Efficacy and Mechanism of Qingre Lishi Prescription in Treating Children with Acute Bacterial Lower Urinary Tract Infection of Bladder Damp-heat Syndrome / 中国实验方剂学杂志

Objective:To observe the efficacy of Qingre Lishi prescription in treating children with acute bacterial lower urinary tract infection of bladder damp-heat syndrome， and to explore its mechanism of action. Method:Eighty children with acute bacterial lower urinary tract infection of late bladder damp-heat syndrome who were admitted to the Affiliated Hospital of Changchun University of Chinese Medicine were divided into control group and observation group， 40 cases in each group. Patients in control group were given Bazhengsan for oral treatment on basis of basic treatment， while patients in observation group were given Qingre Lishi prescription for oral administration plus external washing treatment. After two weeks of treatment， the clinical and etiological effect， traditional Chinese medicine （TCM） syndrome scores， antipyretic time and urinary negative time， adverse reactions， and urine pathogens （<italic>Escherichia coli， Enterococcus faecalis， Strange proteus， Klebsiella pneumoniae</italic>）， serum inflammatory factor indicators ［tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， calcium lowering PCT， white blood cell count （WBC） and serum C-reactive protein （CRP）］， immune function indicators ［T cell subsets （CD3⁺， CD4⁺， CD8⁺） and complement （C3， C4）］ were comapred between two groups. Result:The clinical efficacy of observation group was 92.50% （37/40）， which was significantly higher than 65.00% （26/40） in control group （<italic>χ²</italic>=9.038， <italic>P</italic><0.01）， the etiological efficacy of observation group was 87.50% （35/40）， which was significantly higher than 60.00% （24/40） in control group （<italic>χ²</italic>=7.813， <italic>P</italic><0.01）. After treatment， the scores of TCM syndromes of the two groups were significantly reduced （<italic>P</italic><0.05）. The scores of fever， frequent urination， urgent urination， painful urination， difficulty urinating and abdominal pain in two groups were significantly lower than those before treatment （<italic>P</italic><0.05）， and the TCM syndrome scores in observation group were lower than those in control group （<italic>P</italic><0.05）， the antipyretic time and urinary bacteria turning negative time of observation group were significantly lower than those in control group （<italic>P</italic><0.05）， the <italic>Escherichia coli， Enterococcus faecalis， Proteus mirabilis， Klebsiella pneumoniae</italic> pathogenic bacteria detected in both groups were both significantly lower than those before treatment （<italic>P</italic><0.05）. After treatment， the levels of inflammatory factors such as TNF-<italic>α</italic>， IL-6， IL-8， PCT， WBC and CRP in two groups were significantly lower than those before treatment （<italic>P</italic><0.05）， the immune function of the two groups was significantly improved， and the levels of CD3⁺， CD4⁺， C3， and C4 in observation group were higher than those in control group（<italic>P</italic><0.05）， and the CD8⁺ level was lower than that in control group （<italic>P</italic><0.05）. The incidence of adverse reactions had no significant difference between two groups. Conclusion:Qingre Lishi prescription has good clinical effect in treating children with acute bacterial lower urinary tract infection with bladder damp-heat syndrome. It can improve TCM syndromes and clinical symptoms. Its mechanism is related to inhibiting pathogenic bacteria， reducing inflammation， and improving immune function， and it has good security.

Disease burden on uterine fibroids in China, 1990 and 2016 / 中华流行病学杂志

Objective To assess the disease burden on uterine fibroids in China in 1990 and 2016.Methods Data were extracted from the Global Burden of Disease Study 2016.Burdens of uterine fibrosis among different age groups and provinces were measured in 1990 and 2016,with key indicators including number of cases,prevalence rates,disability-adjusted life year (DALY) and the rates of DALY.The WHO world standard population,2010-2035 was used to calculate the agestandardized rates.Results In 1990 and 2016,there were 13 695 567 and 27 169 312 women aged 15 years and older,suffered from uterine fibrosis respectively,with prevalence rate as 2.48％ and 4.10％,DALY as 146 045.05 life years and 281 976.67 life years,and the DALY rate as 26.40/100 000 and 42.50/100 000,in 1990 and 2016 respectively.Both the prevalence rate and the DALY rate increased with age,reaching the peak on the 45-49 years-old,in both 1990 and 2016.Women aged 40-54 years accounted for 55.60％ (1990) and 66.74％ (2016) of the total cases while 48.37％ (1990) and 60.65％ (2016) of the total DALY.The first three provinces with highest DALYs were Shandong (1990:12 574.67 life year;2016:22 728.12 life year),Henan (1990:10 849.29 life year;2016:18 454.32 life year) and Jiangsu (1990:10 501.55 life year;2016:18 274.10 life year),while the three provinces with leading standardized DALY rates were Heilongjiang (1990:48.20/100 000;2016:47.00/100 000),Shanxi (1990:44.50/100 000;2016:47.70/100 000) and Tianjin (1990:43.80/100 000;2016:46.40/100 000) in both 1990 and 2016.Compared with 1990,the number of cases with uterine fibroids increased by 13 473 745 (with rate of change as:98.38％),standardized prevalence rate increased by 1.88％,DALY value increased by 135 931.62 life years (with the rate of change as 93.08％) and standardized DALY rate increased by 5.92％ among Chinese women,in 2016.Conclusion Menopausal women were the ones hard hit by uterine fibrosis.Compared with data from 1990,the disease burden of uterine fibrosis increased rapidly in China,in 2016.

Disease burden of diabetes attributable to high body mass index in China,1990-2016 / 中华流行病学杂志

Objective To analyze the burden of disease (BOD) on diabetes attributable to high BMI in China from 1990 to 2016.Methods Data based on population of the 2016 Global Burden of Disease Study for China were used to analyze the attributable fractions (PAF) of BOD for diabetes attributable to high BMI.Measurements for attributable BOD of diabetes included disability adjusted life years (DALY),years of lost life (YLL),years living with disability (YLD),death number and mortality rate.The average world population from 2010 to 2035 was used as a reference.Results In 2016,death number of diabetes attributable to high BMI was 40 310,which was significantly higher than that in 1990 (15 008).Age-standardized death rate of diabetes attributable to high BMI increased from 2.01/100 000 in 1990 to 2.60/100 000 in 2016,which showed a more significant increasing trend in both males and people aged 15-49 years.DALYs of diabetes attributable to high BMI increased from 1.09 million person years to 3.30 million person years.YLL and YLD also showed increasing trends.The highest increasing rate of YLD was in people aged 15-49 years.High BMI was responsible for 26.01％ of the diabetes deaths in 2016 in China,an increase of 39.39％ compared with that in 1990 (18.66％).Most provinces in China experienced a sharp increase of DALY of diabetes attributable to high BMI from 1990 to 2016.Inner Mongolia,Xinjiang,Zhejiang,Macao SAR,Sichuan and Qinghai had the most significant increase tendency in terms of DALY rate during this period.Conclusions There was a rapid increase of the deaths and mortality rate of diabetes attributable to high BMI,causing a heavy disease burden,in China from 1990 to 2016.The BOD varied in both different age and gender groups.More attention should be paid to males and people aged 15-49 years in the prevention and control programs of diabetes.

Application and effect evaluation of "3-PR" participatory health education model in the improvement of health literacy of secondary health school / 中国学校卫生

Objective@#To compare the effect of two different methods of "3-PR" participatory health education and traditional distribution of publicity materials on health literacy improvement of medical students, to provide a reference for making more effective measure to improve health literacy.@*Methods@#173 Second-grade students in nursing major were selected in a secondary vocational school in Datong City. Two different intervention methods were used to intervene for 8 weeks. The experimental group (92 students) received "3-PR" participatory health education; the traditional health education intervention in the control group(81 students). The "National Residents’ Health Literacy Monitoring Questionnaire 2015" was used to conduct a questionnaire survey on the experimental group and the control group before and after the intervention, and to compare the effects before and after the intervention.@*Results@#The average score of health literacy was (36.04±9.43) points and (36.01±10.17) points before and after intervention in the control group; (35.78±8.91) points and (49.53±13.53) points before and after intervention in the experimental group; No statistical difference between experimental and control group was found before intervention(t=0.18, P=0.86); There was no significant difference in health literacy score before and after intervention for the control group(t=0.03, P=0.98); Health literacy significantly increased in the experimental group after intervention(t=-11.36, P=0.00). Adequate health literacy accounted for 3.70% and 4.94% before and after intervention in the control group and 4.35% and 45.65% in the experimental group before and after intervention. No significant difference was found in adequate health literacy proportion between the two groups before intervention(χ2=0.00, P=1.00). However, the difference showed statistically significant after intervention(χ2=36.58, P=0.00). The change of health literacy score in the control group and the experimental group was (-0.02±7.52) and (12.75±10.77), respectively, accounting for 1.24% decrement and 41.30% increment. The difference between the two groups was statistically significant (t=-8.93, P=0.00). The dimension-and type-specific score of health literacy showed similar pattern.@*Conclusion@#The "3-PR" participatory health education model is more effective than the traditional health education method in improving health literacy, and it could be carried out by multi-disciplinary students.

Disease burden on uterine fibroids in China, 1990 and 2016 / 中华流行病学杂志

Objective To assess the disease burden on uterine fibroids in China in 1990 and 2016.Methods Data were extracted from the Global Burden of Disease Study 2016.Burdens of uterine fibrosis among different age groups and provinces were measured in 1990 and 2016,with key indicators including number of cases,prevalence rates,disability-adjusted life year (DALY) and the rates of DALY.The WHO world standard population,2010-2035 was used to calculate the agestandardized rates.Results In 1990 and 2016,there were 13 695 567 and 27 169 312 women aged 15 years and older,suffered from uterine fibrosis respectively,with prevalence rate as 2.48％ and 4.10％,DALY as 146 045.05 life years and 281 976.67 life years,and the DALY rate as 26.40/100 000 and 42.50/100 000,in 1990 and 2016 respectively.Both the prevalence rate and the DALY rate increased with age,reaching the peak on the 45-49 years-old,in both 1990 and 2016.Women aged 40-54 years accounted for 55.60％ (1990) and 66.74％ (2016) of the total cases while 48.37％ (1990) and 60.65％ (2016) of the total DALY.The first three provinces with highest DALYs were Shandong (1990:12 574.67 life year;2016:22 728.12 life year),Henan (1990:10 849.29 life year;2016:18 454.32 life year) and Jiangsu (1990:10 501.55 life year;2016:18 274.10 life year),while the three provinces with leading standardized DALY rates were Heilongjiang (1990:48.20/100 000;2016:47.00/100 000),Shanxi (1990:44.50/100 000;2016:47.70/100 000) and Tianjin (1990:43.80/100 000;2016:46.40/100 000) in both 1990 and 2016.Compared with 1990,the number of cases with uterine fibroids increased by 13 473 745 (with rate of change as:98.38％),standardized prevalence rate increased by 1.88％,DALY value increased by 135 931.62 life years (with the rate of change as 93.08％) and standardized DALY rate increased by 5.92％ among Chinese women,in 2016.Conclusion Menopausal women were the ones hard hit by uterine fibrosis.Compared with data from 1990,the disease burden of uterine fibrosis increased rapidly in China,in 2016.

Disease burden of diabetes attributable to high body mass index in China,1990-2016 / 中华流行病学杂志

Objective To analyze the burden of disease (BOD) on diabetes attributable to high BMI in China from 1990 to 2016.Methods Data based on population of the 2016 Global Burden of Disease Study for China were used to analyze the attributable fractions (PAF) of BOD for diabetes attributable to high BMI.Measurements for attributable BOD of diabetes included disability adjusted life years (DALY),years of lost life (YLL),years living with disability (YLD),death number and mortality rate.The average world population from 2010 to 2035 was used as a reference.Results In 2016,death number of diabetes attributable to high BMI was 40 310,which was significantly higher than that in 1990 (15 008).Age-standardized death rate of diabetes attributable to high BMI increased from 2.01/100 000 in 1990 to 2.60/100 000 in 2016,which showed a more significant increasing trend in both males and people aged 15-49 years.DALYs of diabetes attributable to high BMI increased from 1.09 million person years to 3.30 million person years.YLL and YLD also showed increasing trends.The highest increasing rate of YLD was in people aged 15-49 years.High BMI was responsible for 26.01％ of the diabetes deaths in 2016 in China,an increase of 39.39％ compared with that in 1990 (18.66％).Most provinces in China experienced a sharp increase of DALY of diabetes attributable to high BMI from 1990 to 2016.Inner Mongolia,Xinjiang,Zhejiang,Macao SAR,Sichuan and Qinghai had the most significant increase tendency in terms of DALY rate during this period.Conclusions There was a rapid increase of the deaths and mortality rate of diabetes attributable to high BMI,causing a heavy disease burden,in China from 1990 to 2016.The BOD varied in both different age and gender groups.More attention should be paid to males and people aged 15-49 years in the prevention and control programs of diabetes.

Deaths attributable to alcohol use and its impact on life expectancy in China, 2013 / 中华流行病学杂志

Objective To analyze the deaths attributable to alcohol use and its impact on people's life expectancy in China in 2013.Methods The mortality data from the Disease Surveillance Points System and alcohol use data from China Chronic Disease Surveillance (2013) were used.The deaths attributed to alcohol use and its impact on the life expectancy of Chinese residents were estimated based on the principle of comparative risk assessment by calculating population attributable fraction.Results In 2013,alcohol use resulted in 381 200 deaths,including 97 100 hemorrhagic stroke deaths,88 200 liver cancer deaths,61 400 liver cirrhosis deaths and 48 700 esophageal cancer deaths,and prevented 76 500 deaths,including 68 500,4 900 and 3 100 deaths which might be caused by ischemic heart disease,hemorrhagic stroke and diabetes respectively.If risk factor of alcohol use is removed,the people's life expectancy would rise by an average of 0.43 years,especially in westem China by 0.52 years,which was 0.12 years higher than that in eastern and central China,and the life expectancy of the population in rural and urban areas would rise by 0.48 years and 0.31 years respectively.Conclusions Although alcohol has a protective effect on reducing ischemic heart disease,stroke and diabetes deaths,alcohol use is still a risk factor influencing the mortality and life expectancy of residents in China.It is necessary to take targeted measures to reduce the health problems caused by harmful use of alcohol.

Disease burden for gynecological disease in China, 2016 / 中华妇产科杂志

Objective To assess the disease burden for gynecological disease in China in 2016. Methods Data were extracted from the global burden of disease study 2016(GBD 2016). The burden of gynecological disease among age groups and provinces groups was assessed by prevalence rate, mortality rate, years lived with disability (YLD), years of life lost due to premature mortality (YLL) and disability-adjusted life years(DALY). An average world population age-structure for the period 2010-2035 was adopted to calculate age-standardized rates. Results In 2016, the prevalence rate of gynecological disease in women aged 15 years and above in China was 24.94%, of which was 36.71%to women of childbearing age. The number of DALY from gynecological disease was 2727637.82 life years in 2016, with the DALY rate was 411.12/100000 and standardized DALY rate was 341.80/100000. The first three gynecological diseases with highest DALY and DALY rate among Chinese women aged ≥15 years were premenstrual syndrome(815004.64 life years, 122.84/100000), uterine fibroids(281976.67 life years, 42.5/100000) and endometriosis (154792.89 life years, 23.33/100000). The DALY caused by gynecological disease in Guangdong (220871.19 life years), Shandong (190968.72 life years), Henan (171273.92 life years), Jiangsu(168404.27 life years)and Sichuan(144358.5 life years)were higher than other provinces. The standardized DALY rate attributable to gynecological disease were highest in Xinjiang Uygur Autonomous Region(404.00/100000), Shanghai(394.90/100000), Heilongjiang(382.00/100000), Beijing(365.70/100000)and Jiangsu (357.50/100000). Conclusions Gynecological disease is a great threat to women' s reproductive health. Effective measures should be taken to address the issue, especially to women of childbearing age.

Effect of lifestyle intervention among high risk group of chronic diseases in Shenzhen Futian district / 中华预防医学杂志

Objective@#To evaluate the effect of lifestyle intervention among high risk group of chronic diseases in Shenzhen Futian district.@*Methods@#12 out of 115 communities were randomly selected in Futian district of Shenzhen city from October to November, 2013, and 1 923 cases were screened by multiple ways as high risk groups of chronic diseases. High risk groups of chronic diseases were divided into intervention group (1 338 cases, from five residential communities and three villages within city) and control group (585 cases, from four residential communities). The intervention group received group based health education activities as well as lifestyle intervention. The intervention group was provided with health management which was mainly lifestyle intervention. No intervention was implemented in the control group. All participants were followed up over two years. 1 563 participants (1 002 in intervention group and 561 in control group) were followed up from October to November, 2015. The changes of lifestyle related outcome indicators were analyzed to examine the effect of intervention.@*Results@#In the intervention group, 21.8% (219 persons) in high risk groups of chronic diseases became healthy individuals and 15.2% (152 persons) became patients with chronic diseases. In the control group, 9.6% (54 persons) in high risk groups of chronic diseases became healthy individuals and 20.5% (115 persons) became patients with chronic diseases. The outcome of the intervention group was better than that of the control group and the difference was statistically significant (χ2=-5.67, P<0.001). The proportion of people who knew how to correctly use of oil control pot in the intervention group increased from 61.00% (61/100) to 80.00% (280/350). The proportion of people who took oil control measures in the intervention group increased from 36.43% (365/1 002) to 56.99%(571/1 002). The changes in the intervention group were statistically different (P<0.001), but there was no statistical difference in the control group over the years (P>0.05). The proportion of people who knew how to correctly use of the salt restriction spoon increased from 81.95% (109/133) to 97.99% (342/349). The proportion of people who took salt control measures increased from 45.61% (457/1 002) to 62.67% (628/1 002) in the intervention group. The changes in the intervention group were statistically different (P<0.001). There was no statistical difference in the control group over the years (P>0.05).@*Conclusion@#The proportion of people who adopted healthy lifestyles has increased after 2 years intervention and the lifestyle intervention demonstrated good effect.

Role and mechanism of Epac protein in regulation of inflammatory pain in paraventricular nucleus of hypothalamus / 中国药理学通报

Aim To investigate the role and mecha-nism of exchange protein directly activated by cAMP (Epac) protein in the paraventricular nucleus(PVN) of the hypothalamus in the development of inflammatory pain in rats. Methods Adult SD male rats were cho-sen to establish the model of inflammatory pain through subcutaneous injection of complete Freund's adjuvant(CFA) on the center of left hind foot. Western blot was used to detect the changes of the expression of Ep-ac protein. Thermal withdrawal latency(TWL) was ob-served after the PVN injecting 8p-CPT-2′-O-Me-cAMP (8p-CPT),the agonist of Epac. Then activated down-stream MEK1/2 protein of Epac in PVN was detected using Western blot when the potency was the strongest.Results ① Compared with normal saline(control group),TWL decreased significantly on d 1, d 3, d 5, d 7,d 9 on the ipsilateral foot of CFA group rats(P<0.01),whereas it returned to normal level in d 13;the paw mechanical withdrawal threshold(PMWT) de-creased significantly on d 6,d 8,d 10,d 12 and d 14 (P<0.05);②Compared with the control,the Epac1 protein in CFA group rats began to decrease from d 3, and significantly decreased on d 3 and d 9(P<0.05), however the expression of Epac2 had no significant change, meanwhile p-MEK1/2 protein decreased sig-nificantly on d 3(P<0.05);③Compared with micro-injection of saline into the PVN(Saline group), the heat hyperalgesia of 20 min and 1h decreased signifi-cantly and TWL increased significantly after PVN ad-ministration of 8p-CPT(8p-CPT group)(P <0.05);paraventricular nucleus p-MEK1/2 protein expression increased significantly in 30 min(P <0.05) and re-covered to normal level 2 h after administration. Con-clusion The Epac1-MEK1/2 signaling pathway in the paraventricular nucleus of the hypothalamus may be in-volved in the development of chronic inflammatory pain induced by CFA.

Clinical evaluation of the anti-gingivitis efficacy of a novel stabilized stannous-containing sodium fluoride dentifrice / 实用口腔医学杂志

Objective: To evaluate the anti-gingivitis efficacy of a novel stabilized stannous-containing sodium fluoride dentifrice. Methods: A randomized, controlled and double blind clinical study was conducted. 156 adults with gingivitis were enrolled and randomly assigned to experimental group(group of novel stabilized stannous-containing sodium fluoride dentifrice, n = 51), positive control group (group of Yunnan Baiyao dentifrice, n = 54) and negative control group (group of Crest dentifrice, n = 51). Gingival health was assessed using Mazza Modification of the Papillary Bleeding Index(Mazza GI) at Baseline, day 3 and week 4 and pocket depth was evaluated at baseline and week 4, respectively. Results: At day 3 and week 4, the experimental and positive control groups exhibited lower clinical parameters than the negative control group(P＜ 0. 000 1). At week 4, the mean Mazza GI scores and PD of the experimental group were significantly lower than those of the positive control group(P＜ 0. 05). Conclusion: The novel stannous-containing sodium fluoride dentifrice has anti-gingivitis efficacy.

The strategy and results of percutaneous endoscopic surgery for cervical disc herniation / 中华骨科杂志

Objective To evaluate the strategy and clinical effects of percutaneous endoscopic surgery for cervical disc herniation.Methods Fifty-one patients with cervical disc herniation were treated with percutaneous endoscopic surgery from June 2015 to March 2017,including 32 men and 19 women,with an average age of 52.2 years (range,28-66 years).Radicular symptoms were present in all patients,while 23 patients had mild myelopathy (Nurick Grade:0-3) and 3 patients of multilevel stenosis had severe myelopathy (Nurick Grade:4-5).According to axial image of preoperative magnetic resonance imaging (MRI),31 patients had lateral herniation that was located lateral to the edge of spinal cord,20 patients had central herniation that was located within the lateral edge of spinal cord.Among them,48 patients had soft herniation and 3 patients had ossified lateral herniation combined with foraminal stenosis.All surgery was carried out under general anesthesia,while posterior and anterior percutaneous endoscopic surgeries were performed for lateral herniation and central herniation respectively.Posterior endoscopic surgery was performed with "keyhole" fenestration at "V" point (the junction of lateral edge of lamina space and inner edge of facet).Lateral edge of thecal sac and nerve root were exposed and decompressed,soft herniation was explored and removed.Anterior endoscopic surgery was performed through puncture and 4mm tube between the visceral sheath and vascular sheath.The tube was inserted through disc to the base of herniation under fluoroscopy.The herniation was removed until the dura sac was exposed and relaxed.One stage open-door laminoplasty was performed for 3 patients with severe multiple segmental stenosis and huge central herniation.The operative time and blood loss were recorded,and patients were followed-up (range,6-18 months,average 12.1 months) to evaluate the clinical efficacy.Results The mean operative time of posterior endoscopic surgery was 90 min (range,45-150 min).The nerve root was not well exposed,and the fenestration was too lateral in 1 patient,with partial relieve of symptoms;and simple nerve root decompression was performed for 3 patients of ossified herniation combined with foraminal stenosis.Herniated or sequestered nucleus pulposus was removed for 27 patients,one of them had transient paralysis ipsilateral limb and 2 of them had linkage of cerebrospinal fluid.The Visual Analogue Score (VAS) score improved form preoperative 8.9±1.6 to 0.5±0.4,and the Oswestry Disability Index (ODI) score improved form 32.8±4.2 to 2.3± 1.9 at final follow-up.For anterior percutaneous endoscopic surgery,the mean operative time was 80 min (range,45-120 min).Herniated or free nucleus was successfully removed for all patients.The thecal sac was lacerated due to unclear exposure in 1 case.The VAS score improved form preoperative 6.9±2.3 to 0.9±0.8,and the ODI score improved form 40.1±8.6 to 5.6±3.0 at final follow-up,with improvement of myelopathy at least one Nurick Grade.During follow-up,the alignment of cervical spine was well preserved without kyphosis for two groups,while the height of intervertebral space decreased with 0.4±0.3 mm and 0.9±0.6 mm in posterior and anterior surgery respectively.Conclusion Percutaneous endoscopic surgery provides minimally invasive alternatives for some cervical disc herniation with predominant radicular pain.Posterior endoscopic surgery is suitable for lateral herniation,and anterior endoscopic discectomy is suitable for some central soft herniation without obvious collapse and instability.However,the long-term results of disc space collapsed after anterior approach remains unclear.

Clinical study of anterior cervical decompression assisted with microscope versus mobile microendoscopic discetomy for cervical spondylotic myelopathy / 中华骨科杂志

Objective To explore the feasibility of anterior cervical decompression assisted with the microscope and mobile microendoscopic discectomy (MMED),and to compare their clinical efficacy.Methods From May 2015 to February 2017,thirty patients with cervical spondylotic myelopathy (CSM) underwent anterior cervical decompression assisted with microscope or MMED.Among them,conventional transverse anterior cervical incisions were used,and intervertebral distractors were placed in order to complete the decompression,then the fusion and fixation procedure were conducted under direct vision,and the operative time and intraoperative blood loss were recorded.Of 30 cases,15 cases were in microscope cohort (anterior cervical discectomy and fusion,ACDF 12 cases;anterior cervical corpectomy and fusion,ACCF 3 cases),including 4 males and 11 females with a mean age of 54.00±11.10 years (range,32-71 years).Another 15 cases were in MMED cohort (ACDF 13 cases,ACCF 2 cases),including 9 males and 6 females with a mean age of 59.60± 11.10 years (range,39-73 years).Neurological and cervical function were evaluated before surgery and at the follow-up according to the Japanese Orthopaedic Association (JOA) and the neck disability index (NDI) scores,and the neurologic improvement grade (NIG) was used to evaluate the neurological function.Results Both the microscope and MMED cohort underwent decompression successfully,and the visual field was clear.No neurological symptoms became worse.For the microscope,its lens and the instrument had to be adjusted separately,whereas MMED lens could move synchronously with the instrument.It was easier for MMED to reveal the posterior edge of the vertebral body and the left and right side of the spinal canal.The operation time of the microscope cohort was 90-180 min,with an average of 124.67±36.42 min;the M MED cohort was operated for 80-130 min with an average of 110.00± 15.12 min,and there was no significant difference between the two cohorts (t=1.440,P=0.161).The intraoperative blood loss for microscope cohort was 20-200 ml,with an average of 66.00±49.11 ml;MMED cohort was 30-150 ml with an average of 60.00±35.25 ml;there was no significant difference between the two cohorts (t=0.384,P=0.704).The JOA score of the microsurgery cohort improved from 8.67±3.20 preoperatively to 15.93± 1.53 at the latest follow-up,and its difference was significant (t=8.687,P=0.000).According to NIG,neurological improvement was excellent in 12 cases and good in 3 cases,giving an excellent to good rate of 100％.NDI was reduced from 18.00％±9.75％ preoperatively to 5.93％±2.58％ at the latest follow-up,with significant difference (t=5.137,P=0.000).The JOA score in MMED cohort improved from 8.87±3.11 preoperatively to 15.53±1.69 at the latest follow-up,and its difference was significant (t=9.413,P=0.000).and Among these 15 patients,11 were excellent and 4 were good,giving an excellent-good rate 100％.NDI decreased from 17.13％± 8.00％ preoperatively to 5.80％±2.43％ at the latest follow-up,and its difference was significant (t=5.592,P=0.000).There was no significant difference in JOA (t=0.680,P=0.502),NIG (P=1.000) and NDI (t=0.146,P=0.885) between the two cohorts at the latest follow-up.Conclusion Both microscope and MMED could provide a clear and magnified field of view,which was beneficial for adequate decompression during the anterior cervical surgery to ensure better clinical results.Compare to the microscope,MMED has relatively narrow indications and steep learning curve,so the surgeon should select cases strictly.

Deaths attributable to alcohol use and its impact on life expectancy in China, 2013 / 中华流行病学杂志

Objective To analyze the deaths attributable to alcohol use and its impact on people's life expectancy in China in 2013.Methods The mortality data from the Disease Surveillance Points System and alcohol use data from China Chronic Disease Surveillance (2013) were used.The deaths attributed to alcohol use and its impact on the life expectancy of Chinese residents were estimated based on the principle of comparative risk assessment by calculating population attributable fraction.Results In 2013,alcohol use resulted in 381 200 deaths,including 97 100 hemorrhagic stroke deaths,88 200 liver cancer deaths,61 400 liver cirrhosis deaths and 48 700 esophageal cancer deaths,and prevented 76 500 deaths,including 68 500,4 900 and 3 100 deaths which might be caused by ischemic heart disease,hemorrhagic stroke and diabetes respectively.If risk factor of alcohol use is removed,the people's life expectancy would rise by an average of 0.43 years,especially in westem China by 0.52 years,which was 0.12 years higher than that in eastern and central China,and the life expectancy of the population in rural and urban areas would rise by 0.48 years and 0.31 years respectively.Conclusions Although alcohol has a protective effect on reducing ischemic heart disease,stroke and diabetes deaths,alcohol use is still a risk factor influencing the mortality and life expectancy of residents in China.It is necessary to take targeted measures to reduce the health problems caused by harmful use of alcohol.

On National Demonstration Areas: a cluster analysis / 中华流行病学杂志

Objective To understand the'backward'provinces and the relatively poor work among the construction of National Demonstration Area,so as to promote communication and future visions among different regions.Methods Methods on Cluster analysis were used to compare the development of National Demonstration Area in different provinces,including the coverage of National Demonstration Area and the scores of non-communicable disease (NCDs) prevention and control work based on a standardized indicating system.Results According to the results from the construction of National Demonstration Area,all the 29 provinces and the Xinjiang Production and Construction Corps (except Tibet and Qinghai) were classified into 6 categories:Shanghai;Beijing,Zhejiang,Chongqing;Tianjin,Shandong,Guangdong and Xinjiang Production and Construction Corps;Hebei,Fujian,Hubei,Jiangsu,Liaoning,Xinjiang,Hunan and Guangxi;Shanxi,Jilin,Henan,Hainan,Sichuan,Anhui and Jiangxi;Inner Mongolia,Shaanxi,Ningxia,Guizhou,Yunnan,Gansu and Heilongjiang.Based on the scores gathered from this study,24 items that representing the achievements from the NCDs prevention and control endeavor were classified into 4 categories:Manpower,special day on NCD,information materials development,policy/strategy support,financial support,mass media,enabled environment,community fitness campaign,health promotion for children and teenage,institutional structure and patient self-management;healthy diet,risk factors on NCDs surveillance,tobacco control and community diagnosis;intervention of high-risk groups,identification of high-risk groups,reporting system on cardiovascular and cerebrovascular events,popularization of basic public health service,workplace intervention programs,construction of demonstration units and mortality surveillance;oral hygiene and tumor registration.Contents including oral hygiene,tumor registration,intervention on high-risk groups,identification of high-risk population,reporting system on cardiovascular and cerebrovascular events,popularization of basic public health service,workplace intervention programs,construction of demonstration units and mortality surveillance were discerned as the relatively weak areas in the construction programs of National Demonstration Area.Conclusions Western regions,especially in some remote provinces had the poorest performance during the construction of National Demonstration Area.Programs regarding chronic disease surveillance,identification and intervention on high-risk groups showed the lowest scores and these outcome-oriented tasks should be further focused on,during the next term of review,in these areas.

Endoscopic surgical treatment of lumbar intervertebral disc herniation associated with vertebral osteochondrosis / 中华骨科杂志

Objective To investigate the feasibility and effects of endoscopic surgical treatment of lumbar intervertebral disc herniation associated with veitebral osteochondrosis.Methods From June 2008 to December 2015,276 cases of lumbar intervertebral disc herniation associated with vertebral osteochondrosis were treated with endoscopic surgery,including 185 men and 91 women,with an average 39.2 years old (range,16-65 years old).The involved level included L2.3 in 2 cases,L3.4 in 9 cases,L4,5 in 126 cases and L5S1 in 139 cases.On preoperative axial CT,the diameter of ossification was more than half of the transverse or sagittal diameter of the spinal canal in 89 cases,and no more than half of the transverse and sagittal diameter of the spinal canal in 187 cases.All patients were operated on the side with serious symptom,181 cases were operated with mobile microendoscopic discectomy (MMED),and 95 cases were operated with percutaneous endoscopic surgery,including percutaneous transforaminal endoscopic discectomy (PTED) in 61 cases and the percutaneous interlaminar endoscopic discectomy (PIED) in 34 cases.The operation and complications were analyzed.Results The soft herniation,broken disc material and the periphery of compressing ossification were removed under the endoscope in all cases,until the nerve was well decompressed.However,the ossification was not complete resected.Dural sac tear occurred in 3 cases of MMED.In the early stage of PTED,2 cases converted to MMED because of intraoperative pain and difficulty,and one case had exiting nerve root injury.At the final follow-up of 12-60 months (average,20.6 months),visual analogue scale decreased from preoperative 8.5±1.2 to 1.0±0.9,Oswestry disability index decreased from preoperative 40.2±8.6 to 3.1±3.0.According to Macnab scale,the results were excellent in 89,good in 154 cases,moderate in 33 cases.Conclusion For most lumbar intervertebral disc herniation associated with vertebral osteochondrosis,good results can be achieve by removal of herniated and broken intervertebral disc and decompression of nerve with endoscope.Therefore,we speculate that the soft disc herniation and spinal stenosis are main pathogenic factors,and that the complete resection of ossification is not needed.

Preliminary experience of percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation / 天津医药

Objective To investigate the feasibility of percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. Methods One patient with thoracic disc herniation involved the level of vertebral segment in T11/12 was treated with percutaneous transforaminal endoscopic spine system and followed up for 1 month. The targeted puncture was performed under local anesthesia and fluoroscopic guidance with patient in prone position. The foramen of T 11/12 was enlarged gradually with four trephinations, and the working cannula was inserted transforaminal into the canal. Then the herniation was exposed and removed with full endoscopic technique, including the loosen nucleus pulposus. The dural sac was exposed and released adequately. Drainage was placed during operation. Results The procedure was successfully carried out and the dural sac was completely released. The drainage was removed in the second day of operation. The patient could walk in the third day after operation with obvious relief of back and leg pain. At the follow-up of one month postoperation, the visual analogue scale of leg pain decreased from 8 to 1, and the Oswestry disability index (ODI) decreased from 64 to 4. According to MacNab scale, excellent result was acquired. Conclusion There is the feasibility of the percutaneous transforaminal endoscopic spine system in thoracic discectomy for disc herniation. It is a good minimal invasive technique with good results and high technical requirements for surgeons.

Clinical analysis of APECD and ODLP in the treatment of multisegmental cervical stenosis and giant disc herniation / 天津医药

Objective To investigate the effect of anterior percutaneous endoscopic discectomy (APECD) and open-door laminoplasty (ODLP) through hybrid surgery in the treatment of multisegmental cervical stenosis and giant disc herniation. Methods This study involved 3 patients with multisegmental cervical stenosis and giant disc herniation confirmed by MRI. Among them, there were 2 males and 1 female, with ages from 56-61. All patients showed significant paresthesia or weakness, and were treated between September and November 2016. The surgery was performed by first the ODLP that made spinal cord back shift, and then APECD for the second step. The visual analog scale (VAS) and neck disability index (NDI) were assessed before and after operation. Results The VAS and NDI scores were improved two weeks after operation. No adverse events like spinal cord injury and vascular injury were found during the operation. After operation, no patients were found incision infection, hematoma formation, cerebrospinal fluid leakage, dysphagia, trachyphonia and so on. Conclusion The hybrid surgery of APECD and ODLP for the treatment of the multisegmental cervical stenosis and giant disc herniation can not only decompress the nerve safely and improve the function, but also preserve cervical intervertebral disc and motion segments, therefore delaying the degeneration of adjacent segments with clinical significance.

Anterior cervical discectomy with fusion and posterior cervical expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy: its postoperative stability / 中国组织工程研究

BACKGROUND: The treatment of multilevel cervical spondylotic myelopathy (MCSM) aims at sustaining the spinal cord compression and restoring the stability of the cervical vertebrae at most.OBJECTIVE: To analyze the clinical characters of anterior cervical discectomy with fusion and expansive open-door laminoplasty for MCSM.METHODS: Sixty-seven patients with MCSM were divided into two groups, and treated with anterior cervical discectomy with fusion (group A) or posterior cervical expansive open-door laminoplasty (group B). All the patients were followed up for 12 months, and the range of motion of cervical vertebrae, cervical curvature index were observed,as well as the Visual Analogue Scale and Japanese Orthopaedic Association scores were condueted. Moreover, the operation time, blood loss and adverse reactions were recorded.RESULTS AND CONCLUSION: (1) The loss of range of motion of the cervical vertebrae in the group B was significantly less than that in the group A (P 0.05). (5) The intraoperative blood loss in the group B was significantly more than that in the group A (P < 0.05). (6) The incidence of hoarseness and dysphagia in the group A was 19％. The incidence of wound infection, cerebrospinal fluid leakage and C5 nerve root palsy in the group B was 9％. (7) These results suggest that during choosing an appropriate method for MCSM,surgeons' skills and patients' situation should be considered.

The design and clinical application of cervical canal enlargement preserving posterior ligament composite with mobile microendoscopic discectomy technique / 天津医药

Objective To provide a minimally invasive surgical treatment using mobile microendoscopy (mobile MED) for limited cervical spine canal stenosis. Methods Eleven patients were collected from February 2015 to February 2016 in Tianjin Hospital, including 6 males and 5 females, aged 51- 77 years, mean (67.4 ± 7.6) years. Clinical treatment was performed on 11 patients of limited cervical spinal stenosis. The levels of stenosis included C3-5 in 5 cases, C4-6 in 4 cases, C5-7 in 2 cases. The working channel of mobile MED (MMED) can be tilted according to the need of operation. The design of surgical methods:the levels of stenosis were located with fluroscopy, through a posterior median 2.5 cm incision, the nachal ligaments was separated and the spinous process was reached. After a little dissection of paraspinal mascle, the working canal was inserted along the spinous process, and the target lamina was exposed. With MMED, the partial laminectomy was performed along the junction groove of lamina and articular process with high-speed burr, and flavum was exposed and resected with ultra-thin Kerisson, and the dural sac was well exposed. Then the working canal was inserted on the contralateral side along the spinous process, and the decompression was performed with the same method. After bilateral direct decompression, the spinous process and posterior ligament complex shift posteriorly with enlargement of spinal canal. The operation time and blood loss were recorded and the efficacy was followed-up. Results There was no serious complications such as neurological injury. The operation time ranged 80-120 min, with an average of (100 ± 18) min. The intraoperative blood loss ranged (50-120) mL, with an average of (80 ± 20) mL. Postoperative CT showed sufficient decompression and enlargement of the canal with the posterior shift of the spinous process and posterior ligament complex. The patients were followed up for 6-18 months. The alignment of cervical spine was well preserved on X-ray. The ODI decreased from 42.2 ± 16.3 preoperatively to 6.2 ± 4.3. The JOA score improved from 8.2 ± 3.3 preoperatively to 15.1 ± 4.2 at the last follow-up. According to the improvement rate [(JOA-preoperative JOA)/(17-preoperative JOA)], the results were excellent in 5 cases, good in 5 cases, and effective in 1 case. Conclusion The cervical canal enlargement with mobile microendoscopic discectomy technique preserving posterior ligament composite provides a minimally invasive procedure for limited cervical stenosis with adequate decompression.