Autophagy and its role in the pathogenesis of multiple sclerosis / 解放军医学杂志

Autophagy generally reside in eukaryote and is a highly conserved protein degradation pathway,which take part in the maintenance of cellular homeostasis as well as the growth of cells.The characterization of autophagy being reported over years has revealed that it involved in immune response,such as removal of intracellular bacteria,inflammatory cytokine secretion,antigen presentation,and lymphocyte development,and then involved in the pathogenesis of multiple sclerosis indirectly.So,in this review,we focus on the pathway ofautophagy and the role of which in the multiple sclerosis (MS) in order to further understand the important effect and potential therapeutic value of autophagy in MS.

Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population: Results from a Nationally Representative Survey / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population.</p><p><b>METHODS</b>A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH.</p><p><b>RESULTS</b>NONFH was diagnosed in 218 subjects (0.725%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02% vs. 0.51%, χ2 = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85% vs. 0.61%, χ 2 = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH.</p><p><b>CONCLUSIONS</b>Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk factors with atherosclerosis.</p>

Cost-effectiveness analysis on the once-in-a-lifetime cervical cancer screening program for women living in rural and urban areas of China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To estimate the cost-effectiveness of once-in-a-lifetime cervical cancer screening program and to predict the optimal modality for its operation on women living in rural and urban areas of China, based on Markov modeling and simulation.</p><p><b>METHODS</b>Three modalities including visual inspection with acetic acid plus Lugol's iodine (VIA/VILI), conventional Pap Smear (Pap Smear), and simple HPV DNA testing (careHPV) were hypothesized for the rural cohort, whereas other five modalities including Pap Smear, liquid-based cytology (LBC), simple HPV DNA testing (careHPV), Hybrid Capture 2 HPV DNA testing (HC2), and LBC plus HC2 (LBC + HC2) were tested for the urban cohort. A Markov model was constructed based on the factors as natural history, screening, diagnosis and treatment on cervical cancer using data related to the epidemics and the costs from rural and urban areas of the country. Long-term effectiveness and cost-effectiveness were predicted through simulation of the model.</p><p><b>RESULTS</b>Compared to the non-screening scenario, the amount of life years saved were 277.97 - 2727.53 and 134.02 - 1446.84 years per 100 000 women, respectively, for different cohorts in rural and urban areas. The cost-effectiveness ratios were 1520.99 - 2453.74 and 3847.35 - 44 570.35 RMB per life year saved, respectively, for different cohorts in rural and urban areas. The incremental cost-effective ratio for careHPV starting from 40 years old (careHPV@40) and careHPV from 30 years old (careHPV@30) dominated other strategies for the rural cohort, while careHPV@40, careHPV@30, HC2 from 30 years old (HC2@30), and LBC + HC2 from 30 years old (LBC + HC2@30) were dominant for the urban cohort.</p><p><b>CONCLUSION</b>All eight once-in-a-lifetime cervical cancer screening modalities were cost-effective based on our model. In particular, careHPV screening starting from 40 years old seemed to be the most cost-effective one for women living in both rural and urban areas.</p>

Comparative analysis of the efficacies of entecavir capsules and lamivudine in chronic hepatitis B patients / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the efficacy profile of entecavir capsule (ETV) as a chronic hepatitis B therapy, as compared to lamivudine (LAM).</p><p><b>METHODS</b>In this multicenter, randomized, double-blind, parallel group evaluation of ETV, 232 subjects were administered a 96-week course of 0.5 mg/day ETV or 100 mg/day LAM. PCR measurement of hepatitis B virus (HBV) was conducted throughout the treatment course to determine achievement of complete virologic response (CVR; defined as less than 500 copies/ml of HBV DNA) or experience of virology rebound ( more than 500 copies/ml of HBV DNA after achievement of CVR).</p><p><b>RESULTS</b>After week-48 of treatment, the ETV group showed a higher CVR rate (90.3% vs. LAM: 59.4%) and lower virology rebound rate (1.9% vs. LAM: 13.9%). After week-96 of treatment, the ETV group continued to have a higher CVR rate (86.0% vs. LAM: 71.4%), and virology rebound was experienced by significantly less subjects in the ETV group (1.2% vs. LAM: 11.9%, P = 0.005).</p><p><b>CONCLUSION</b>ETV therapy can quickly and continuously suppress HBV replication in chronic hepatitis B patients, and has a lower resistance rate than LAM. Compared to LAM, ETV may be a superior long-term treatment choice for chronic hepatitis B.</p>

Effectiveness and health economic analysis of strategies on cervical cancer screening and early diagnosis and treatment / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the appropriate strategies which are suitable for the areas with diverse health and economic resource settings in China by estimating the life outcomes and cost-effectiveness of several cervical cancer screening strategies.</p><p><b>METHODS</b>Markov model was used to calculate the long-term effectiveness, utility, benefit and cost among screened and unscreened cohorts in rural and urban areas, and then analyses of cost-effectiveness, cost-utility and cost-benefit were performed. The assessed screening strategies were acetic acid of visual inspection combined with Lugol's iodine staining (VIA/VILI), conventional Pap smear and simple HPV DNA testing (careHPV) in rural areas, and conventional Pap smear, simple HPV DNA testing (careHPV), HPV DNA testing (HC2) and liquid-based cytology (LBC) alone or combined with HPV DNA testing (LBC+HC2) in urban areas. We estimated the life outcomes and cost-effectiveness of the above screening strategies at one-year, 3-year and 5-year intervals.</p><p><b>RESULTS</b>All of the screening strategies were effective to decrease cervical cancer mortality and to increase life years, with a trend of shorter screening interval having better effectiveness. However, no matter in urban or rural areas, compared with careHPV testing at 5-year interval, the costs of other screening strategies were 1.28 - 13.86 folds, 1.31 - 14.14 folds, and 1.27 - 12.80 folds higher to avoid one death, to save a year of life, and a QALY, and the benefit per cost of other screening strategies was 9.9%-90.2%.</p><p><b>CONCLUSIONS</b>careHPV testing at 5-year interval has the best cost-effectiveness performance and the highest benefit-cost ratio with the moderate life outcomes. It is the optimal cervical cancer screening strategy to be generalized in our country. careHPV testing at 3 years interval can be considered in more developed areas to achieve better effectiveness.</p>

Tympanoplasty using fascia-form molds to shape autogenous temporalis fascia for closing large perforations / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the efficiency of using autogenous temporalis fascia which was formed and shaped by formaldehyde cross-linking with special fasciaform molds in the repair of large tympanic membrane perforations.</p><p><b>METHODS</b>Base on machine technique and published data, the molds was designed according to the shape of tympanic membrane (TM), autologous fascia graft shaped by 4% formaldehyde (pH 5.6) was cross-linked on the mold to resemble the natural TM more closely repairing the large perforations of tympanic membrane with the formed fascia. Sixty-one operations were performed to close large perforations in patients with intact ossicular chain in fifty-seven patients from November 2006 to April 2009. The follow up was done from one month to thirty months; the average follow up period was eleven months. Statistical analysis was performed using a SPSS 13.0 software.</p><p><b>RESULTS</b>The repairing of the perforations were successfully with rate of 95.1% (58/61). Three ears were remained small remnant perforations after the surgery, but all hearing had been improved except one patient with biauricular total sensorineural hearing loss within the group. The air bone gap (ABG) of preoperative average (x ± s) hearing level of fifty-nine ears was (31.5 ± 6.1) dB, and the ABG of postoperative average hearing level of same group was (14.2 ± 4.4) dB, the difference was significant (t = 21.3, P < 0.01). During the early stage of using this technique, six ears were found to have graft lateralization recovery, but one case was slightly blunting recovery. No pearl tumor and epicyst had been found during the follow-up period.</p><p><b>CONCLUSIONS</b>The formaldehyde fasciaform technique produces consistent, reliable as well as reproducible results for repairing large tympanic membrane perforations with minimal complications.</p>

Thyroid nodular diseases in the population indergoing medical examination and the analysis of its relative factors in Dalian City,Liaoning Province / 中国地方病学杂志

Objective To investigate the characteristics about the prevalence of thyroid nodules detected on color Doppler uhrasonography(US) in people residing in Dalian City who undergo regular physical examinations, as well as its relative factors. Methods All thyroid sonographic and questionair procedures were performed in the 6020 people above 18-year-old living in the four districts of Dalian City for at least 5 years, who were examined at the department of health medical center of Dalian Municipal Central Hospital from May 2006 to March 2007. Urinary iodine concentration was measured in 2039 healthy adults selected by age layers in our study population. Moreover, urinary iodine concentrations were determined in 220 children aged 8-10 years old who were randomly chosen from four communities (55 children per elementary school from each community). The analysis of logistic regression was conducted for the risk factors linked to thyroid nodules. Results The prevalence of thyroid nodules in the 6020 adults was 38.5%(2319/6020), in which nodules sized between 0.3 and up to 0.5 cm were found in 17.1% (1030/6020), and those above 0.5 cm in 21.4% (1289/6020). Ultrsonography revealed solitary nodules in 17.2% (1036/6020), multinodular goiter in 21.3% (1283/6020). Fifty-four point nine percent (1272/2319) thyroid nodules showed solid internal echographic structures, 30.2%(701/2319) mixed and 14.9%(346/2319). The thyroid nodule detected rate in female individuals was 46.1% (1102/2393), among whom multinodular goiter [59.1% (651/1102)] was more than solitary nodules[40.9(451/1102)] in female; while only 33.6%(1217/3627) of male were detected to have thyroid nodule, there was a difference between the genders (χ2=95,079,P<0.01). The mediam urinary iodine concentration(MUI) was 184.32 μg/L in children and 216.75 μg/L in the health adults, moreover, it was 216.55 μg/L and 217.00 μg/L in the people with thyroid nodules and those without nodules without a significant difference (P>0.05). The rate of thyroid nodules gradually increased with age(χ2=344.998, P<0.01). The occurance of thyroid nodules was significant associated with gender and age(P<0.01). Conclusions The nutritional iodine intake in the four communities of Dalian City are adequate. The prevalence of thyroid incidentalomas is relatively high in this group of people receiving medical examination.

Gene expression profiles of peri-implantation endometrium of high responders during controlled ovarian hyperstimulation / 上海第二医科大学学报

Objective To investigate the gene expression profiles of peri-implantation endometrium of high responders during controlled ovarian hyperstimulation. Methods High responders with cancelled embryo-transfer during controlled ovarian hyperstimulation (high responder group, n=4) and healthy fertile volunteers (control group, n=3) were performed endometrial biopsies during peri-implantation. Histologic changes of endometrium were observed by HE staining, genes of differential expression were screened with microarrays Affymetrix U133A 2.0 and identified by Real-time PCR. The biological process analysis was performed by online biological information analysis tool PANTHER. Results The ehdometrium was in mid-secretory phase in control group, while development delay was found in some glandular organs in endometrium of high responder group. Three hundred and sixty-four genes of differential expression were screened, among which 233 were up-regulated genes and 131 were down-regulated genes. OPN, PLA2G2, DPPIV, IGFBP5 and SSAT were identified as endometrial function-related genes, whose Real-time PCR findings were positively correlated to gene signal values detected by microarray(r=0.44, P<0.01). PANTHER analysis indicated that genes of differential expression participated in the biological processes of cytokine signal transduction and immunological regulation. Conclusion Ovarian high response affects the gene expression profiles of peri-implantation endometrium, which may be one of the causes of sub-optimal endometrial receptivity.

Effects of serum estradiol levels during controlled ovarian hyperstimulation on outcomes of IVF-ET / 上海第二医科大学学报

Objective To analyse the effects of serum estradiol levels during controlled ovarian hyperstimulation (COH) on the outcomes of in vitro fertilization and embryo transfer (IVF-ET). Methods The clinical data of 472 patients undergoing IVF-ET with GnRH analogues recombinant FSH long protocol were retrospectively analysed. The area under the curve (AUC) of estradiol (E2) level was calculated during COH, and patients were categorized into groups according to the percentile of AUC of E2(AUCE2) during COH. The general characteristics and parameters related to the outcomes of IVF-ET were compared among groups. Results The 10th percentile and 90th percentile of AUCE2 were 3 347.0 pmoL/L and 14 414.3 pmol/L, respectively. Four hundred and seventy-two patients were divided into lower reaction group (AUCE2 3 347.0 pmol/L, n=48), normal reaction group (14 414.3 pmol/L>AUCE2 > 3 347.0 pmol/L, n=376) and higher reaction group (AUCE2≥14 413.3 pmol/L, n=48). There was no significant difference in age, body mass index, baseline follicle stimulating hormone level, time of treatment with gonadotropin, endometrium thickness on day of transfer and embryos transferred(P>0.05). Compared with lower reaction group and normal reaction group, the number of oocytes per retrieval and number of embryos frozen were significantly larger(P<0.01) and the mild/severe ovarian hyperstimulation syndrome rate was significantly higher in higher reaction group(P<0.05). There was no significant difference in fertilization rate, cumulative embryo score, high-grade embryo rate, clinical pregnancy rate and implantation rate among groups (P> 0.05). Conclusion Sustained snpraphysiological serum E2 levels during the COH process do not adversely affect the quality of oocytes and embryos, clinical pregnancy rate and implantation rate to some extent in IVF-ET.

Impact of body mass index on outcome of in vitro fertilization-embryo transfer in patients with polycystic ovarian syndrome / 上海第二医科大学学报

Objective To compare the clinical outcomes of in vitro fertilization-embryo transfer(IVF-ET) in polycystic ovary syndrome(PCOS) patients with different body mass index(BMI).MethodsEighty-seven PCOS patients who received IVF-ET were classified into four groups according to BMI: group A,BMI0.05).ConclusionThe doses of gonadotropins are increased in PCOS patients with increasing BMI.The number of usable embryo is significant decreased in PCOS patients with BMI≥25 kg/m2.

Analysis of Bilingual Teaching in Seven-year Program / 中华医学教育探索杂志

An investigation and analysis on the effect of current bilingual teaching has been done among the 2002rd seven-year program students by using questionnaire.The result can provide basic foundation for improving the quality of bilingual teaching.