of the patients as defined in this study were aware of their condition. A higher prevalence of chronic kidney disease in females than that in males ( 47. 3% vs 37.8%). The prevalence of chronic kidney disease increased with age (χ2tend＝38.663,P<0.01). Female gender, older age, lower education, lower monthly income per capital, long duration of diabetes, uncontrolled glycosylated hemoglobin, uncontrolled systolic blood pressure, and uncontrolled triglycerides, were influencing factors of chronic kidney disease. Conclusion The patients under diabetes management in community health centers had higher prevalence of chronic kidney disease with lower awareness. Patients with type 2 diabetes should be encouraged to control blood glucose, blood pressure and blood lipids, to reduce the risk for chronic kidney disease. 而下降,2、3期均随年龄增大而升高(2 期 χ2趋势＝34.626,3 期,均 P<0.01) .城乡患病率总体上无差别,仅见3期患病率市区高于郊区(14.4%对9.2%, χ2＝10.465,P<0.01).按糖尿病病程长短进行分层发现,总的患病率随病程延长而升高 ,2、3期也呈现同样趋势( 2 期,3 期,均 P<0.05,图1) .

Detection trend of vaginal intraepithelial neoplasia diagnosed by colposcopy guided biopsy from 2013 to 2015 / 中华妇产科杂志

Objective To explore the detection trend of vaginal intraepithelial neoplasia(VaIN)of lower genital tract from 2013 to 2015. Methods A retrospective analysis was undertaken of colposcopy-directed biopsy of cervical, vaginal and vulvar intraepithelial neoplasia lesions include cervical intraepithelial neoplasia (CIN), VaIN and vulvar intraepithelial neoplasia (VIN) in Obstetrics and Gynecology Hospital of Fudan University from January 2013 to December 2015. Results (1) Overall data of CIN, VaIN and VIN:a total of 16732 cases were diagnosed of lower genital intraepithelial neoplasia in 3 years, accounting for 23.20% (16732/72128) of total colposcopy-directed biopsy cases. Among them, CIN, VaIN and VIN accounted for 19.48%(14053/72128), 2.67%(1923/72128), 1.05%(756/72128) of total colposcopy-directed biopsy cases of the lower genital tract, 83.99%(14053/16732), 11.49%(1923/16732), 4.52%(756/16732) of total lower genital intraepithelial neoplasia, respectively. (2) Annual data of CIN, VaIN and VIN from 2013 to 2015. The annual proportion of CIN in all intraepithelial neoplasia of lower gential tract was basically stable, consisting of 86.02%(3955/4598),83.25%(4795/5760) and 83.20%(5303/6374), respectively. The annual proportion of VaIN was gradually increasing, consisting of 8.09% (372/4598), 12.45%(717/5760) and 13.08%(834/6374), respectively. The annual proportion of VIN was gradually decreasing, consisting of 5.89% (271/4598), 4.31% (248/5760) and 3.72% (237/6374), respectively. Conclusion The increasing detection of VaIN from 2013 to 2015 might correlate with the increasing attention to inspection of the entire vaginal wall.

Effect of artesunate on rat liver fibrogenesis in vitro and in vivo / 中国药理学通报

Aim To study the effect of artesunate on immuno-injured hepatic fibrosis induced by bovine ser-um albumin in rat model and the effect of artesunate on hepatic stellate cells ( HSCs ) proliferation, so as to provide experimental evidence for clinical application of artesunate and the treatment of hepatic fibrosis. Methods The model of immuno-injured hepatic fibro-sis induced by bovine serum albumin was established in Wistar rats. Rats were randomly divided into 5 groups:normal group, model group, low dose of arte-sunate, middle dose of artesunate and high dose of ar-tesunate. Drugs were given to the corresponding thera-peutic groups, and then were continued once a day for two months. Distilled water was given to the rats of normal and model groups according to the same meth-od. Liver tissues were used for measuring the content of collagen, the rat serum activities of albumin( Alb) , alanine aminotransferase ( ALT ) and aspartate amin-otransferase(AST). Liver tissue’ s pathological chan-ges were observed by HE and collagen staining. Isola-ted and cultured rat primary HSCs in the flask for 10 days to make cells activated, MTT assay was used to detect rate of cellular proliferation; concentration of hydroxyproline in supernatant was detected by digestive method; the expression of p53 was investigated by Western blot and RT-PCR. Results Serum levels of Alb in model group were significantly lower ( P <0. 05 ) , and levels of ALT and AST in model group were significantly higher ( P <0. 05 ) compared with normal group. Levels of AST in low, middle and high dose groups(3. 2, 9. 6, 28. 8 mg·kg-1 ) were signifi-cantly lower(P <0. 05) compared with model group, and levels of ALT in high dose groups were significant-ly lower(P<0. 01) compared with model group. The contents of collagen in model groups were significantly higher(P<0. 01) compared with normal group, while the contents of collagen in therapy groups significantly decreased ( P < 0. 05 ) compared with model group. Activated HSCs treated with various concentrations of artesunate (150, 175, 200 μmol·L-1 ) were inhibi-ted on dose and time-effect relationships. Production/secretion of hydroxyproline decreased after HSCs was treated by artesunate for 24 h; the expression of p53 was up-regulated showed by Western blot and RT-PCR in artesunate treated cells. Conclusion Artesunate brings about anti-fibrosis in vitro and in vivo by increas-ing the expression of p53 .

Role of SDF-1 and CXCR4 in the proliferation, migration and invasion of cervical cancer

This study was to investigate the role of stromal cell-derived factor 1 [SDF-1] and its corresponding receptor CXCR4 in the proliferation, migration and invasion of cervical cancer HeLa cells. CXCR4 expression in HeLa cells was measured by flow cytometry and Western Blot. Role of SDF-1 and CXCR4 in the HeLa cells proliferation was measured by MTT. Role of SDF-1 and CXCR4 in the migration and invasion of HeLa cell was measured by Boyden chamber. High expression of CXCR4 was observed on the surface of HeLa cells. Proliferation ability of HeLa cells was significantly increased after SDF-1 stimulation, which showed dose-dependent manner. After knock-down of CXCR4 expression by RNAi, SDF-1-stimulated HeLa cells proliferation was significantly blocked [P<0.05]. SDF-1 can induce migration and invasion of Hela cells, SDF-1-stimulated HeLa cells migration and invasion was significantly blocked [P<0.05] after knock-down of CXCR4 expression by RNAi. High expression of surface CXCR4 plays an important role in the proliferation, migration and invasion of HeLa cells

Two less common human microRNAs miR-875 and miR-3144 target a conserved site of E6 oncogene in most high-risk human papillomavirus subtypes

Human papillomaviruses (HPVs) including high-risk (HR) and low-risk (LR) subtypes have distinguishable variation on both genotypes and phenotypes. The co-infection of multiple HR-HPVs, headed by HPV16, is common in cervical cancer in female. Recently accumulating reports have focused on the interaction between virus and host, particularly the role of human microRNAs (miRNAs) in anti-viral defense by targeting viral genome. Here, we found a well-conserved target site of miRNAs in the genomes of most HR-HPVs, not LR-HPVs, by scanning all potential target sites of human miRNAs on 24 HPVs of unambiguous subtypes of risk. The site is targeted by two less common human miRNAs, miR-875 and miR-3144, and is located in E6 oncogene open reading frame (ORF) and overlap with the first alternative splice exon of viral early transcripts. In validation tests, miR-875 and miR-3144 were identified to suppress the target reporter activity markedly and inhibit the expression of both synthetically exogenous E6 and endogenous E6 oncogene. High level of two miRNAs can inhibit cell growth and promote apoptosis in HPV16-positive cervical cancer cells. This study provides a promising common target of miRNAs for most HR-HPVs and highlights the effects of two low expressed human miRNAs on tumour suppression.

Agreement between colposcopic diagnosis with 2011 international terminology of colposcopy and cervical pathology in cervical lesions / 中华妇产科杂志

Objective To evaluate the agreement between colposcopic diagnosis with 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy (IFCPC) and cervical pathology in cervical lesions. Methods A retrospective cohort study was performed, which included 376 patients who underwent colposcopy with 2011 international terminology of colposcopy at Obstetrics and Gynecology Hospital of Fudan University from September 2014 to November 2014. With conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated and correlations between variables were analyzed. Results With 2011 international terminology of colposcopy, agreement of colposcopic diagnosis and cervical pathology was 60.9%(229/376)perfectly matched, and the strength of agreement with weighted Kappa statistic was 0.401 (P<0.01), and agreement within one grade was 97.6%(367/376), which were improved compared with traditional methods. Colposcopic diagnosis were 19.9%(75/376) overestimated and 19.1%(72/376) underestimated. There were no significant difference between agreements in various grade lesions (χ2=1.996, P=0.573). Positive predictive value of high grade colposcopy or more was 84.4%, the negative predictive value of low grade colposcopy or less was 88.8%, whereas false positives were 3.5%and false negatives were 39.3%. A linear trend among three types of transformation zone and patient ages was found (χ2=45.910, P<0.01), whereas lesion sizes were not linearly correlated with lesion degrees (χ2=0.690, P=0.406). In grade 1, grade 2 and nonspecific findings, thin acetowhite epithelium, dense acetowhite epithelium and Lugol′s non-staining were most frequent, the Youden indexes of each were 0.170, 0.373 and 0.145, 0.069 respectively. Positive predictive value of some other findings (such as fine mosaic) and two new signs (inner border sign and ridge sign) were 100.0%. There were no significant difference between agreements in examiners with different levels of experience (χ2=1.197,P=0.550). Conclusions Compared to traditional methods (such as Reid index), 2011 international terminology of colposcopy could improve the agreement between colposcopic diagnosis and pathologic diagnosis, without significant differences by the severity of lesion and the level of examiners′experience. Common findings were classified reasonably, and some signs were highly reliable, which is important for guiding biopsy. However, the reproducibility of transformation zone types and the implication of lesion size need to be further discussed.

Association between polymorphism of α-Synuclein gene and Parkinson's disease of Uygurs nationality in Xinjiang / 中华老年医学杂志

Objective To explore the association between the single-nucleotide polymorphism (SNP) rs3822086 site of the α-Synuclein(SNCA)gene and Parkinson's disease (PD) of Uygurs versus Hans in Xinjiang,and to compare the distribution difference of this polymorphic site between the Uygurs and Hans.Methods The rs3822086 polymorphism was determined by polymerase chainreaction restriction fragment length polymorphism (PCR-RFLP) in 237 patients with idiopathic Parkinson's disease (IPD,including 92 Uygurs and 145 Hans) and 247 health controls (including 103 Uygurs and 144 Hans).Results In the group aged ≥60 years,the T/T,C/T genotypes and T allele frequency were higher in PD group (196 cases) than in control group (196 cases) (25.5％ vs.20.9％,52.0％ vs.44.4％ and 51.5％ vs.43.1％),for genotype:P=0.027,allele:P=0.018.Between the Uygur versus Han nationality population,the T/T,C/T genotype and T allele frequency in the Uygurs were lower than in the Hans (15.4％ vs.30.4 ％,45.6％ vs.50.5％ and 38.2％ vs.55.7％),for genotype:P =0.000,allele:P =0.000.Conclusions The SNP rs3822086 site of SNCA gene may be a potential susceptibility site of IPD patients over the age of 60 years in Xinjiang,and rs3822086C/T + T/T is susceptible genotypes and rs3822086T is susceptible alleles.The distribution of rs3822086 polymorphism of SNCA might have a significant difference between the Xinjiang Uygur and Han populations.

Effects of fluoxetine on special learning and memory and serum S100B level in depressed model rats / 中华行为医学与脑科学杂志

ObjectiveTo explore the effects of fluoxetine on special learning and memory and serum S100B level in depressed model rats.MethodsAdult male SD rats were divided into six groups randomly according random digits table:control group ( A ),depressed model group ( B ),group of depressed model treated with single dose of fluoxetine for one day ( C ),group of depressed model treated with fluoxetine for one week (D),group of depressed model treated with fluoxetine for two weeks (E) and group of depressed model treated with fluoxetine for four weeks (F),ten rats in each group.Except control group,others were subjected to forced-swimming for four weeks,15 min a day.Fluoxetine (10 mg/kg) was given intragastric administration to group C-F before swimming everyday.Morris water maze ( MWM ) was used to measure the spatial learning and memory of rats.ELISA was used to determine the level of serum S100B.ResultsIn the hiding platform test of MWM,there was significant longer of escape latency (EL) in B group than that in A group(P ＜ 0.05 ).And the EL in all groups treated with fluoxetine became shorter with the prolonging of treatment.In the probe test,there were significant longer time in target quadrant in D,E,F than in other quadrant (F =5.162,P ＜ 0.01 ).The levels of serum S100B were lower in E,F groups ( E group ( 0.91 ± 0.23 ) ng/ml,F group ( 0.85 ± 0.21 ) ng/ml) than that in B group (( 1.26 ±0.61 )ng/ml,P＜0.05).ConclusionChronic administration of fluoxetine could improve the impairment of spatial learning and memory and reverse the increase of S100B level in serum of depressed model rats.

The prevalence of metabolic syndrome in Shanghai adults / 中华内分泌代谢杂志

Objective To assess the prevalence of the metabolic syndrome (MS) in Shanghai adults according to the criteria of the US National Cholesterol Education Programme Adult Treatment PanelⅢ ( NCEP ATP Ⅲ) definition. Methods Randomly selected adults were studied by means of stratified sampling. A cross-sectional study was conducted in Shanghai with a representative sample of 7 414 Chinese adults aged 35-74 years.Results Defined by the ATPⅢ criterion, the preliminary prevalence of MS was 19.81%. The prevalence of MS was 16.21% (95%CI 15.37%-17.05% ) after age was adjusted. The prevalence of MS was higher in female than in male (22.59% vs 16.64% ,P<0.01 ), and higher in urban than rural residents( 17.43% vs 17.16% ,P<0.01 ). The prevalence of MS increased with age in both male and female, especially in females aged above 55 years. There were 19.81% subjects with over 3 risk factors. The most common combination of four components in MS were central obesity, high triglyceridemia, low high-density lipoprotein-cholesterol and hypertension. Conclusions There is a high prevalence of MS in Shanghai adults. MS is increasingly becoming a noteworthy health problem. Early-diagnosis and integrated-methods of prevention and treatment of MS are mandatory.

The Screening Model Construction and its Validity Evaluation for Population with Impaired Glucose Regulation in Community / 中国慢性病预防与控制

Objective To build the screening model for population with Impaired Glucose Regulation (IGR)in community, and to evaluate its validity by using the model in general population. Methods Based on the epidemiological survey of DM in the community population in 2006, the analysis of the risk factors and the risk factors scoring method were used to build the screening model for IGR in community which was then used to screen for IGR in 2 120 general population in community to evaluate its validity. Result When the screening model was built with the accumulative score of risk factors ≥5, the sensitivity and specificity for identifying undiagnosed IGR were 68.2% and 61.7%, Youden's index was 0.299 and the positive predictive value was 14.2%. When 2 120 general population used the screening model, only 974 (45.9% of them)had to take OGTT test, and 124 (68.9%) IGR were identified. Conclusion The screening model with the accumulative score of risk factors ≥5 is an easy, effective and economic tool for IGR screening, and it can be tried to use in the screening for IGR in community, further research is needed.