The status quo, problems and challenge of chronic disease management system in Shanghai Hongkou district / 中华全科医师杂志

From April to November 2019, 5 community health service centers in Shanghai Hongkou District were randomly selected for thematic group interviews to investigate the current status, problems and challenge for further development of chronic disease management. The community chronic disease management was mainly divided into growth period (typically hypertension and diabetes) and introduction period (cardiovascular and cerebrovascular diseases, respiratory diseases, dementia, osteoporosis). The management of hypertension and diabetes in the growing stage mainly faced difficulties such as refusal or non-cooperation of patients, loss of follow-up, incomplete quality control, not meeting quality control indicators, repeated management of comorbidities, insufficient information sharing, and discrepancy in assessment indicators of multiple parties. The management of cardiovascular and cerebrovascular diseases, respiratory diseases and other diseases in the introduction period mainly faced poor awareness rate of patients, loss of follow-up, difficulty in diagnosis, irregular medication, insufficient information sharing, lack of management plan, insufficient resource investment, and few variety of medicines in the community. The current management system should be refined to provide more effective and efficient chronic disease management in the community. Meanwhile, the awareness of residents, the information network and multi-center collaborative research also need to be strengthened.

In vivo Kinematic Characteristics of the Elbow during Active Flexion-Extension Motion Using Dual Fluoroscopic Imaging System / 医用生物力学

Objective To investigate the translation and rotation of healthy elbow joints during active flexion and extension, so as to provide references for the treatment of elbow instability and injuries. Methods Ten healthy subjects with no history of upper extremity trauma were recruited. Dual fluoroscopic imaging system (DFIS) was applied to quantify six-degree-of-freedom (6-DOF) kinematics of humeroulnar and humeroradial joint from full extension to maximum flexion in supination position. Correlation analysis was used to evaluate the relationship between the 6-DOF kinematics of the elbow joint. Results Valgus angle of humeroulnar joint gradually decreased from 15.2°±3.1° to 5.3°±2.3° with the flexion increasing. Valgus angle of humeroradical joint gradually decreased from 19.7°±4.2° to 8.2°±2.4° from full extension to maximum flexion. The valgus angle of humeroulnar and humeroradial joint was linearly related to the flexion angle during flexion and extension. The internal rotation of humeroulnar joint was quadratic nonlinearly related to the flexion angle during motion. The maximum internal rotation of the ulnar was 4.0°±4.9° at 110° flexion, and the maximum external rotation was 5.1°±4.2°. The internal rotation of humeroulnar joint gradually increased from 3.2°±16.0° to 27.2°±18.0°. Conclusions During normal flexion and extension of the elbow, the valgus angle of humeroulnar joint decreased linearly, while the internal and external rotation angle showed a nonlinear change, which first rotated internally and then rotated externally. The valgus angle of humeroradial joint decreased linearly and the internal rotation angle increased linearly. Therefore, humeroulnar joint is not a hinge joint during elbow flexion and extension. There is a kinematic difference between humeroulnar joint and humeroracial joint. For clinical treatment of complex elbow injuries, elbow instability and elbow replacement, different motion characteristics in joints should be considered to improve the outcome after surgery.

Bioactive β-tricalcium phosphate modified by stem cell screen-and-enrich-and-combine circulating system for regeneration of bone defects / 中华创伤骨科杂志

Objective To introduce a new method for preparation of bioactive β-tricalcium phosphate (β-TCP) by rapid stem cell screen-and-enrich-and-combine circulating system (SECCS) and evaluate its efficacy in the treatment of fresh fractures and bone defects.Methods Twenty-two patients with fresh fracture and bone defects were treated with SECCS from July 2013 to April 2016.They were 16 males and 6 females with an average age of 52.2 years (from 27 to 81 years).There were 15 tibial plateau fractures and 7 calcaneal fractures.The average size of bone defects was 12.5 mL.Bioactive β-TCP was prepared by SECCS intraoperatively and implanted back immediately into the bone defects.Radiographic examination,Lysholm knee scoring and Maryland foot scoring were used for assessment of curative efficacy.Results The 22 patients were followed up for an average of 25.7 months (from 12 to 46 months).By SECCS,the enrichment efficiency of bone marrow stromal cells (BMSCs) reached up to 82.4％ and the cell viability was not affected.The tibial plateau fractures were re-transplanted with 13,381.3 BMSCs on average and healed after an average of 8.9 weeks (from 6 to 15 weeks).The Lysholm knee scores at one year postoperatively averaged 93.6 points (from 84 to 100 points),yielding 10 excellent cases,4 good cases and one fair case.The calcaneal fractures were implanted back with 16,677.7 BMSCs on average and healed after an average of 9.4 weeks (from 8 to 13 weeks).The average Maryland foot score at one year after operation was 93.6 points (from 85 to 98 points),yielding 6 excellent cases and one good case.Conclusion Bioactive materials prepared by SECCS are good bone grafts for fresh fractures and bone defects.

Effects of siRNAs targeting CD97 immune epitopes on biological behavior in breast cancer cell line MDA-MB231 / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effects of siRNAs targeting CD97 immune epitopes on proliferation, infiltration, apoptosis and cell cycle of breast cancer cells.</p><p><b>METHODS</b>siRNA sequences targeting CD97and CD97immune epitopes were designed according to Gene Bank NM_001025160.2 with smart siCatchsiRNA design software. CD97siRNAs were transfected into MDA-MB231 cells in which CD97 was highly expressed. Highest sensitive CD97and CD97siRNA were screened by Western blotting. Inverted microscope was used to observe the growth of CD97siRNAs-transfected MDA-MB231 cells; the proliferation activity of MDA-MB231 cells was detected by MTT method; the wound healing assay and Transwell migration test were performed to examine the migration and infiltration ability of CD97and CD97siRNA-transfected MDA-MB231 cells; the effects of CD97siRNA and CD97siRNA on cell apoptosis and cell cycle of MDA-MB231 cells were detected by TUNEL and flow cytometry.</p><p><b>RESULTS</b>The growth and proliferation activity of CD97siRNAs-transfected MDA-MB231 cells were significantly lower than those in the control groups, and such differences were more significant in CD97siRNA-transfected group (all<0.05); scratch test showed that the wound healing rate was lower in CD97siRNAs-transfected groups, especially in CD97siRNA-transfected group (all<0.05); Transwell migration showed that the number of MDA-MB231 cells crossing through chambers were less in CD97siRNAs-transfected groups, especially in CD97siRNA-transfected group (all<0.05); no significant difference in cell apoptosis was observed between CD97siRNAs-transfected groups and control groups; cell cycle detection showed that CD97siRNAs-transfected groups had less cells in G/Gphase and more cells in S phase compared with the control groups, and such effect on cell cycle was more marked in CD97siRNA-transfected group (all<0.05).</p><p><b>CONCLUSIONS</b>CD97 plays an important role in the cell growth, proliferation, migration and invasion of breast cancer MDA-MB231 cells, and compared with CD97, CD97may have more effective inhibitory effects on cellular malignant behaviors.</p>

Review and analysis of transplant biological research projects funded by National Natural Science Foundation of China / 中华外科杂志

<p><b>OBJECTIVE</b>To study the funding and achievements in the field of organ transplantation support by the National Natural Science Foundation of China (NSFC).</p><p><b>METHODS</b>A search of NSFC database was made by using the key word "transplantation" and excluding "bone marrow transplantation" for the projects funded between 1988 and 2013. SCI indexed publications that marked with NSFC project number were collected by searching each grant number in the database of the Web of Science.</p><p><b>RESULTS</b>Six hundreds fifty-five projects were identified and received about 220 million yuan in grant funding. These funded research projects were distributed among 25 provinces and autonomous regions, however, which were mainly in the developed coastal areas; of them, 43 (6.56%) projects were granted in xenotransplantation and 17 projects (2.60%) were funded in the field of traditional Chinese medicine-related organ transplantation; Transplantation on blood vessels, heart, kidney, liver, lung, small intestine, pancreatic, cornea, trachea, skin, etc. were primarily performed in research. Nine hundreds and sixty-one SCI-indexed publications were achieved.</p><p><b>CONCLUSIONS</b>Magnitude and intensity of NSFC funding, output of SCI publications have been increasing, suggesting that NSFC positively promotes the development of organ transplantation. Although a great progress of transplantation has been made, basic and translational studies should be vigorously strengthened.</p>

National Natural Science Foundation of China (NSFC) and the progress of basic research of pancreatitis in China / 中华胰腺病杂志

Objective To evaluate the funding and output of pancreatitis related projects supported by National Natural Science Foundation of China (NSFC),and provide suggestions for the funding strategy in the field of pancreatitis research.Methods Database of funded projects and completion reports of NSFC between 1990 and 2012 were retrieved.The number of grants,amount of grants,types,contents,and paper output of funded projects were respectively analyzed.Results From 2000 to 2012,114 projects involving pancreatitis were funded by NSFC,including 71 general programs (62.3％),8 regional programs,34 youth programs (29.8％),1 key program.The total fund during 2011-2012 reached 25.44 million RMB for pancreatitis research,which was 2.76 times higher than that of 2000-2010.According to PubMed search,93 SCI papers funded by NSFC were published during 2011-2012,which was 2.07 times more than that of 2000-2010.The researches mostly focused on molecular mechanism and therapeutic effect of acute pancreatitis,chronic pancreatitis and severe acute pancreatitis,which accounted for 61.4％ of all projects.Conclusions The number of grants,amount of grants,and NSFC funded SCI paper output of pancreatitis research have grown steadily,and it indicates that long-term funding of NSFC has played a positive role in promoting the development of clinical and basic research in the field of pancreatitis.

Management window for patients with atrial fibrillation in community health center / 中华全科医师杂志

A management window model for patients with atrial fibrillation (AF) was established in Tilanqiao Community Health Service Center cooperated with tertiary hospitals.Patients were screened and treated in the community health service center,and a comprehensive management plan was conducted and patients were followed-up.A total of 105 patients with atrial fibrillation (97.2％) were effectively managed with an average follow-up of 10.6 months.The CHADS2 score ≥ 2 in 78 cases,including 11 cases with administration of warfarin (14.1％) and 26 cases with paroxysmal AF without transition to persistent atrial fibrillation.Compared to the data before management,the rate of taking aspirin and warfarin in managed patients was increased (all P ＜ 0.05),the international normalized ratio (INR) of patients receiving warfarin was improved (P ＜ 0.05) ; the ratio of receiving comprehensive treatment program,standardized treatment and health education were significantly increased (P ＜ 0.05) ; the awareness of the disease,treatment compliance and satisfaction of patients were improved significantly (all P ＜ 0.05).The results suggest that the management widow model is feasible and effective for management of patients with atrial fibrillation in community health service centers.

Proximal femoral nail antirotation for treatment of intertrochanteric fractures: an analysis of 112 patients / 中华创伤杂志

Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high-energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90％.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.

giant ganglion cyst of hip joint causing lower limb edema

lower limb edema caused by a gaint ganglion cyst of hip joints, Rather than deep venous insufficiency or lymphedema, is unusual particularly for guiding clinical practice. In this study, we present a rare case of a 76-year old man with a 3-month history of progressive swelling of right lower extremity and 2-month history of a known inguinal mass, which was initially thought as hemangioma by using ultrasound. But, subsequent computed tomography examination and exploration surgery revealed a gaint ganglion cyst compressing the right femoral vein. Resection of the cyst led to complete resolution of symptoms postoperatively. To the best of our knowledge this is a very rare case of gaint ganglion cyst of hip joint origin causing lower limb edema in the literature

Management of colorectal injuries / 中国普通外科杂志

Objective To study the current management strategy for colorectal injuries. Methods The clinical data of 86 consecutively admitted patients with penetrating colorectal injuries were retrospectively reviewed. Results Most injuries were of closed type. Iatrogenic colon injury accounted for 14%. There were 61 patients (71%) associated with other abdominal organ injuries. Operations were performed in all patients. Seventy six patients were treated with primary repair or resection and anastomosis, and 10 with diverting colostomy. In recent 10 years mortality rate dwindled from 10% to 4%(2/46). Mortality was most often caused by hemorrhagic shock, associated organ injuries or severe secondary infection. Conclusions Most colorectal traumas are blunt closed type in China. Primary repair or resection and anastomosis at the time of initial exploration is most often used for colorectal injuries. Indications for diverting colostomy are severe shock, heavy intra abdominal contamination, poor condition, and rectal injury. Fecal peritonitis should be effectively prevented and treated.