Clinical efficacy and prognosis of sacubatrovalsartan combined with dapagliflozin in patients with heart failure with reduced ejection fraction / 中华急诊医学杂志

Objective:To investigate the clinical efficacy and prognosis of sacubatrovalsartan combined with dapagliflozin in patients with heart failure with reduced ejection fraction (HFrEF).Methods:Totally 206 consecutive patients with HFrEF in our hospital from March 2021 to September 2021 were enrolled and randomly(random number) divided into the control group ( n = 51), the sacubatrovalsartan group ( n = 52), the dapagliflozin group ( n=51) and the combined treatment group ( n= 52). The baseline clinical data of patients and laboratory examination results were collected. The changes of related results before and after treatment in each group were analyzed and compared. After discharge, the enrolled patients were followed up by outpatient or telephone for an average of 6 months to determine whether the patients had heart failure rehospitalization, ventricular arrhythmia, major adverse cardiovascular events (MACE), etc. Results:After anti-heart failure treatment, there were significant differences in NT-proBNP, left ventricular ejection fraction (LVEF) and soluble growth stimulating gene 2 protein (ST2) among the four groups. NT-proBNP and ST2 in the combined treatment group were significantly lower than those in the other groups, and LVEF was significantly higher. Compared with the control group, the rehospitalization due to heart failure and MACE events in the other three groups were significantly lower ( P < 0.05), and the combined treatment group had the lowest ( P < 0.05). The Kaplan-Meier survival curve showed that the survival probability of the other groups was significantly higher than that of the control group, and was the highest in the combined treatment group. Conclusions:The clinical efficacy and prognosis of HFrEF patients could be significantly improved after the treatment of sacubatrovalsartan combined with dapagliflozin.

Application value of modified Overlap esophagogastric tube reconstruction in totally laparos-copic radical proximal gastrectomy / 中华消化外科杂志

Objective:To investigate the application value of modified Overlap esophago-gastric tube (MO-EG) reconstruction in totally laparoscopic radical proximal gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 7 patients with upper gastric cancer or adenocarcinoma of esophagogastric junction (AEG) who underwent totally laparoscopic radical proximal gastrectomy with MO-EG reconstruction in the Second Hospital of Jilin University from January 2019 to December 2020 were collected. There were 4 males and 3 females, aged 62(range, 55-72)years. The body mass index of the 7 patients was 21.5(range, 18.5-26.0)kg/m 2. Of the 7 patients, 2 cases had early upper third gastric cancer and 5 cases had Siewert Ⅱ AEG. All patients underwent totally laparoscopic radical proximal gastrectomy with MO-EG recons-truction using barbed sutures. Observation indicators: (1) surgical situations; (2) postoperative recovery situations; (3) postoperative histopathological examinations; (4) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative esophageal reflux, endoscopic classification of esophageal reflux, anastomotic complications, tumor recurrence and metastasis and survival of patients up to December 2021. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All the 7 patients underwent totally laparoscopic radical proximal gastrectomy and D 1+ lymph node dissection with MO-EG reconstruction through abdominal transhiatal approach. None of the 7 patients underwent conversion to open surgery or additional thoracotomy. The operation time, time of digestive reconstruction, volume of intraoperative blood loss and length of esophagus dissected of 7 patients were (271±36)minutes, (44±10)minutes, (53±26)mL and (6.4±0.3)cm, respec-tively. (2) Postoperative recovery situations. The time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial liquid food intake and duration of hospital stay of 7 patients were (21±5)hours, (2.9±0.9)days, (5.0±0.7)days and (10.1±1.9)days, respectively. None of the 7 patients had postoperative severe complications such as bleeding, anasto-motic leakage or mortality. One patient had postoperative pulmonary infection and recovered after anti-infection treatment. Two patients had pleural effusion and were improved after conserva-tive treatment. (3) Postoperative histopathological examinations. The tumor diameter of 7 patients was (2.5±0.7)cm. Histopathological examination of upper margins of 7 patients was negative. The distance between the esophagus margin and the superior margin of the tumor of patients with AEG was (1.8±0.6)cm. The number of lymph node dissected and the number of inferior mediastinum lymph node dissected of 7 patients were 26.0±3.6 and 3.7±1.1, respectively. Pathological TNM stages of 7 patients were 2 cases of stage ⅠB, 4 cases of ⅡA, 1 case of ⅡB. (4) Follow-up. All the 7 patients were followed up for 18(range, 12?36)months. Of the 7 patients, 4 cases reported asymptomatic, 2 cases had symptoms of reflux and 1 case had chocked feeling after eating. All the 7 patients underwent barium meal examination of gastrointestinal tract without anastomotic dysfunction or anastomotic stenosis. Six of the 7 patients underwent gastroscopy at postoperative 1 year and only 1 of them reported grade B reflux esophagitis according to Los Angeles classification, while the rest of 5 patients had no evidence of obvious reflux. None of the 7 patients had postoperative gastric cancer tumor recurrence, metastasis or death. Conclusion:Application of MO-EG reconstruction in totally laparoscopic radical proximal gastrectomy is safe and feasible, with satisfactory short-term effects.

Influence of Tuina plus oxiracetam on serum inflammatory factors and oxidative stress in mild vascular dementia patients / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of Tuina (Chinese therapeutic massage) plus oxiracetam in treating mild vascular dementia (VD) and seek its underlying mechanism. Methods: Ninety-six patients with mild VD were randomized into an observation group and a control group, with 47 cases in the observation group and 49 cases in the control group. The control group received oral oxiracetam capsules for treatment, and the observation group was given additional Tuina treatment. Before and after treatment, the mini-mental state examination (MMSE) was adopted to assess the patient's cognitive function; the activities of daily living (ADL) scale was used to evaluate their ability to conduct daily activities; changes in the serum inflammatory factors and oxidative stress indicators were also detected. Results: After treatment, the serum content of malondialdehyde (MDA) decreased in both groups (P<0.05) and was lower in the observation group than in the control group (P<0.05); the serum contents of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) increased in both groups (P<0.05) and were higher in the observation group than in the control group (P<0.05); the serum contents of interleukin (IL)-1, tumor necrosis factor (TNF)-α, IL-6, and IL-8 declined in both groups (P<0.05) and were lower in the observation group than in the control group (P<0.05). After the intervention, the levels of systolic velocity (Vs) and mean velocity (Vm) of the middle cerebral artery elevated, and the pulsatility index (PI) dropped in patients in the two groups, showing significant intra-group differences (P<0.05); the levels of Vs and Vm in the observation group were higher than those in the control group, and the PI was lower in the observation group than in the control group, showing significant between-group differences (P<0.05). The MMSE and ADL scores increased in both groups after the intervention (P<0.05) and were higher in the observation group than in the control group (P<0.05). Conclusion: In the treatment of mild VD, Tuina plus oxiracetam can improve the cerebral blood supply, ADL, and cognitive function; the mechanism may be associated with the reduction of oxidative stress damages and inflammatory reactions.

Analysis of the efficacy of precision hepatectomy in the treatment of single hepatocellular carcinoma with microvascular invasion and the risk factors of positive incisal margin after operation / 国际外科学杂志

Objective:To explore the efficacy of precision hepatectomy in the treatment of single hepatocellular carcinoma with microvascular invasion (MVI) of and the risk factors of positive incisal margin after operation.Methods:The clinical data of 212 patients with single hepatocellular carcinoma with MVI treated in Affiliated Hospital of Panzhihua University from July 2016 to July 2019 were analyzed retrospectively. 152 patients were treated with precision hepatectomy and 60 patients with traditional hepatectomy. According to the pathological results of postoperative liver resection, the patients treated with precision hepatectomy were divided into two groups: negative group ( n=129) and positive group ( n=23). The operation-related indexes, postoperative complications and disease-free survival rate of precision hepatectomy and traditional hepatectomy were compared, and the general data of patients with negative and positive liver cutting edge were compared. multivariate analysis of the factors affecting the positive liver cutting edge after operation; to construct a line chart prediction model to predict the positive liver cutting edge after operation, and to evaluate its predictive efficiency. Normally distributed measurement data are represented by mean±standard deviation ( Mean± SD), independent t-test is used for comparison between groups; count data are represented by the number of cases and percentages, and χ2 test is used for comparison between groups. Results:The operative time, intraoperative blood loss, postoperative hospital stay, positive rate of surgical margin, total incidence of postoperative complications, AFP negative conversion rate 6 months after operation, and 1-year disease-free survival rate of precision hepatectomy were (328.62±38.74) min, (496.83±59.76) mL, (15.28±3.61) d, 15.13% (23/152), 3.95% (6/152), 81.58% (124/152), 67.11% (102/152), respectively. The mean values of traditional hepatectomy were (315.29±40.95) min, (681.46±58.27) mL, (23.87±4.65) d, 28.33% (17/60), 21.67% (13/60), 66.67% (40/60) and 46.67% (28/60), respectively, the difference was statistically significant ( P<0.05). Univariate analysis showed that the positive liver resection margin after precision liver resection was related to the maximum diameter of the tumor, vascular tumor thrombus, TNM staging, BCLC staging, liver cirrhosis, AFP 2 months after surgery, and the distance between the tumor and the resection margin ( OR=3.645, 5.248, 4.285, 4.462, 3.883, 3.964, 3.872; 95% CI: 2.875-4.415, 4.426-6.070, 3.271-5.299, 3.354-5.570, 3.062-4.704, 3.248-4.680, 2.987-4.757; P<0.05). Maximum tumor diameter >5 cm, vascular tumor thrombus, TNM stage Ⅲ, BCLC stage C, liver cirrhosis, postoperative AFP ≥20 μg Uniql, the distance between the tumor and the resection margin was <1 mm were the risk factors of positive incisal margin after precision hepatectomy in patients with single liver cancer with MVI( OR=6.685, 8.425, 7.758, 7.854, 7.124, 7.246, 6.926; 95% CI: 5.828-7.542, 7.6385-9.212, 6.926-8.590, 7.062-8.646, 6.583-7.665, 6.618-7.874, 6.028-7.824; P<0.05). The constructed line chart prediction model had better differentiation and higher accuracy. Conclusions:Precision hepatectomy in the treatment of single hepatocellular carcinoma with MVI has the advantages of less intraoperative bleeding, faster postoperative recovery, less postoperative complications, low positive rate of liver incisal margin and high disease-free survival rate. The construction of a risk prediction model with positive surgical margin provides a reference for improving the survival rate of patients in clinic.

Cardioprotective effects of metformin / 中国基层医药

Metformin is a first-line drug in the treatment of type 2 diabetes (T2DM), which has been used clinically for over 60 years.In recent years, metformin's effects beyond glycaemia have been gradually discovered, including weight loss, anti-tumor, anti-inflammatory, anti-aging, and cardioprotection.Compared with other hypoglycemic drugs, metformin has a clear cardioprotective effect.This article will systematically explain the cardioprotective effects of metformin.

Metformin inhibits proliferation and functions of regulatory T cells in acidic environment / 南方医科大学学报

OBJECTIVE@#To investigate the regulatory effect of metformin on regulatory T cells (Treg) in acidic environment.@*METHODS@#CD4 CD25 Treg cells were obtained by magnetic bead sorting. Treg and conventional T cells (Tcon) cells were cultured for 24-72 h in pH 7.4 or pH 6.7 medium, and the cell proliferation, apoptosis and Foxp3 expression were detected by flow cytometry. Real-time PCR was used to detect the expression levels of the genes related with glucose metabolism. Thirty-two C57BL/6 male mouse models bearing subcutaneous prostate cancer xenograft derived from RM-1 cells were randomized into 4 equal groups for treatment with PBS, metformin, tumor vaccine, or both metformin and the vaccine. The treatment started on the 4th day following tumor cell injection, and metformin (100 mg/kg) or PBS was administered by intraperitoneal injection on a daily basis; the vaccine was intramuscularly injected every 4 days. The tumor size was continuously monitored, and the mice were euthanized on day 25 after tumor implantation to obtain tumor and blood samples. Flow cytometry was used to detect the changes in CD4, CD8, CD4Foxp3 cell subsets in the tumor tissue and peripheral blood.@*RESULTS@#Treg cells showed significantly enhanced proliferation ( < 0.05) while the proliferation of Tcon cells was suppressed in acidic medium ( < 0.001). Treg cells cultured in acidic medium showed significantly increased expressions of OXPHOS-related genes pgc1a ( < 0.001) and cox5b ( < 0.01), which did not vary significantly in Tcon cells in acidic medium. Treg cells exhibited significantly decreased apoptosis in acidic medium ( < 0.01) with increased Foxp3 cells ( < 0.001) and intracellular alkaline levels ( < 0.01). Metformin obviously reversed the acid tolerance of Treg cells without producing significant effect on Tcon cells. In the animal experiment, both metformin ( < 0.05) and vaccine ( < 0.01) alone reduced the tumor volume, but their combined treatment more potently reduced the tumor volume ( < 0.001). Metformin alone did not obviously affect CD4 cells or CD8 cells but significantly decreased the percentage of CD4Foxp3 ( < 0.05); the vaccine alone significantly increased CD4 cells and CD8 cells ( < 0.001) and also the percentage of CD4Foxp3 cells ( < 0.05). The combined treatment, while reducing the percentage of CD4Foxp3cells to a level lower than that in the vaccine group ( < 0.01), produced the strongest effect to increase CD4 cells and CD8 cells ( < 0.01).@*CONCLUSIONS@#Metformin can inhibit the proliferation and function of regulatory T cells in an acidic environment and enhance the effect of tumor vaccine by reducing the proportion of Treg cells to achieve the anti-tumor effect.

Effectiveness and safety of recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction in elderly in combination with cardiac failure

Objective: To investigate the effects and safety of recombinant human brain natriuretic peptide [rhBNP] in the treatment of elderly acute myocardial infarction induced cardiac failure

Methods: One hundred and forty-six patients who were diagnosed as elderly acute myocardial infarction induced cardiac failure in the hospital from July 2014 to July 2015 were selected. They were divided into a test group and a control group, 73 each. Patients in both groups were given conventional treatment such as stabilization of atherosclerotic plaques, anti-platelet and remodeling and reversion of myocardium. The curative effects and the incidence of adverse reactions of the two groups were observed

Results: The overall efficacy of the test group and the control group was 87.7% and 65.8% respectively, and the difference had statistical significance [P<0.05]. The heart rate, urine volume, n-terminal probrain natriuretic peptide level and left ventricular ejection fraction [LVEF] of both groups significantly improved after treatment, and the improvement of the test group was superior to that of the control group [P<0.05]. The serum creatinine of the test group remarkably reduced after treatment [P<0.05]. The incidence of hypotension and arrhythmia of the test group was lower than that of the control group during hospitalization period [P<0.05]

Conclusion: rhBNP can effectively relieve the clinical symptoms, cardiac function indexes and hemodynamic indexes of patients with elderly acute myocardial infarction induced cardiac failure, with a high safety. It can be extensively applied in the treatment of acute myocardial infarction in combination with cardiac failure

The study of intracranial aneurysms screened by CTA among the population with family history of stroke / 实用放射学杂志

Objective To explore the status of intracranial aneurysms screened by CTA among the population with family history of stroke.Methods 200 patients including 108 men and 92 women in our hospital were involved,who had a family history of stroke.Head CTA examination,physical examination and laboratory tests were performed.Results 200 male and female had no statistical significance in demographic characteristics,past medical history and physical testing (P＞0.05);in lifestyle,smoking and drinking prevalence among male were higher than female (P＜0.05),and drug-usage rate of female were higher than male (P＜0.05).27 cases (13.5 ￥)had intracranial aneurysms,including 13 male cases (12.03 ％) and 14 females cases(15.22 ％),and there was one occurred aneurysm rupture and subarachnoid hemorrhage,the prevalence rate of aneurysm rupture was 87％.The 27 intracranial aneurysms cases had 29 CPC aneurysms,with 2 cases had two aneurysms.The number of aneurysm diameter ＜3 mm were 7 (24.14％),3 7 mm diameter were 12 (41.38％),and ＞7 mm were 10 (34.48％).Classified by the morphology,there were 7 (24.14％) fusiform aneurysm,22 (75.86％) cystic,3 (10.34％) small drops of blood sample.Conclusion CTA is a noninvasive and effective method for intracranial aneurysm,can provide additional valuable diagnostic information particularly for emergency of aneurysm screening.

Clinical experience of combined laparoscopic-endoscopic Heller myotomy and modified Dor fundoplication for cardiochalasia / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication for cardiochalasia patients.</p><p><b>METHODS</b>Clinical data of 11 cardiochalasia patients who underwent combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication by the same medical team from January 2015 to December 2016 at The Second Hospital of Jilin University were retrospectively analyzed. The procedure was as follows: an incision was made in the anterior wall of esophagus and dissection of esophageal muscular layer was performed, then the bulged esophageal mucosa was covered by the fundus after 180 degrees fold to the right (fundoplication), finally the gastric fundus was joined to the right diaphragmatic foot by 3 to 5 knotted suture. The efficacy was judged by the Eckardt scoring standard: the postoperative Eckardt score ≤3 points indicated effectiveness, otherwise the treatment was invalid.</p><p><b>RESULTS</b>Combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication was completed successfully in all the 11 patients without any subsequent laparotomy and death. The mean operative time was 85 (78 to 137) min, blood loss was 15 (5 to 35) ml, and no upper digestive tract perforation occurred. The mean postoperative hospital stay was 7.0(6 to 9) d. After the operation, the pressure of lower esophageal sphincter decreased significantly compared to that before operation [(5.31±6.23) mmHg vs. (35.72±17.13) mmHg, P<0.05], and the Eckardt score decreased significantly as well (0.53±0.56 vs. 6.17±1.17, P<0.05). During the follow-up of 2 to 23 months, there was no postoperative mortality. One case experienced mild gastroesophageal reflux 6 months after operation, and another patient had recurrent dysphagia 17 months after operation, who both were improved after receiving proton pump inhibitors or gastric dynamic drugs, and balloon dilation.</p><p><b>CONCLUSION</b>Combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication is an effective and safe surgical procedure for cardiochalasia with minimal invasion and fast recovery.</p>

Mechanisms Behind the Therapeutic Effects of Er Chen Combined with Tao Hong Si Wu Tang (ECSWT) on Rheumatoid Arthritis / 世界科学技术-中医药现代化

Rheumatoid arthritis (RA) is a chronic autoimmune disorder primarily occurred in small joints.Our previous studies suggested that sufficient lymphatic drainage was favorable for the recovery of RA.This study aimed at exploring the effect of Er Chen combined with Tao Hong Si Wu Tang (ECSWT) on RA in TNF transgenic (TNF-Tg) mice.Ten-week old TNF-Tg mice and WT littermates were detected with indocyanine green-nearinfrared (ICG-NIR) lymphatic imaging system before and after accepting the 12-week intragastric administration of ECSWT.All ankle joints were assessed by micro-CT scanning.According to three dimensional images of Micro-CT,it was found that the ankle joints in the TNF-Tg group were much eroded compared with the control group.The bone mass and structure were protected after the treatment of ECSWT.ICG-NIR results showed that lymphatic clearance rate of the TNF-Tg group decreased compared with those of the control group.In comparison with the TNF-Tg group,ECSWT promoted the repair of lymphatic function.Compared with the control group,the pulse value of the TNF-Tg group declined;while this condition could be rescued by ERSWT.In conclusion,ECSWT mitigated bone erosion of astragalus bone area in TNF-Tg mice in contrast to the saline mice,while promoted the pulse value and clearance of lymphatic vessels afferent from footpad to popliteal lymph node,implying that ECSWT was a promising agent for treating RA through its promoting lymphatic drainage function effects.

Advantage investigation of totally laparoscopic modified Roux-en-Y reconstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical advantage of the application of modified Roux-en-Y reconstruction after totally laparoscopic total gastrectomy.</p><p><b>METHODS</b>Clinical data of 36 patients who underwent totally laparoscopic total gastrectomy with Roux-en-Y reconstruction by one medical team for gastric adenocarcinoma between January 2014 and December 2014 in the Second Hospital of Jilin University were retrospectively analyzed. Patients were divided into classic Roux-en-Y group (CRY, 16 cases) and modified Roux-en-Y group (MRY, 20 cases) according to reconstructive methods. The data concerning the intraoperative and postoperative situation in two groups were compared.</p><p><b>RESULTS</b>Operation was successfully completed in all the cases without conversion to laparotomy. Compared to CRY group, MRY group had shorter mean operative time [(260.9 ± 21.2) min vs. (287.9 ± 19.0) min, P=0.000], shorter mean reconstruction duration [(32.4 ± 9.2] min vs. (45.4 ± 13.2) min, P=0.001] and less intraoperative bleeding [(50.9 ± 23.5) ml vs. (67.0 ± 20.5) ml, P=0.000]. Jejunum mesentery dissection and jejunum resection were not necessary in MRY group. However, there were no significant differences in lymph nodes harvested, time to flatus, hospital stay and postoperative complications between two groups.</p><p><b>CONCLUSIONS</b>As compared to classic Roux-en-Y reconstruction, the modified Roux-en-Y reconstruction can simplify the surgical procedures and achieve similar efficacy. It is feasible and safe, and worth further promotion in clinical practice.</p>

Preliminary study on the change of fetal frontal lobe signal value in normal second-third trimester pregnancy with gestational age / 实用放射学杂志

Objective To explore the change of signal value in the fetal frontal lobe with gestational age in normal second-third trimester fetuses.Methods MRI findings of 125 normal second-third trimester fetuses were divided into 5 groups according to gesta-tional age (unit:week)including 1 7-21,22-26,27 -31,32 -36,37 -40,respectively.The signal values were measured in inferior frontal,middle and upper,respectively.Results The signal value of fetal frontal lobe in 5 groups were 387.38 ± 1 66.75,354.46 ± 1 74.78,342.24±141.23,338.90±1 10.94,310.23±1 18.62,respectively.The signal value was 341.77 ±149.22,35 1.00±145.1 6, 342.85±140.61 in inferior frontal,middle and upper,respectively.The signal value of frontal lobe was 350.34±147.68 in the left and 340.73±144.29 in the right.There were no significant statistical differences on fetal frontal lobe signal value in each group (P>0.05).But the signal value in the frontal lobe had a gradually decreasing trend with fetal age,along with the signal value in the central frontal was higher than the other two parts of the frontal lobe and the left is slightly higher than the right.Conclusion The signal values in frontal lobe of normal second-third trimester fetuses were gradually decreased as gestational age increasing,with the signal values in central frontal lobe was higher than that of in margin of frontal lobe,and the left side was slightly higher than the right.

Clinical Significance of IL-22 Expression and Percentage of IL-22-producing Th22 Cells in Primary Sj?gren′s Syndrome / 中国医科大学学报

Objective to measure the percentage of th22 cells and evaluate the levels of plasma interlukin-22(IL-22)in human peripheral blood, so as to determine their clinical significance in primary Sj?gren′s syndrome(pSS). Methods Patients with pSS were divided into three subgroups based on severity of labial gland involvement:mild,moderate and severe. Healthy people served as controls. the percentage of th22 cells and the lev-els of IL-22 in human peripheral blood from pSS patients and healthy controls were measured and compared. Results Compared to healthy con-trols,pSS patients had significantly higher percentage of th22 cells and higher plasma IL-22 levels(P < 0.05). Among pSS patients,the more seri-ous illness they had,the higher percentage of th22 cell and levels of IL-22 were observed. Severe patients had higher percentage of th22 cells and IL-22 levels than moderate patients(P < 0.05),and moderate patients had higher percentage of th22 cells and IL-22 levels than mild patients(P <0.05). Conclusion Increased peripheral IL-22-secreting th22 cells are detected in primary Sj?gren′s syndrome,which have a close association with disease severity. these data suggest that th22 and its released cytokine IL-22 may be considered as potential valuable biomarkers for severity of pSS,which may provide a novel therapeutic target for treatment.

Utilization of rural primary care physicians' visit services for diabetes management of public health in southwestern China: a cross-sectional study from patients' view

Primary care physicians' visit services for diabetes management are now widely delivered in China's rural public health care. Current studies mainly focus on supply but risk factors from patients' view have not been previously explored. This study aims to present the utilization of rural primary care physicians' visit services for diabetes management in the last 12 months in southwestern China, and to explore risk factors from patients' view. This cross sectional study selected six towns at random and all 385 diabetics managed by primary care physicians were potential participants. Basing on the inclusion and exclusion criteria, 374 diabetics were taken as valid subjects and their survey responses formed the data resource of analyses. Descriptive indicators, chi[2] contingency table analyses and Logistic regression were used. 54.8% respondents reported the utilization of visit services. According to the multivariate analysis, the positive factors mainly associated with utilization of visit services include disease duration [OR=1.654], use of diabetic drugs [OR=1.869], consulting diabetes care knowledge [OR=1.602], recognition of diabetic complications [OR=1.662], needs of visit services [OR=2.338]. The utilization of rural primary care physicians' visit services still remains unsatisfactory. Mass rural health policy awareness, support, and emphasis are in urgent need and possible risk factors including disease duration, use of diabetic drugs, consulting diabetes care knowledge, recognition of diabetic complications and needs of visit services should be taken into account when making rural health policy of visit services for diabetes management in China and many other low- and middle-income countries

Characteristics of early changes in serum interleukin 17 and interferon-γ levels in elderly patients with acute myocardial infarction / 中华老年医学杂志

Objective To investigate the characteristics of early changes in serum IL-17 and IFN-γ levels in elderly patients with acute myocardial infarction (AMI).Methods 70 hospitalized elderly patients with AMI and 35 healthy people were selected.Serum level of interleukin-17 (IL 17) and interferon-γ (IFN-γ) were assayed by enzyme linked immunosorbent assay (ELISA).Results Serum levels of IL17 and IFN-γ showed increasing trends in elderly patients with AMI as compared with that in control group,but there were no significant differences between the two group [(35.73 30.28) pg/ml vs.(28.70±17.12) pg/ml,(15.29±14.64) pg/ml vs.(11.38±10.10) pg/ml,t=0.144 and 0.138,P=0.365 and 0.377].There were correlations between serum IL-17 and IFN γ levels in patients with AMI and controls(r=0.936 and 0.989,both P=0.00).Serum levels of IL-17 or IFN-γhad no significant differences between AMI patients with well and poor prognosis [(35.43± 34.36) ng/L vs.(36.11±30.16) ng/L,(13.90±13.98) ng/L vs.(15.99±14.14) ng/L,U=0.266 and 0.166,P=0.687 and 0.668].Conclusions Serum IL-17 level has an increasing trend in AMI patients within 24h,but has no statistical significant.Serum IL 17 level has a significantly positively correlation with serum IFN γ level in the elderly,but serum levels of IL-17 or IFN γ have no significant correlations with short term prognosis in elderly patients with AMI.

Application of Spider Web map in assessment of CSCD-covered journals of pediactrics / 中华医学图书情报杂志

Objective To assess the CSCD-covered 7 journals of pediactrics.Methods The average number of refe rences,cited half life, H index, citation half life, self citation, IF, immediate index, self-cited rate of each paper pub-lished in 2013 in 7 journals of pediactric, covered in China Science and Technology Journal Citation Index Database, were divided into positive correlation group and negative correlation group.Their Spider Web maps were plotted.The papers published in the 7 journals of pediactrics were assessed.Results The top 3 journals, assessed according to the average number of references, IF, and immediate index, were Chinese Journal of Pediatrics,Chinese Journal of Prac-tical Pediatrics, and Chinese Journal of Evidence-based Pediatrics while the top 3 journals, assessed according to their citation half life , self citation, cited half life, and self cited rate, were Chinese Journal of Evidence-based Pe-diatrics,Chinese Journal of Pediatrics, and Journal of Clinical Pediatrics.Conclusion The academic level of the 7 journals of pediatrics is rather high.Chinese Journal of Evidence-based Pediatrics and Chinese Journal of Pediatrics have the highest assessment score.There is a large room for the other 4 journals to improve their academic level.

Comparison of serum markers between pure hepatitis B infection and superinfection of hepatitis B together with hepatitis D / 国际检验医学杂志

Objective To understand the characteristics of the superinfection of hepatise B virus (HBV)together with hepatitis D virus(HDV)by comparing the differences of serum markers ALT,HBV DNA,HBVM,etc.In the pure HBV infection and the superinfection of HBV and HDV and to preliminarily invesitigate the pathogenesis of HDV.Methods The results of major bio-chemical indicators and hepatitis virus markers in 95 cases of HBV together with HDV infection and 100 cases of pure HBV infec-tion as the control group were statistically analyzed.Results Among 95 cases in the superinfection group,the incidence rate of chronic HBV was the highest,accounting for 66.32% and followed by liver cirrhosis.There was no statistical difference between the two groups according to the HBV DNA loads(P >0.05).The good positive correlation existed between the ALT abnormal rate of the liver function and HBV DNA in the superinfection group(r=0.90,P 250 IU/mL (P >0.05).According to HBsAg>250 IU/mL and HBeAg > 1 S/CO,the pure HBV infection group was higher than the super infec-tion group (P <0.05).The positive rate of HBcAb-IgM in the super infection group was significantly higher than that in the pure HBV group (P <0.05).Conclusion The superinfection of HBV together with HDV infection has the high occurrence rate in chro-nic hepatitis B.With the HBV DNA level increase,the abnormal rate of the liver function is also increased.HDV infection can inhib-it the HBeAg expression.The high positive rate of HBcAb-IgM in the superinfection patients might be related with chronic hepatitis B aggravation and recurrence.

Epidemiological features of metabolic syndrome in Gansu province / 中华流行病学杂志

Objective To understand the prevalence of metabolic syndrome in Gansu.Methods A multistage stratified cluster sampling method was conducted.A total of 6 609 adults (range 18-96 years old) from 5 cities located in different areas of Gansu province were included in the analyses and all of them underwent physical examinations.Metabolic syndrome was diagnosed under the modified 2005 National Cholesterol Education Program Adult Treatment Panel Ⅲ (ATP Ⅲ) guidelines as well as the 2004 Chinese Diabetes Society (CDS) guidelines.Results Using the modified ATP Ⅲ criterion for diagnosis,the unadjusted prevalence rate of metabolic syndrome was 30.43％ (35.25％ in males and 23.02％ in females,respectively) and the age-adjusted prevalence was 29.05％.The prevalence of metabolic syndrome increased with age.Combination of central obesity,high TG hyperlipidemia and low HDL-C hyperlipidemia was most frequently seen.Under the CDS criterion,the unadjusted prevalence of metabolic syndrome was 13.42％,with the age-adjusted prevalence as 12.65％.A low level of agreement between the ATP Ⅲ and CDS was observed (Kappa index=0.496).Conclusion Under the ATP Ⅲ definition,more adults with MS were identified thus could be recommended as the preferred diagnostic criterion.Metabolic syndrome had become a noteworthy public health problem.Prevention programs related to metabolic syndrome should be urgently warranted.

Generation of streptavidin-tagged human-granulocyte macrophage colony-stimulating factor fusion proteins / 南方医科大学学报

<p><b>OBJECTIVE</b>To obtain streptavidin-tagged human granulocyte-macrophage colony-stimulating factor (SA/hGM-CSF) fusion protein and evaluate its bioactivity .</p><p><b>METHODS</b>PET24a-6His-SA-L-hGM-CSF and PET24a-hGM-CSF-L-SA-6His plasmids were constructed and expressed in Rosetta (DE3) host bacteria to generate the fusion proteins. The two fusion proteins were refolded by gradient dialysis after Ni-NTA affinity chromatography and finally purified using DEAE-sepharose FF anion exchange chromatography. MTT method was used to evaluate the effect of SA/hGM-CSF fusion proteins in inducing the proliferation of human erythroleukemia cells (TF-1). The efficiency of the fusion proteins for surface modification of biotinylated MB49 tumor cells was evaluated by flow cytometry.</p><p><b>RESULTS</b>The recombinant fusion proteins SA-hGM-CSF and hGM-CSF-SA were highly expressed in Rosetta (DE3) at about 20% of the total bacterial proteins, with a purity of about 96% after purification. The two fusion proteins exhibited bifunctional activities, namely the pro-proliferation effect on human erythroleukemia cells (TF-1) and SA-mediated high-affinity binding to biotinylated cell surfaces (with an anchoring modified rate of about 99%).</p><p><b>CONCLUSION</b>SA/hGM-CSF bi-fusion proteins obtained in this study lays the groundwork for the development of cancer cell vaccines with surface modification by hGM-CSF.</p>

Short and long term effects of the low-big hole choledochoduodenostomy / 中国综合临床

Objective To investigate the indications and clinical effect of the low-big hole choledochoduodenostomy. Methods Two hundred and ninty-eight patients, had bile duct stone accompanied with common bile duct lower segment stenosis, were prospectively enrolled into the study and randomly divided into the low-big hole choledochoduodenostomy (improved CD ) group (n = 148 ) and the Roux-en-Y choledochojejunostomy (CJ) group (n = 150). Their perioperative period and long term effect indices were recorded and compared. Results Perioperative period indices:The time of cholangio-jejunostomy was much shorter in improved CD group than the CJ group ([31.0±10.5] min vs [53.0±12.3] min, P＜0.001);The anastomotic leakage was significantly less in improved CD group than the CJ group (2 vs 9, P ＜ 0. 001 ). The long term effect indices: The occurrence of peptic ulcer (3 vs 15 ) and the bile duct cecum or blind loop syndrome (5 vs 158) were significantly lower in group improved CD group than CJ group (Ps＜0.01);The occurrence of bile duct backflow (70 vs 42) was significantly higher in improved CD group than CJ group (P＜0. 0l). Conclusion The clinical effect of the low-big hole choledochoduodenostomy gastrointestinal had excellent effect for bile duct stone accompanied with common bile duct lower segment stenosis, especially for old,weak and critical patients,and it can not be replaced by the Roux-en-Y choledochojejunostomy.