Incidence and prognosis of olfactory and gustatory dysfunctions related to infection of SARS-CoV-2 Omicron strain: a national multi-center survey of 35 566 population / 中华耳鼻咽喉头颈外科杂志

Objective: This cross-sectional investigation aimed to determine the incidence, clinical characteristics, prognosis, and related risk factors of olfactory and gustatory dysfunctions related to infection with the SARS-CoV-2 Omicron strain in mainland China. Methods: Data of patients with SARS-CoV-2 from December 28, 2022, to February 21, 2023, were collected through online and offline questionnaires from 45 tertiary hospitals and one center for disease control and prevention in mainland China. The questionnaire included demographic information, previous health history, smoking and alcohol drinking, SARS-CoV-2 vaccination, olfactory and gustatory function before and after infection, other symptoms after infection, as well as the duration and improvement of olfactory and gustatory dysfunction. The self-reported olfactory and gustatory functions of patients were evaluated using the Olfactory VAS scale and Gustatory VAS scale. Results: A total of 35 566 valid questionnaires were obtained, revealing a high incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain (67.75%). Females(χ2=367.013, P<0.001) and young people(χ2=120.210, P<0.001) were more likely to develop these dysfunctions. Gender(OR=1.564, 95%CI: 1.487-1.645), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), oral health status (OR=0.881, 95%CI: 0.839-0.926), smoking history (OR=1.152, 95%CI=1.080-1.229), and drinking history (OR=0.854, 95%CI: 0.785-0.928) were correlated with the occurrence of olfactory and taste dysfunctions related to SARS-CoV-2(above P<0.001). 44.62% (4 391/9 840) of the patients who had not recovered their sense of smell and taste also suffered from nasal congestion, runny nose, and 32.62% (3 210/9 840) suffered from dry mouth and sore throat. The improvement of olfactory and taste functions was correlated with the persistence of accompanying symptoms(χ2=10.873, P=0.001). The average score of olfactory and taste VAS scale was 8.41 and 8.51 respectively before SARS-CoV-2 infection, but decreased to3.69 and 4.29 respectively after SARS-CoV-2 infection, and recovered to 5.83and 6.55 respectively at the time of the survey. The median duration of olfactory and gustatory dysfunctions was 15 days and 12 days, respectively, with 0.5% (121/24 096) of patients experiencing these dysfunctions for more than 28 days. The overall self-reported improvement rate of smell and taste dysfunctions was 59.16% (14 256/24 096). Gender(OR=0.893, 95%CI: 0.839-0.951), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), history of head and facial trauma(OR=1.180, 95%CI: 1.036-1.344, P=0.013), nose (OR=1.104, 95%CI: 1.042-1.171, P=0.001) and oral (OR=1.162, 95%CI: 1.096-1.233) health status, smoking history(OR=0.765, 95%CI: 0.709-0.825), and the persistence of accompanying symptoms (OR=0.359, 95%CI: 0.332-0.388) were correlated with the recovery of olfactory and taste dysfunctions related to SARS-CoV-2 (above P<0.001 except for the indicated values). Conclusion: The incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain is high in mainland China, with females and young people more likely to develop these dysfunctions. Active and effective intervention measures may be required for cases that persist for a long time. The recovery of olfactory and taste functions is influenced by several factors, including gender, SARS-CoV-2 vaccination status, history of head and facial trauma, nasal and oral health status, smoking history, and persistence of accompanying symptoms.

Analysis of the efficacy of endoscopic transnasal surgery for sinonasal and skull base adenoid cystic carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the efficacy of endoscopic transnasal surgery for sinonasal and skull base adenoid cystic carcinoma (ACC), and to analyze the prognostic factors. Methods: Data of 82 patients (43 females and 39 males, at a median age of 49 years old) with sinonasal and skull base ACC who were admitted to XuanWu Hospital, Capital Medical University between June 2007 and June 2021 were analyzed retrospectively. The patients were staged according to American Joint Committee on Cancer (AJCC) 8th edition. The disease overall survival(OS) and disease-free survival(DFS) rates were calculated by Kaplan-Meier analysis. Cox regression model was used for multivariate prognostic analysis. Results: There were 4 patients with stage Ⅱ, 14 patients with stage Ⅲ, and 64 patients with stage Ⅳ. The treatment strategies included purely endoscopic surgery (n=42), endoscopic surgery plus radiotherapy (n=32) and endoscopic surgery plus radiochemotherapy (n=8). Followed up for 8 to 177 months, the 5-year OS and DFS rates was 63.0% and 51.6%, respectively. The 10-year OS and DFS rates was 51.2% and 31.8%, respectively. The multivariate Cox regression analysis showed that late T stage and internal carotid artery (ICA) involvement were the independent prognostic factors for survival in sinonasal and skull base ACC (all P<0.05). The OS of patients who received surgery or surgery plus radiotherapy was significantly higher than that of patients who received surgery plus radiochemotherapy (all P<0.05). Conclusions: Endoscopic transonasal surgery or combing with radiotherapy is an effective procedure for the treatment of sinonasal and skull base ACC. Late T stage and ICA involvement indicate poor prognosis.

Systematic review and Meta-analysis of Gusongbao preparation in treatment of primary osteoporosis / 中国中药杂志

This study aims to provide evidence for clinical practice by systematically reviewing the efficacy and safety of Gusongbao preparation in the treatment of primary osteoporosis(POP). The relevant papers were retrieved from four Chinese academic journal databases and four English academic journal databases(from inception to May 31, 2022). The randomized controlled trial(RCT) of Gusongbao preparation in the treatment of POP was included after screening according to the inclusion and exclusion criteria. The quality of articles was evaluated using risk assessment tools, and the extracted data were subjected to Meta-analysis in RevMan 5.3. A total of 657 articles were retrieved, in which 15 articles were included in this study, which involved 16 RCTs. A total of 3 292 patients(1 071 in the observation group and 2 221 in the control group) were included in this study. In the treatment of POP, Gusongbao preparation+conventional treatment was superior to conventional treatment alone in terms of increasing lumbar spine(L2-L4) bone mineral density(MD=0.03, 95%CI[0.02, 0.04], P<0.000 01) and femoral neck bone mineral density, reducing low back pain(MD=-1.69, 95%CI[-2.46,-0.92], P<0.000 1) and improving clinical efficacy(RR=1.36, 95%CI[1.21, 1.53], P<0.000 01). Gusongbao preparation was comparable to similar Chinese patent medicines in terms of improving clinical efficacy(RR=0.95, 95%CI[0.86, 1.04], P=0.23). Gusongbao preparation was inferior to similar Chinese patent medicines in reducing traditional Chinese medicine syndrome scores(MD=1.08, 95%CI[0.44, 1.71], P=0.000 9) and improving Chinese medicine syndrome efficacy(RR=0.89, 95%CI[0.83, 0.95], P=0.000 4). The incidence of adverse reactions of Gusongbao preparation alone or combined with conventio-nal treatment was comparable to that of similar Chinese patent medicines(RR=0.98, 95%CI[0.57, 1.69], P=0.94) or conventio-nal treatment(RR=0.73, 95%CI[0.38, 1.42], P=0.35), and the adverse reactions were mainly gastrointestinal discomforts. According to the available data, Gusongbao preparation combined with conventional treatment is more effective than conventional treatment alone in increasing lumbar spine(L2-L4) bone mineral density and femoral neck bone mineral density, reducing low back pain, and improving clinical efficacy. The adverse reactions of Gusongbao preparation were mainly gastrointestinal discomforts, which were mild.

Efficacy and Safety of Lianhua Qingwen for Patients with COVID-19: A Systematic Review and Meta-Analysis / 中国结合医学杂志

BACKGROUND@#Corona virus disease 2019 (COVID-19) has spread around the world since its outbreak, and there is no ascertained effective drug up to now. Lianhua Qingwen (LHQW) has been widely used in China and overseas Chinese, which had some advantages in the treatment of COVID-19.@*OBJECTIVE@#To evaluate the efficacy and safety of LHQW for COVID-19 by conducting a systematic review with meta-analysis.@*METHODS@#A comprehensive literature search was conducted in 12 electronic databases from their establishment to October 30, 2021. Note Express 3.2.0 was used for screening of trials, and the data was independently extracted in duplicate by 2 researchers. The risk of bias of randomized controlled trials (RCTs) and retrospective studies were assessed by using the Cochrane collaboration tool and Newcastle Ottawa Scale, respectively, followed by data analysis using RevMan 5.3. The RCTs or retrospective studies to treat COVID-19 using LHQW were included. The intervention measures in the experimental group were LHQW alone or combined with chemical drugs (LCWC), and that in the control group were chemical drugs (CDs). Outcome measures included computed tomography (CT) recovery rate, disappearance rates of primary (fever, cough, fatigue), respiratory, gastrointestinal and other symptoms, exacerbation rate and adverse reaction. Subgroup analysis was conducted according to whether LHQW was combined with CDs and the different treatment methods in the control group.@*RESULTS@#Nine trials with 1,152 participants with COVID-19 were included. The CT recovery rates of LHQW and LCWC were 1.36 and 1.32 times of CDs, respectively (P<0.05). Compared with CDs, LCWC remarkably increased the disappearance rates of fever, cough, fatigue, expectoration, shortness of breath, and muscle soreness (P<0.05). LHQW also obviously decreased the exacerbation rate, which was 0.45 times of CDs alone (P<0.05). There was no obvious difference between LCWC and CDs in adverse reaction (P>0.05).@*CONCLUSIONS@#LHQW was more suitable for treating COVID-19 patients with obvious expectoration, shortness of breath and muscle soreness. LHQW had advantages in treating COVID-19 with no obvious exacerbation. (PROSPERO No. CRD42021235937).

Prognostic factors affecting the success of conversion chemotherapy in patients with unresectable liver metastases from initially colorectal cancer / 中华胃肠外科杂志

Objective: To investigate the factors affecting the success of conversion therapy in patients with initially unresectable colorectal cancer liver metastases (CRLM) in order to provide evidence-based medical evidence for formulating individualized treatment strategies for patients. Methods: A retrospective case-control study was used in this study. Clinical data of 232 patients with initially unresectable CRLM receiving first-line systemic treatment in Sun Yat-sen University Cancer Center from January 2013 to January 2020 were collected, including 98 patients of successful conversion and 134 patients of failed conversion as control. Conversion therapy scheme: 38 patients received FOLFOXIRI regimen chemotherapy (irinotecan, oxaliplatin, calcium folinate and fluorouracil), 152 patients received FOLFOX regimen (oxaliplatin, calcium folinate and fluorouracil), 19 patients received FOLRIRI regimen (irinotecan, calcium folinate and fluorouracil), 23 patients received systemic chemotherapy combined with fluorouridine hepatic artery infusion chemotherapy; 168 patients received targeted therapy, including 68 of bevacizumab and 100 of cetuximab. Logistics analysis was used to compare the factors affecting the success of conversion therapy. The Kaplan-Meier method was used to calculate progression-free survival (PFS), and the Log-rank test was used for survival comparison. Results: Among 232 patients, 98 patients had successful conversions and 134 patients had failed conversions with a successful conversion rate of 42.2%, meanwhile 30 patients underwent simple hepatectomy and 68 underwent hepatectomy combined with intraoperative radiofrequency ablation. After first-line chemotherapy, 111 patients (47.8%) were partial remission, 57 patients (24.6%) were stable disease, and 64 patients (27.6%) were progression disease. During the median follow-up of 18.8 (1.0-87.9) months, 148 patients were dead or with tumor progression. The median PFS time of patients with successful conversion was longer than that of patients with failed conversion (31.0 months vs. 9.9 months, P<0.001). Univariate analysis found that the bilobar distribution of liver tumors (P=0.003), elevated baseline carcinoembryonic antigen (CEA) levels (P=0.024), tumor invasion of the portal vein (P=0.001), number of metastatic tumor>8 (P<0.001), non-FOLFOXIRI (P=0.005), and no targeted therapy (P=0.038) were high risk factors for the failed conversion therapy. The results of multivariate logistics analysis indicated that the number of metastatic tumor >8 (OR=2.422, 95%CI: 1.291-4.544, P=0.006), portal vein invasion (OR=2.727, 95%CI: 1.237-4.170, P=0.008) were the independent risk factors for failed conversion therapy, while FOLFOXIRI regimen (OR=0.300, 95%CI: 0.135-0.666, P=0.003) and targeted drugs (OR=0.411, 95%CI: 0.209-0.809, P=0.010) were independent protective factors for successful conversion therapy. Conclusions: The number of metastatic tumor and portal vein invasion are key factors that affect the outcomes of conversion therapy for initially unresectable CRLM. If a patient can tolerate chemotherapy, a combination program of three-drug and targeted therapy is preferred for the active conversion therapy.

Research progress in association of neurological disorders and periodontal diseases / 中华口腔医学杂志

Periodontal diseases are inflammatory diseases caused by oral pathogens around the periodontal supporting tissues, leading to systemic and chronic inflammatory conditions. The continuous chronic systemic inflammation may be a trigger of neuroinflammation, which is the prominent feature of a variety of neurological disorders. It implies that there may be a causal link between periodontal diseases and neurological disorders. This article presents epidemiological and biological evidences that periodontal diseases can induce or exacerbate neurological disorders, including Alzheimer's disease, Parkinson's disease, multiple sclerosis and major depressive disorder, and analyzes the possible mechanisms. The importance of maintaining oral health as well as preventing and treating periodontal diseases are emphasized. At the same time, this may provide novel approaches to study the relationship between periodontal diseases and neurological disorders in the prevention and treatment strategies of neurological disorders.

Comparative clinical efficacy analysis of pancreatoduodenectomy for distal bile duct and pancreatic head cancer: a report of 1 005 cases / 中华外科杂志

Objective: To compare and analyze the clinical efficacy of pancreaticoduodenectomy for distal bile duct cancer and pancreatic head cancer. Methods: Clinical data of 1 005 patients who underwent pancreaticoduodenectomy and postoperative pathological examination confirmed the diagnosis of distal bile duct cancer and pancreatic head cancer at the Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were analyzed retrospectively. There were 112 cases in the distal bile duct cancer group, 71 males and 41 females,with age (M(IQR)) of 65(15) years(range: 40 to 87 years); 893 cases in the pancreatic head cancer group, 534 males and 359 females,with age of 64(13)years(range: 16 to 91 years). The differences between clinicopathological characteristics and postoperative overall survival of the two groups were analyzed by χ2 test, Fisher's exact probability method, rank sum test or log-rank test, respectively. The difference in postoperative overall survival between the two groups was compared using Kaplan-Meier method after propensity score matching (1∶1). Results: Compared with the pancreatic head cancer group,the distal bile duct cancer group had shorter operative time (240.0(134.0) minutes vs. 261.0(97.0) minutes, Z=2.712, P=0.007),less proportion of combined venous resection (4.5% (5/112) vs. 19.4% (173/893), χ²=15.177,P<0.01),smaller tumor diameter (2.0(1.0) cm vs. 3.0(1.5) cm,Z=10.567,P<0.01),higher well/moderate differentiation ratio (51.4% (56/112) vs. 38.0% (337/893), χ²=7.328, P=0.007),fewer positive lymph nodes (0(1) vs. 1(3), Z=5.824, P<0.01),and higher R0 resection rate (77.7% (87/112) vs. 38.3%(342/893), χ²=64.399, P<0.01),but with a higher incidence of overall postoperative complications (50.0% (56/112) vs. 36.3% (324/892), χ²=7.913,P=0.005),postoperative pancreatic fistula (28.6% (32/112) vs. 13.9% (124/893), χ²=16.318,P<0.01),and postoperative abdominal infection (21.4% (24/112) vs. 8.6% (77/892), χ²=18.001,P<0.01). After propensity score matching, there was no statistical difference in postoperative overall survival time between patients in the distal bile duct cancer group and the pancreatic head cancer group (50.6 months vs. 35.1 months,Z=1.640,P=0.201),and multifactorial analysis showed that tumor site was not an independent risk factor affecting the prognosis of patients in both groups after matching (HR=0.73,95%CI:0.43 to 1.23,P=0.238). Conclusions: Patients with distal bile duct cancer are more likely to benefit from early diagnosis and surgical treatment than patients with pancreatic head cancer,but with a relative higher postoperative complication rates. The different tumor origin site is not an independent risk factor for prognosis of patients with distal bile duct cancer and pancreatic head cancer after propensity score matching.

Atrial fibrillation in critically ill patients who received prolonged mechanical ventilation: a nationwide inpatient report

Background/Aims@#To evaluate temporal trends of atrial fibrillation (AF) prevalence in critically ill patients who received prolonged mechanical ventilation (MV) in the United States. @*Methods@#We used the 2008 to 2014 National Inpatient Sample to compute the weighted prevalence of AF among hospitalized adult patients on prolonged MV. We used multivariable-adjusted models to evaluate the association of AF with clinical factors, in-hospital mortality, hospitalization cost, and length of stay (LOS). @*Results@#We identified 2,578,165 patients who received prolonged MV (21.27% of AF patients). The prevalence of AF increased from 14.63% in 2008 to 24.43% in 2014 (p for trend < 0.0001). Amongst different phenotypes of critically ill patients, the prevalence of AF increased in patients with severe sepsis, asthma exacerbation, congestive heart failure exacerbation, acute stroke, and cardiac arrest. Older age, male sex, white race, medicare access, higher income, urban teaching hospital setting, and Western region were associated with a higher prevalence of AF. AF in critical illness was a risk factor for in-hospital death (odds ratio, 1.13; 95% confidence interval, 1.11 to 1.15), but in-hospital mortality in critically ill patients with AF decreased from 11.6% to 8.3%. AF was linked to prolonged LOS (2%, p < 0.0001) and high hospitalization cost (4%, p < 0.0001). LOS (–1%, p < 0.0001) and hospitalization cost (–4%, p < 0.0001) decreased yearly. @*Conclusions@#The prevalence of comorbid AF is increasing, particularly in older patients. AF may lead to poorer prognosis, and high-quality intensive care is imperative for this population.

Application of island flap and its combined flap on repairing nasal alae defects / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the application of island flap and combined flap in one-stage reconstruction of nasal alae defects after external nasal tumor resection. Methods: Data of 11 patients with perforating or full-thickness defects of the alae after nasal tumor resection in XuanWu Hospital, Capital Medical University between June 2016 and February 2021 were analyzed retrospectively. There were 7 males and 4 females, and the ages ranged from 51 to 89 years. Island flap, island flap combined with nasolabial flap or V-Y advancement flap, and island flap combined with bilobed flap were applied according to the range of defects. Descriptive statistical method was applied to analyze the treatment effects. Results: All flaps of the 11 patients were successful survival and the incisions were primary healing. Being followed up for 5 to 59 months, the patients had satisfying appearance and ventilation function, and no tumor relapsed. Conclusion: For the patients with nasal alae defects after external nose tumor resection, selecting suitable island skin flap or combined skin flap can be used to reconstruct the ideal nasal appearance and function of the nose.

Application of membrane induced by antibiotic loaded bone cement in skin grafting for tendon exposed wound healing / 中国骨伤

OBJECTIVE@#To evaluate the effects of membrane induced by antibiotic-loaded bone cement in skin grafting for tendon exposed wound healing.@*METHODS@#A total of 10 traumatic patients with tendon exposed wound were admitted to our department between February 2016 and December 2018, including 6 males and 4 females, with a mean age of 34.6 years old (ranged, 19 to 43 years old), and treatment duration ranged from 2 to 6 months. There were 7 cases of traffic accidents, 3 cases of mechanical belt injuries, including 8 cases of lower leg and foot wounds and 2 cases of hand back wounds. These tendons exposed wound were covered by antibiotic-loaded bone cement at the earlier stageto induce the formation of the biomembrane, and then skin grafting were performed on the induced membrane. The survival, appearance, texture, sensation of the skin grafting and healing condition of the wounds were studied.@*RESULTS@#Among the 10 patients, skin graft survived well in 8 patients. Partial skin graft necrosis occurred in 2 patients and cured by dressing.@*CONCLUSION@#Using antibiotic bone cement to seal the wound to form induction membrane followed by skin grafting can effectively repair the tendon exposed wound, which has the characteristics of simple operation and less trauma.

Cannulated screw fixation directly via the anterior approach for femoral neck fractures difficultly reducible in young and middle-aged patients / 中华创伤骨科杂志

Objective:To investigate the clinical outcomes of open reduction and cannulated screw fixation directly via the anterior approach for femoral neck fracture of Garden type Ⅳ which is difficultly reducible in young and middle-aged patients.Methods:Forty patients aged younger than 65 years old were treated by open reduction and cannulated screw fixation directly via the anterior approach for femoral neck fractures which were difficulty reducible at Department of Orthopaedics, Mindong Hospital from March 2015 to October 2017. They were 28 males and 12 females, aged from 22 to 62 years (mean, 49.2 years). All the fractures were type Ⅳ by the Garden classification. The time from injury to operation averaged 3.2 d (range, from 1 to 6 d). Their postoperative fracture nonunion and femoral head necrosis were recorded. The reduction quality and hip function were evaluated using Garden reduction index and Harris hip scores.Results:All the 40 patients were followed up for 11 to 44 months (mean, 22.3 months). Nonunion occurred in one patient who had to accept secondary artificial hip replacement. No avascular necrosis of the femoral head occurred in any patients. The anteroposterior Garden reduction indexes at 2 d after surgery and at the last follow-up for the 40 patients were respectively 156.97°±1.40° and 157.07°±1.47°, showing no significant difference( t=-0.302, P=0.765); so were the lateral Garden reduction indexes (171.82°±4.48° and 172.10°±4.27°) ( t=-2.333, P=0.817). The Harris hip scores at the final follow-up for the hip ranged from 77 to 98 (average, 92); 31 cases were rated as excellent, 6 as good, 2 as fair and one as poor, giving an excellent to good rate of 92.5%. Conclusion:In the treatment of femoral neck fracture of Garden type Ⅳ which is difficultly reducible in young and middle-aged patients, if closed reduction has failed, open reduction and cannulated screw fixation directly via the anterior approach can achieve satisfactory short-term outcomes because it facilitates fracture reduction and fixation under direct vision, promotes fracture union and reduces avascular necrosis of the femoral head.

Analysis of anemia among children under 5 years old in Shanghai and Tibet / 中国医师杂志

Objective:To compare the complete blood count of children under 5 years old in outpatient department of pediatrics in general hospitals in Shanghai and Shigatse, and to explore the incidence and risk factors of anemia among children in different regions.Methods:Complete blood count of 19 863 children in outpatient department of pediatrics of Shanghai Ninth People′s Hospital in 2018 and 2 476 children in outpatient department of pediatrics of Shigatse People′s Hospital in 2018 were retrieved. The value of haemoglobin (HB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) were analyzed. The types, incidence and degree of anemia in different regions were compared. The information during pregnancies, supplementary foods, residence and educational level of mothers of anemic children in Shigatse area and Shanghai were collected.Results:The incidence of nutritional anemia in Tibetan children was higher than that in Shanghai, with mild to moderate anemia predominating in Tibetan area and mild anemia predominating in Shanghai. The incidence of anemia in Shigatse area was 41.32% (1 023/2 476), which was higher than that in Shanghai [14.35%(2 852/1 9 863)], and the difference was statistically significant ( P<0.05) .The incidence of mild anemia was 84.65% (866/1 023) in Shigatse and 94.81% (2 704/2 852) in Shanghai, with statistically significant difference ( P< 0.01). The incidence of moderate anemia in Shigatse was 14.08% (144/1 023) higher than that in Shanghai 5.05% (144/2 852), with statistically significant difference ( P<0.01). The incidence of severe anemia in Shigatse was 1.27% (13/1 023) higher than that in Shanghai 0.14% (4/2 852), with statistically significant difference ( P<0.01). Through the analysis of the questionnaires, being from pastoral areas, low educational level of mothers, poor nutrition during pregnancy, premature delivery, pure breastfeeding irregular maternity examinations and unreasonable supplementary food were related to nutritional anemia in ≤1 year-old babies. Conclusions:Nutritional iron deficiency anemia in the main type of anemia among children in both areas. Compared with Shanghai, the incidence of anemia of children in Tibet was higher, which may be caused by different feeding habits, cultural level and economic income between different regions. It is imperative to establish and improve the management of pregnant and lying-in women in Tibet, and provide scientific feeding and healthy lifestyle.

Colonoscopy Adherence and Related Factors Among Preliminary Screened-Positive Population in Guangzhou：A Follow-Up Study / 中山大学学报(医学科学版)

@#【Objective】To explore colonoscopy adherence and related factors among preliminary screened-positive population in Guangzhou. 【Methods】This study was a part of the Guangzhou Community-based Colorectal Cancer Screening Program. We retrospectively analyzed the 1-year follow-up data of population aged 50~74 years old and positive in preliminary colorectal cancer screening in 2015. Kaplan- Meier method was used to describe the respond time to colonoscopy examination. Cox proportional hazard model was performed to identify factors associated with colonoscopy adherence. The effect of studied factors on colonoscopy adherence was reported according to hazard ratio（HR）.【Results】 A total of 18 604 preliminary screened-positive residents were included ，among whom 4 014 completed colonoscopy examination within one year，with a colonoscopy adherence of 21.6% . Colorectal lesions were found in 2 012 cases （50.1%），of which 96（2.4%）were colorectal cancers. The adherence of 1 month，3 months and 6 months were 9.7% ，15.8% ，and 18.6% respectively. Multivariate Cox regression analysis showed that those who were female ，in older age ， unmarried/widowed/divorced，without health insurance，and had a history of chronic cholecystitis or cholecystectomy were less likely to undergo colonoscopy；while those who were fecal occult blood test- positive，had colonoscopy preferential policies，worked in government or public institution，had medical insurance for urban workers，had a history of chronic diarrhea，a history of chronic constipation，a history of mucous and/or blood stool，and a history of bad life incidents were more likely to undergo colonoscopy. 【Conclusions】 This study suggested that the colonoscopy adherence of preliminary screened- positive population in Guangzhou was low and such low adherence was associated with different factors. Community health workers should timely track the completion of colonoscopy of preliminary screened-positive residents ， and take targeted measures to promote colonoscopy adherence.

Clinical Efficacy of Endoscopic Tympanoplasty for Large Tympanic Membrane Perforation / 中山大学学报(医学科学版)

@#【Objective】To investigate the clinical efficacy of endoscopic tympanoplasty for chronic suppurative otitis with large tympanic membrane perforation.【Methods】A total of 110 cases（115 ears）which were diagnosed as chronic suppurative otitis with large tympanic membrane perforation were retrospectively collected from May 2017 to Jan 2019. All cases were performed endoscopic tympanoplasty；including removing tympanic lesions，reconstruction of ossicular chain， and myringoplasty with cartilage and perichondrium complex by underlay technique. At the same time of tympanoplasty ， balloon eustachian tuboplasty（BET）was performed in patients who were diagnosed with eustachian tube dysfunction. The graft success rate，pure tone threshold average（PTA）of speech frequency and the air-bone gap（ABG）were assessed at 3 months after surgery.【Results】The primary graft success rate was 95.7%，and the PTA and ABG were（25.7±11.8）dB HL and（13.8 ± 6.9）dB HL，respectively，which showed significant differences compared with pre- operation conditions （P < 0.001）. Furthermore，29 ears which were diagnosed with eustachian tube dysfunction were treated with BET at the same time of tympanoplasty. Compared with simply tympanoplasty （86 ears），no difference was found in primary graft success rate ，PTA and ABG post-operation（P > 0.05）.【Conclusions】 Endoscopic tympanoplasty is an effective surgery，and the cartilage and perichondrium complex is a reliable repair material for large tympanic membrane perforation ，which are both worthy of clinical promotion. Furthermore ，BET at the same time of tympanoplasty could ensure clinical efficacy for the patients with eustachian tube dysfunction.

Enhanced Cell Surviving against Oxidative Stress and Treg-inducing Ability of Dedifferentiated Human Umbilical Cord Mesenchymal Stem Cells Modified by IDO Gene / 中山大学学报(医学科学版)

@#【Objective】 To investigate whether the dedifferented human umbilical cord mesenchymal stem cells（hMSC）modified by IDO gene can get improved ability to survive oxidative stress as well as to induce regulatory T（Treg） lymphocytes.【Methods】The dedifferentiated hMSC（De- hMSC）were obtained by a transient adipogenic induction and subsequent recovery culture in normal medium. The IDO gene modified De-hMSC （IDO/De-hMSC）were prepared by retroviral infection using recombinant retrovirus harboring IDO gene. The De- hMSC infected by retrovirus containing ZsGreen1 gene，the non- infected De- hMSC and hMSC were set as controls. Exogenous expression of IDO protein was confirmed by Western blot. Flow cytometry analysis was performed to detect the immunophenotype of IDO/De- hMSC ， and their osteogenic/adipogenic differentiation abilities were also assessed. Cell survival rates under the oxidative stress of 300 μmol/L t- BHP were determined by Annexin V- FITC/PI double staining flow cytometry. Human peripheral blood mononuclear cells （PBMC） were isolated and treated with conditioned medium containing the culture supernatant of hMSC，De-hMSC，Mock/De-hMSC and IDO/De-hMSC，respectively. Changes in the proportion of CD4+ CD25+ CD127low Treg cells in PBMC were determined by triple fluorescent labeling flow cytometry.【Results】The De-hMSC modified by IDO gene still have the immunophenotype as well as the osteogenic/adipogenic differentiation abilities that are typical of mesenchymal stem cells. When challenged by 300 μmol/L t-BHP，the number of viable cells in De-hMSC significantly elevated compared with hMSC（P<0.05），and the survival advantage of De-hMSC was not obviously affected by IDO gene modification（P>0.05）. Conditioned medium containing the supernatant from IDO/De- hMSC dramatically up- regulated the percentage of CD4+CD25+CD127low Treg cells in PBMC in contrast to the control groups（P<0.05）.【Conclusions】IDO/ De- hMSC have the same immunophenotype and differentiation capacity as the native hMSC ，and can simultaneously enhance the ability of hMSC to survive against oxidative stress and to induce Treg cells ，which may be a potential modification strategy of mesenchymal stem cells for immunosuppressive therapy.

Chemical constituents from twig and leaves of Taxus media / 中草药

Objective: To study the chemical constituents from the petroleum ether and ethyl acetate extract of the twig and leaves of Taxus media. Methods: Several column chromatography including silica gel, Sephadex LH-20 gel, ODS and so on were applied in isolation and purification. The structures were elucidated on the basis of physicochemical properties and spectral data. Results: Eight taxane diterpenoids, five flavonoids, three phenolic acids, and two other compounds were isolated and determined as taxinine-11,12-oxide (1), 2-deacetoxytaxuspine C (2), 2-deacetoxytaxinine E (3), 7,9-deacetyltaxinine B (4), taxagifin (5), 9-deacetyltaxinine A (6), 9-deacetyltaxinine (7), 10-desacetylbaccatin III (8), kaempferol (9), aromadendrin (10), apigenin (11), sciadopitysin (12), ginkgetin (13), 4-hydroxy-benzaldehyde (14), p-hydroxybenzoic acid (15), pyrocatechol (16), β-sitosterol (17), and eicosan-10-ol (18), respectively. Conclusion: Compounds 1-4, 6, 7, 10, 14-16 are firstly isolated from the plant of T. media, and compound 18 is obtained from the Taxaceae for the first time.

Comparison of application value of LTH and LAVH in hysterectomy / 中国内镜杂志

Objective To investigate the effect of total laparoscopic hysterectomy (LTH) and laparoscopic assisted vaginal hysterectomy (LAVH) for hysterectomy. Methods From February 2015 to February 2017, 182 patients with total hysterectomy were enrolled, among them, LTH was performed in 97 patients, and LAVH was performed in 85 patients, the operation time, intraoperative blood loss, the length of scar, postoperative anal exhaust time and so on were observed in the two groups, C reactive protein (CRP), interleukin -2 (IL-2) and IL-6 were detected before and after operation in two groups. Results In group LTH, the amount of bleeding and the length of scar were (104.33 ± 40.20) ml and (2.03 ± 0.84) cm respectively, which were significantly lower than those in group LAVH (P < 0.05); There was no significant difference between LTH group and LAVH group in postoperative anal exhaust time, hospital stay, postoperative analgesia and hospitalization costs (P > 0.05); The CRP and IL-6 in the LTH group postoperative were (26.43 ± 6.11) mg/L and (40.04 ± 11.03) ng/ml, significantly lower than those in LAVH group (P < 0.05), while IL-2 was (44.20 ± 12.29) ng/ml, was significantly higher than that of the control group (P < 0.05); The incidence of postoperative complications in LTH group was 6.19%, which was significantly lower than that of LAVH group (P < 0.05). Conclusion LTH is a safe and reliable method for hysterectomy, has the advantages of less complications, less influence on immune function and so on, is worthy of clinical application.

Changes of fibrinogen in a mouse model of radiation-induced brain injury / 中国组织工程研究

BACKGROUND: Preliminary findings have shown that radiation can impair the mouse blood-brain barrier, which is a cause of secondary brain injury. However, there is little information concerning radiation effects on fibrinogen in plasma and fibrinogen deposition in brain tissue. OBJECTIVE: To establish the mouse model of radiation-induced brain injury, to observe the changes of fibrinogen in plasma and brain tissue, and to further understand the mechanism of radiation-induced brain injury. METHODS: Fifty Kunming mice were randomly divided into irradiation and control groups (n=25 per group). Irradiation group rats were irradiated by 60Co γ, 10 Gy, once every other day, and the total dose was 30 Gy. Learning and memory abilities were tested by Morris Water Maze before and after irradiation, the content of fibrinogen in plasma was detected, then fibrinogen in CA3 region of the hippocampus was determined by immunohistochemistry, and the ultrastructural changes of the blood-brain barrier were investigated under transmission electron microscope . RESULTS AND CONCLUSION: Compared with the control group, the swimming time and distance of the irradiated mice were reduced in the target quadrant (P＜ 0.05), while fibrinogen was increased in plasma (P＜ 0.001) and deposited in hippocampal CA3 region. The translucent zone around the basement membrane of blood-brain barrier in the irradiation group was observed under electron microscope. These results suggest that irradiation can increase fibrinogen in plasma and brain, and the fibrinogen deposited in the brain may be the cause of secondary brain injury.

Function of sahH gene in exopolysaccharides synthesis of Streptococcus mutans LuxS null strain / 上海交通大学学报（医学版）

Objective·To investigate the function of sahH gene in exopolysaccharides synthesis of Streptococcus mutans LuxS null strain. Methods·sahH+luxS-SmUA159 was constructed by introducing sahH gene into Streptococcus mutans LuxS null strain,while PIB169+luxS-SmUA159 and its wild strain SmUA159 were used as vector control and blank control. Real-time qPCR and anthrone test were performed to investigate the differences in exopolysaccharides synthesis among sahH+luxS-SmUA159, PIB169+luxS-SmUA159 and the wide-type strain SmUA159. Results·The transcriptional levels of gtfA and gtfD were upregulated in the sahH+luxS-SmUA159,compared to SmUA159 and PIB169+luxS-SmUA159(both P<0.05),but there was no statistical difference in the transcriptional levels of gtfB and gtfC.The results of the anthrone test showed exopolysaccharides synthesis of the three groups was also similar. Conclusion·sahH gene affects the expression of some genes related to exopolysaccharides synthesis,but it has little effect on the whole content of bacterial exopolysaccharides.

Influence of 3,3'-diindolylmethane on expression of inflammatory cytokines in periodontal ligament cells induced by lipopolysaccharide / 上海交通大学学报（医学版）

Objective·To investigate the effect of 3,3'-diindolylmethane (DIM) on the expression of inflammatory cytokines in human periodontal ligament cells (hPDLCs) induced by lipopolysaccharide (LPS) and to study the related mechanism.Methyls· hPDLCs were isolated and cultured,and CCK-8 method was used to detect the effect of DIM on the proliferation of hPDLCs.hPDLCs were randomly divided into 4 groups:blank group (without LPS and DIM),LPS group (10 μg/mL LPS),10 μg/mL LPS+6.25 μg/mL DIM,10 μg/mL LPS+12.50 μg/mL DIM.The cells of all groups were cultured for 12 h.The protein levels of TNF-α,IL-1β and IL-6 in supernatant were detected by enzyme linked immunosorbent assay.The change of mitogenactivated protein kinase (MAPK) and nuclear factor κB (NF-κB) signaling pathways were detected by Western blotting.Results· The cell viability was not affected when the DIM concentration was less than 50 μmol/L (P＞0.05).DIM at 6.25 and 12.50 μg/mL reduced the LPS-induced expression of TNF-α,IL-1β and IL-6 at protein levels (P＜0.05).DIM inhibited the activation of the NF-κB signaling pathway.Conclusion· DIM can reduce the LPS-induced inflammatory cytokine expression in hPDLCs via restraining the activation of the NF-κB signaling pathway.