Genetically predicted insomnia causally increases the risk of erectile dysfunction / 亚洲男科学杂志(英文版)

Sleep has attracted extensive attention due to its significance in health. However, its association with erectile dysfunction (ED) is insufficiently investigated. To investigate the potential causal links between sleep traits (insomnia, sleep duration, and chronotype) and ED, this study was performed. The single-nucleotide polymorphisms (SNPs) associated with insomnia, sleep duration, and chronotype were retrieved from previous genome-wide association studies (GWAS). A conventional two-sample Mendelian randomization (MR) was used to estimate the causal links between sleep traits and ED. The summary statistics of ED were from individuals of European ancestry (6175 cases vs 217 630 controls). As shown by the random effect inverse-variance-weighting (IVW) estimator, genetically predicted insomnia was causally associated with a 1.15-fold risk of ED (95% confidence interval: 1.07-1.23, P < 0.001). Sleep duration and morningness were not causally associated with ED, as indicated by the IVW (all P > 0.05). These findings were consistent with the results of sensitivity analyses. Based on genetic data, this study provides causal evidence that genetically predicted insomnia increases the risk of ED, whereas sleep duration and chronotype do not.

The association between heavy metal exposure and erectile dysfunction in the United States / 亚洲男科学杂志(英文版)

Literature regarding the impacts of heavy metal exposure on erectile dysfunction (ED) is scarce. We aimed to evaluate the correlation between 10 urinary metals and ED in a large, nationally representative adult male sample. The dataset was extracted from the National Health and Nutrition Examination Survey (NHANES) during the period of 2001-2002 and 2003-2004. Weighted proportions and multivariable logistic regression analysis adjusted for confounding variables were utilized to determine the relationship between metal exposure and ED. Weighted quantile sum (WQS) regression was utilized to evaluate the impact of a mixture of urinary metals on ED. A total of 1328 participants were included in our study. In multivariable logistic regression analysis, cobalt (Co) and antimony (Sb) were positively associated with ED (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.10-1.73, P = 0.020; and OR: 1.41, 95% CI: 1.12-1.77, P = 0.018, respectively) after full adjustment. Men in tertile 4 for Co (OR: 1.49, 95% CI: 1.02-2.41, P for trend = 0.012) and Sb (OR: 1.53, 95% CI: 1.08-2.40, P for trend = 0.041) had significantly higher odds of ED than those in tertile 1. Furthermore, the WQS index was significantly linked with increased odds of ED after full adjustment (OR: 1.31, 95% CI: 1.04-1.72, P < 0.05). Our study expanded on previous literature indicating the possible role of heavy metal exposure in the etiology of ED. The evaluation of heavy metal exposure should be included in the risk assessment of ED.

The osteogenic niche-targeted arsenic nanoparticles prevent colonization of disseminated breast tumor cells in the bone

Up to 70% of patients with late-stage breast cancer have bone metastasis. Current treatment regimens for breast cancer bone metastasis are palliative with no therapeutic cure. Disseminated tumor cells (DTCs) colonize inside the osteogenic niches in the early stage of bone metastasis. Drug delivery into osteogenic niches to inhibit DTC colonization can prevent bone metastasis from entering its late stage and therefore cure bone metastasis. Here, we constructed a 50% DSS6 peptide conjugated nanoparticle to target the osteogenic niche. The osteogenic niche was always located at the endosteum with immature hydroxyapatite. Arsenic-manganese nanocrystals (around 14 nm) were loaded in osteogenic niche-targeted PEG-PLGA nanoparticles with an acidic environment-triggered arsenic release. Arsenic formulations greatly reduced 4T1 cell adhesion to mesenchymal stem cells (MSCs)/preosteoblasts (pre-OBs) and osteogenic differentiation of osteoblastic cells. Arsenic formulations also prevented tumor cell colonization and dormancy via altering the direct interaction between 4T1 cells and MSCs/pre-OBs. The chemotactic migration of 4T1 cells toward osteogenic cells was blocked by arsenic in mimic 3D osteogenic niche. Systemic administration of osteogenic niche-targeted arsenic nanoparticles significantly extended the survival of mice with 4T1 syngeneic bone metastasis. Our findings provide an effective approach for osteogenic niche-specific drug delivery and suggest that bone metastasis can be effectively inhibited by blockage of tumor cell colonization in the bone microenvironment.

Physician awareness and attitudes regarding early warning score systems in mainland China: a cross-sectional study

INTRODUCTION@#The purpose of this study was to assess the application of the early warning score system (EWS-S) and gauge physician awareness, perceptions of necessity and attitudes regarding these tools based on previously experienced unnoticed clinical deterioration (CDET).@*METHODS@#A cross-sectional survey was carried out via an online questionnaire at a large 3,500-bed Class 3A general hospital in China. A total of 299 physicians of adult general wards were asked to answer a translated questionnaire that was localised from the original version. Demographic profiles of patients were included as well as three other sections assessing awareness of CDET/EWS-S and gauging attitudes towards and perceptions of the necessity of EWS-S at our hospital.@*RESULTS@#A high level of physician awareness of the CDET problem was observed. Most physicians knew about the existence of a systematic assessment tool for clinical application. Physicians with previous experience in reanimation, unplanned transfer to intensive care unit (UTICU) and/or death tended to consider EWS-S necessary in attentive and well-trained staff (p < 0.05). Physicians who had previous experience with UTICU were more likely to recommend implementing EWS-S in their wards compared with those without such experience (p < 0.05).@*CONCLUSION@#Most physicians have positive attitudes towards EWS-S. However, their awareness should be further heightened. Physicians who had previous experience with CDET/UTICU were more likely to employ EWS-S in their clinical practices. To better facilitate the implementation of EWS-S in Chinese hospitals, existing facilities, policy supports, standardised managements and the development of information systems should be strengthened.

Histological Changes of Cervical Disc Tissue in Patients with Degenerative Ossification

Objective@#: To explore the histological feature of the cervical disc degeneration in patients with degenerative ossification (DO) and its potential mechanisms. @*Methods@#: A total of 96 surgical segments, from cervical disc degenerative disease patients with surgical treatment, were divided into ossification group (group O, n=46) and non-ossification group (group NO, n=50) based on preoperative radiological exams. Samples of disc tissues and osteophytes were harvested during the decompression operation. The hematoxylin-eosin staining, Masson trichrome staining and Safranin O-fast green staining were used to compare the histological differences between the two groups. And the distribution and content of transforming growth factor (TGF)-β1, p-Smad2 and p-Smad3 between the two groups were compared by a semi-quantitative immunohistochemistry (IHC) method. @*Results@#: For all the disc tissues, the content of disc cells and collagen fibers decreased gradually from the outer annulus fibrosus (OAF) to the central nucleus pulposus (NP). Compared with group NO, the number of disc cells in group O increased significantly. But for proteoglycan in the inner annulus fibrosus (IAF) and NP, the content in group O decreased significantly. IHC analysis showed that TGF-β1, p-Smad2, and p-Smad3 were detected in all tissues. For group O, the content of TGF-β1 in the OAF and NP was significantly higher than that in group NO. For p-Smad2 in IAF and p-Smad3 in OAF, the content in group O were significantly higher than group NO. @*Conclusion@#: Histologically, cervical disc degeneration in patients with DO is more severe than that without DO. Local higher content of TGF-β1, p-Smad2, and p-Smad3 are involved in the disc degeneration with DO. Further studies with multi-approach analyses are needed to better understand the role of TGF-β/Smads signaling pathway in the disc degeneration with DO.

Application of"family member-like"care strategies among COVID-19 patients in an isolation ward / 中南大学学报(医学版)

Objective:To control the pandemic of coronavirus disease 2019 (COVID-19) effectively, strict isolation measures have been taken in China. Suspected patients must be isolated, and the confirmed patients specifically are isolated in negative-pressure isolation rooms. During the isolation, patients face difficulty in adapting to their surrounding environment, worry about the prognosis of the disease, lack confidence in treatment, separate from their families, and have a sense of distance from medical staff. Isolated patients may possess the feelings of negativity, including loneliness, anxiety, depression, insomnia, and despair. Hence, to reduce the risk of adverse psychological outcomes,"family member-like"care strategies were developed and implemented to solve problems associated with the COVID-19 pandemic. This study aims to examine whether using"family member-like"care strategies can improve psychological resilience and reduce depression, anxiety, and stress symptoms among patients with COVID-19 in an isolation ward.Methods: A quasi-experimental design was used to evaluate the"family member-like"care strategies for adult patients with COVID-19 in an isolation ward. COVID-19 patients in the Xiangya ward of the West District of the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology in Wuhan, Hubei province, were included in this study from February 9 to March 20, 2020. Healthcare providers who volunteered as family members were assigned to patients. They practiced one-to-one care and provided continuous and whole care for the patients who were from admission to discharge. Connor-Davidson Resilience Scale-10 (CD-RISC-10) and Depression Anxiety Stress Scale-21 (DASS-21) were used to evaluate the resilience and psychological status of COVID-19 inpatients upon hospital admission, 2 weeks after admission, and at their discharge from the hospital. Results: The questionnaire response rate of the"family member-like"strategies was 100％. Of the 60 patients, 39 (65.0％) were male, and 21 (35％) were female. The hospital stay was (27.5±3.5) days. All the 60 patients were cured and discharged without any death and serious complications. The total scores for CD-RISC were 8.83±6.86 at admission, 29.13±5.42 at 2 weeks after admission, and 33.87±6.14 at discharge, which were significantly improved at the 2 follow-ups (F=404.564, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant improvements in tenacity (F=360.839, P<0.001), strength (F=368.217, P<0.001), and optimism (F=328.456, P<0.001) at the 2 follow-ups. The total scores of DASS-21 were 49.27±11.30 at admission, 30.77±16.71 at 2 weeks after admission, and 4.17±11.03 at discharge, and the scores were significantly decreased at the 2 follow-ups (F=270.536, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant decreases in depression (F=211.938, P<0.001), anxiety (F=285.592, P<0.001), and stress (F=287.478, P<0.001) at the 2 follow-ups.Conclusion:"Family member-like"strategies had positive effects on improving psychological resilience and reducing the symptoms of anxiety and depression of COVID-19 patients. It might be an effective care method for COVID-19 patients. It should be incorporated into emergency care management to improve care quality during public health emergencies of infectious diseases.

Depressive males have higher odds of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a retrospective cohort study based on propensity score matching / 亚洲男科学杂志(英文版)

Lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH) and depression are both increasing in Chinese aging males. However, the relationship still remains unknown. To explore their relationship, a retrospective cohort study based on propensity score matching (PSM) was conducted by analyzing the China Health and Retirement Longitudinal Study dataset. After data cleaning, a total of 5125 participants were enrolled and subjected to PSM; 1351 pairs were matched and followed for 2 years. Further logistic regression and restricted cubic spline (RCS) were performed to evaluate, model and visualize the relationship between depression and LUTS/BPH. Moreover, subgroup analyses and sensitivity analyses were adopted to verify the robustness of the conclusions. Before PSM, depressive patients showed higher odds of LUTS/BPH in all three models adjusting for different covariates (P < 0.001). After PSM, univariate logistic regression revealed that depressive patients had higher risks for LUTS/BPH than participants in the control group (odds ratio [OR] = 2.10, P < 0.001). The RCS results indicated a nonlinear (P < 0.05) and inverted U-shaped relationship between depression and LUTS/BPH. In the subgroup analyses, no increased risks were found among participants who were not married or cohabitating, received an education, had an abnormal body mass index (<18.5 kg m

Application of online teaching in clinical practice of obstetrics and gynecology nursing during the COVID-19 epidemic / 中华医学教育探索杂志

Objective:To explore the application and effect of the online teaching in the clinical nursing practice of obstetrics and gynecology during the coronavirus disease 2019 (COVID-19) epidemic.Methods:A total of 26 undergraduate nursing interns in the obstetrics and gynecology department of Xiangya Hospital of Central South University during the epidemic period were enrolled in this study. The interns accepted online practical teaching, and the teaching effect was analyzed and evaluated through the results of the exit examination and online teaching satisfaction.Results:The theoretical course scores of nursing students are all above 80 points, among which 22 (84.62%) are above 90 points. The operation scores are all above 90 (94.04±2.96) points. The results of the online teaching satisfaction survey show that, 23 (88.46%) nursing students are satisfied with the effect of their online practice.Conclusion:The online teaching mode during COVID-19 epidemic can help nursing students master the theoretical knowledge of obstetrics and gynecology, improve their clinical reasoning ability, strengthen their practical operation skills, and enhance their autonomous learning ability.

Preparation of lipid membrane-wrapped nanoparticles loaded with metformin polymer and doxorubicin and evaluation of their therapeutic effect on breast cancer / 药学学报

In this study, the lipid membrane-wrapped nanoparticles loaded with metformin polymer (PolyMet) and doxorubicin (DOX) was prepared and then evaluated therapeutic effect on breast cancer. An anionic chain PGA-DOX based on γ-polyglutamic acid (PGA) with DOX was synthesized via amidation reaction and characterized by 1H NMR. The PGA-DOX and PolyMet were loaded via electrostatic attraction to prepare the co-delivery nanoparticles system (PolyMet-DOX-NPs). Then, PolyMet-DOX-NPs were coated with cationic liposome membrane to form the core-membrane structural system (PolyMet-DOX-lipid-nanoparticles, PolyMet-DOX-LNPs). The structure and morphology of PolyMet-DOX-LNPs were observed by transmission electron microscope. The particle size, zeta potential, encapsulation efficiency (EE), drug loading (DL), release behavior in vitro of PolyMet-DOX-LNPs were investigated. The MTT assay was used to examine the cytotoxicity of PolyMet combined with DOX on 4T-1 cells. The 4T1Fluc tumor-bearing mice model was used to evaluate the therapeutic efficacy of PolyMet-DOX-LNPs in vivo. All animal experiments were performed in line with ethical standards and approved by the Animal Experiments Ethical Committee of Zhejiang Chinese Medical University. 1H NMR spectrum showed that PGA-DOX was successfully synthesized with DOX grafting rate of (72.03 ± 1.29) %. The EE and DL of PolyMet-DOX-LNPs was (72.76 ± 1.92) % and (1.16 ± 0.12) %, respectively. PolyMet-DOX-LNPs exhibited a suitable size of (159.3 ± 7.4) nm and positive charge of (+36.3 ± 1.9) mV with good spheroidal morphology and dispersibility. The release profiles in vitro showed that PolyMet-DOX-LNPs exhibited a slowly and maintained release behavior at physiological pH value (pH 7.4) within 48 h. Further studies showed that PolyMet combined with DOX could synergistically enhance the cytotoxicity on 4T-1 cells. Bioluminescence imaging (BLI) result showed that the luminescence signal intensity of 4T-1Fluc cells was reduced after treatment with PolyMet-DOX-LNPs and the tumor volume growth was also inhibited. Additionally, the H&E staining and changes of body weight showed that PolyMet could reduce the toxicity of DOX. To sum up, PolyMet has a good synergistic effect with DOX in the treatment of breast cancer, which provide the foundation for this novel metformin polymer on the anti-tumor application.

Application of the time series model in prediction of incidence of hand-foot-mouth disease from 2008 to 2016 in China / 中华疾病控制杂志

Objective To predict the monthly incidence of hand-foot-mouth disease (HFMD) in China by using autoregressive integrated moving average (ARIMA) model and provide evidence for prevention and control of HFMD. Methods The monthly incidence data of HFMD in China from 2008 to 2016 were collected from the Public Health Science data Center. The incidence database was established by Excel 2007 and graphed. SAS 9.1 was used to construct the ARIMA model, based on the data of the monthly reported incidence of HFMD in China from January 2008 to December 2015, and then the data in 2016 were used to verify the predicted results. The monthly incidence in 2017 was predicted in the same way.The difference was statistically significant when P<0.05. Result The model predicting monthly incidence of HFMD in China is ARIMA ((12), 2, 0) sparse coefficient and residuals is white noise. The parameters were as follows: moted mean squared error=3.6490, mean absolute error=2.62, mean absolute percentage error=28.24%. Conclusion The sparse coefficient model could well simulate the trend of HFMD case in time series, which has good reference of early warning and prevention of HFMD.

Effects of Elemene Injection on the kinetics of intracellular transport of Gefitinib in PC-9/GR cells / 中成药

AIM To study the effects of Elemene Injection (ELE) on the kinetics of intracellular transport of Gefitinib (GEF) in PC-9/GR cells and to probe the role of ELE in reversing oncological multidrug resistance.METHODS The intracellular pharmacokinetic behavior of D-luciferin potassium salt,a substrate of an ATP-binding cassette (ABC) protein,was investigated in PC-9/GRFluc cells using real-time bioluminescence imaging.The resistance of PC-9/GR cells to GEF was determined by MTT assay.Compusyn software was used to analyze the synergistic effect of GEF and ELE,and HPLC to detect the uptake of GEF in PC-9/GR cells.RESULTS The respective GEF IC50 values of 0.01 μg/mL in PC-9 cells and 1.50 μg/mL in PC-9/GR cells revealed the 150 times drug resistance of PC-9/GR to PC-9 cells.The significantly enhanced intracellular fluorescence intensity of D-fluorescein potassium salt by the intervention of ELE also indicated remarkable GEF uptake increase in PC-9/GR cell line (P ＜ 0.05) due to the synergistic result.CONCLUSION Partly as the mechanism in reversing oncological multidrug resistance,ELE,a booster for the fluorescence intensity of D-luciferin potassium salt,promotes cellular uptake of GEF by inhibiting efflux function of ABC proteins.

Impact of Coix seed oil on fluorescence excretion pharmacokinetics and protein expression in doxorubicin-resistant cells MCF-7/DOX / 药学学报

This study was designed to explore the mechanism of Coix seed oil (Coix) impact on the drug resistance, bioluminescence imaging (BLI) and the efflux of D-luciferin potassium salt, the substrate of ABC transporters, in doxorubicin-resistant breast cancer cells. Multidrug resistance (MDR) gene and protein expression were analyzed in the cells by q-PCR and Western blot. First, in order to investigate the effect of the efflux function by ABC protein, a cell line with overexpressed luciferase was established in MCF-7 cell line. BLI was used to monitor the efflux kinetics of D-luciferin potassium salt before and after Coix treament. The results showed that the efflux of D-fluorescein potassium from MCF-7/DOXFluc was lessened when pretreated with Coix, which means that Coix may decrease the efflux of other chemotherapies using ABC transporters. Both of the results of q-PCR and Western blot showed that gene and protein expression of ABC transporters such as ABCG2, ABCC1 and ABCB1 were down-regulated by Coix treatment. The efficacy of Coix reversing MDR was verified with the chemotherapy medication doxorubicin (DOX). MTT assay showed that Coix increased the inhibitory effect of DOX on proliferation of MCF-7/DOX, and the optimal combination of ratio was 25 times that of DOX. The results suggest that Coix may reverse MDR of the substrate of ABC transporters from two aspects, one is to cut down the ABC protein efflux function, and the other is to decrease the quantity of ABC gene and protein expression.

Effect of Optimized Concentrations of Basic Fibroblast Growth Factor and Epidermal Growth Factor on Proliferation of Fibroblasts and Expression of Collagen: Related to Pelvic Floor Tissue Regeneration / 中华医学杂志(英文版)

Background@#Fibroblasts were the main seed cells in the studies of tissue engineering of the pelvic floor ligament. Basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF) were widely studied but at various concentrations. This study aimed to optimize the concentrations of combined bFGF and EGF by evaluating their effects on proliferation and collagen secretion of fibroblasts.@*Methods@#Fibroblasts were differentiated from rat adipose mesenchymal stem cells (ADSCs). Flow cytometry and immunohistochemistry were used for cell identification. The growth factors were applied at concentrations of 0, 1, 10, and 100 ng/ml as three groups: (1) bFGF alone, (2) EGF alone, and (3) bFGF mixed with EGF. Cell proliferation was evaluated by Cell Counting Kit-8 assays. Expression of Type I and III collagen (Col-I and Col-III) mRNAs was evaluated by real-time quantitative reverse transcription-polymerase chain reaction. Statistical analysis was performed with SPSS software and GraphPad Prism using one-way analysis of variance and multiple t-test.@*Results@#ADSCs were successfully isolated from rat adipose tissue as identified by expression of typical surface markers CD29, CD44, CD90, and CD45 in flow cytometry. Fibroblasts induced from ADSC, compared with ADSCs, were with higher mRNA expression levels of Col I and Col III (F = 1.29, P = 0.0390). bFGF, EGF, and the mixture of bFGF with EGF can enhanced fibroblasts proliferation, and the concentration of 10 ng/ml of the mixture of bFGF with EGF displayed most effectively (all P < 0.05). The expression levels of Col-I and Col-III mRNAs in fibroblasts displayed significant increases in the 10 ng/ml bFGF combined with EGF group (all P < 0.05).@*Conclusions@#The optimal concentration of both bFGF and EGF to promote cell proliferation and collagen expression in fibroblasts was 10 ng/ml at which fibroblasts grew faster and secreted more Type I and III collagens into the extracellular matrix, which might contribute to the stability of the pelvic floor microenvironment.

Meta-analysis on interspinous dynamic stabilization system Wallis versus Coflex for lumbar degenerative disease / 中国组织工程研究

BACKGROUND: It is still controversial that interspinous dynamic stabilization system Wallis and Coflex which one can provide better clinical effects for lumbar degenerative disease.OBJECTIVE: To systematically assess the clinical effectiveness and safety of Wallis and Coflex for lumbar degenerative disease.METHODS: According to the computer-based online search of PubMed, Embase, Medline, Cochrane Library, CBM,CNKI, Wanfang Database, and VIP, articles published before August 1st, 2016 were searched. Articles about Wallis comparing with Coflex for lumbar degenerative disease were included; the quality score of methodology was assessed by MINORS. Research data abstracted and synthesized by Review Manager 5.3 were used for meta-analysis.RESULTS AND CONCLUSION: (1) Six studies were included, and all studies were designed for non-randomized controlled trial. (2) There were no significant statistical differences in Japanese Orthopedic Association, Oswestry disability index, visual analogue scale score, Prolo functional score, segmental lordosis angle, and segment movement degree. Incidence of adverse events was significantlue scale less in the Wallis group than in the Conflex group (P < 0.05).(3) There was no significant difference in clinical efficacy between Wallis and Coflex in the early and mid-term follow-up.We can conclude that Wallis may provide better clinical safety than Coflex.

Relationship between inflammatory cytokines of IL-1β and TNF-α and intervertebral disc degeneration / 中国骨伤

The inflammatory cytokines of IL-1β and TNF-α participate in the process of intervertebral disc degeneration is focused by the spine surgeons. Inflammatory cytokines represented by IL-1β and TNF-α act as the key factors in the process of intervertebral disc degeneration resulting in low back pain and radicular symptoms. Annulus fibrosus and nucleus pulposus can secrete TNF-α and IL-1β under the stimulation of mechanical injury, overstressed, genetic susceptibility and infection. The mechanism of inflammatory cytokines in intervertebral disc degeneration needs further investigation. The emphasis of researches will be on the inflammatory cytokines in the regulation of mechanism in the intervertebral disc degeneration, molecular targeted therapy, cell signaling pathways and the best time of anti-inflammatory therapy providing more evidence in the clinical application.

Research progress of biomechanics and finite element analysis of lumbar interspinous devices / 中国组织工程研究

BACKGROUND:The lumbar interspinous device, as a kind of non-fusion technology has been extensively applied in the clinic and exerts superiority in biomechanics compared with the traditional fusion technology. With the development of prosthesis design and impanation technology, it reveals a better application prospect. OBJECTIVE:To review the biomechanics and finite element analysis of lumbar interspinous devices. METHODS:The first author retrieved the databases of CNKI, WanFang, PubMed and SpringerLink using the keywords of“lumbar spine, interspinous devices, biomechanics, finite element analysis”in Chinese and English, respectively. Researches related to the biomechanics and finite element analysis of lumbar interspinous devices were included and repeated researches were excluded. A total of 44 literatures were enrol ed for review, including 8 Chinese and 36 English literatures. RESULTS AND CONCLUSION:(1) Biomechanical y, several interpinous devices, which are commonly used in the clinic, can increase the stability of the implanted segment in sagittal alignment by limiting the range of flexion-extension, with no significant change in lateral bending and axial rotation. (2) Few studies analyze the influence of the implant size and placement on the implanted segment and on the adjacent segments. (3) Through the stress nephogram, three-dimension finite element analysis can intuitively analyze the changes of the stress distribution in the intervertebral disc, isthmus and facet joints before and after implantation. Both biomechanical studies and finite element analysis indicate that interspinous devices can share the load of the disc and facet joints, and at the same time, make no effect on the range of motion and stress of the adjacent segment. (4) In conclusion, the short-term biomechanical advantage of the interspinous devices is obvious, but further studies are needed. The finite element analysis can simulate different body physical environment, and can analyze mechanical distribution changes after implantation, which is an effective way to evaluate the mechanical mechanism of the interspinous devices.

Expression of Maspin in bladder carcinoma and the relationship between Maspin and lymph node metastasis / 中南大学学报(医学版)

OBJECTIVE@#To examine the expression of Maspin in the bladder carcinoma, and to explore the relationship among Maspin expression, clinical pathology and lymph node metastasis.
@*METHODS@#The expression of Maspin in 72 bladder cancer tissues and 12 normal bladder tissues were detected by immunohistochemistry. Preoperative pelvic CT images and postoperative pathological results of lymph node metastasis in 72 bladder cancer patients were analyzed retrospectively. The sensibility, specificity, positive predictive value and negative predictive value were calculated, and the advantage for diagnosis of lymph node metastasis was compared between Maspin examination and CT scan.
@*RESULTS@#1) The expression of Maspin in 72 bladder cancer tissues was significantly lower than that in the normal bladder tissues (P<0.05); 2) The expression of Maspin was obviously decreased with the progress in clinical stage, pathlogical grade and lymph node metastasis, with significant difference (all P<0.05); 3) There were 27 patients diagnosed as pelvic lymph node metastasis by CT scan, and the positive rate was 37.5% (27/72); there were 22 patients diagnosed as pelvic lymph node metastasis by pathological results, and the positive rate was 30.5% (22/72). The pathological diagnose for pelvic lymph node metastasis was the gold standard. The sensitivity, specificity, positive predictive value and negative predictive value for CT was 45.5%, 73.3%, 37.0%, and 66.7%, respectively; the sensibility, specificity, positive predictive value and negative predictive value was 81.8%, 50%, 41.8% and 86.2% in the diagnosis of lymph node metastasis for the 72 bladder cancer cases by Maspin examination; the sensitivity, specificity, positive predictive value and negative predictive was 90.9%, 78.0%, 64.5% and 95.0% in the diagnose of lymph node metastasis by Maspin examination combined with CT scan.
@*CONCLUSION@#The expression of Maspin in bladder cancer is significantly lower than that in normal bladder cancer, and a statistically significant correlation is also observed between Maspin expression and lymph node metastasis. Maspin maybe a valuable biomarker in diagnose of bladder cancer with lymph node metastasis. Maspin examination combined with CT scan has more advantage in the evaluation of bladder cancer with lymph node metastasis than Maspin or CT alone.

Experience of laparoscopic repair in 5 patients with vesicovaginal fistula / 中南大学学报(医学版)

OBJECTIVE@#To explore new methods for laparoscopic repair of vesicovaginal fistula.@*METHODS@#Five patients with vesicovaginal fistula in Xiangya Hospital, Central South University, were reviewed retrospectively from May 2013 to July 2014. All patients underwent laparoscopic repair surgery, and the surgical methods were analyzed. The operative time, intraoperative blood loss, and hospital stay time were recorded. The duration of follow-up was from 4 to 12 months.@*RESULTS@#Th e surgical procedures for all 5 patients were successful. No open surgery was required. The operative time was 70~120 (mean: 97) min, the intraoperative blood loss was 40~70 (mean: 54) mL, the hospital stay time was 4~8 (mean: 5.8) days. During the follow up of 4~12 (mean: 7.6) months, no recurrence was observed.@*CONCLUSION@#Laparoscopic repair of vesicovaginal fistula is a feasible and safe and effective procedure with less blood loss and shorter recovery time, which can minimize surgery damage and improve successful rate.

Factors influencing the utilization of postpartum visits among rural women in China / 华中科技大学学报（医学）（英德文版）

Postpartum visits (PPVs) are still underutilized in rural China, and identification of factors that influence PPV use is important in ensuring the utilization of maternal health services and for wellbeing of women. A cross-section study was undertaken to collect related data from 347 rural women interviewed six weeks or more after delivery, and an ANOVA was performed to find whether there were significant differences in the number of PPVs among different rural areas in China. According to Andersen's socio-behavioral model of health service use, factors were divided into equitable and inequitable ones. Chi-squared test, univariate and multiple analyses were used to determine the equity of PPV use by identifying factors that were most strongly associated with the use of a PPV. The results showed that 20.2% of the respondents (n=70) did not receive any PPVs, and 62.5% (n=173) of those who had PPVs (n=277) did not receive standard PPVs (referring to at least 3 visits). There was no significant difference among different rural areas in terms of the number of PPVs (F=1.514, P=0.211). Multiple regression analyses revealed that enabling factors such as compensation for delivery expense [OR (95% CI)=2.825 (1.331, 5.995)], village type [OR (95% CI)=1.802 (1.021, 3.182)] and service quality [OR (95% CI)=1.847 (1.074, 3.176)] were strongly associated with PPV use. Both enabling factors such as home visits [OR (95% CI)=1.855 (1.085, 3.174)], service quality [OR (95% CI)=1.993 (1.155, 3.439)] and need factors such as low birth weight [OR (95% CI)=4.424 (1.482, 13.203)] were significantly associated with standard PPV use. Our results suggested that the equitable access to PPVs has been considerably improved in rural areas in China. The associations between inequitable factors and PPV use warrant further exploration, and policies aimed at improving quality and patterns of service supply are needed in order to ensure a full equitable access to maternal health services.

Factors influencing the utilization of postpartum visits among rural women in China / 华中科技大学学报（医学）（英德文版）

Postpartum visits (PPVs) are still underutilized in rural China, and identification of factors that influence PPV use is important in ensuring the utilization of maternal health services and for wellbeing of women. A cross-section study was undertaken to collect related data from 347 rural women interviewed six weeks or more after delivery, and an ANOVA was performed to find whether there were significant differences in the number of PPVs among different rural areas in China. According to Andersen's socio-behavioral model of health service use, factors were divided into equitable and inequitable ones. Chi-squared test, univariate and multiple analyses were used to determine the equity of PPV use by identifying factors that were most strongly associated with the use of a PPV. The results showed that 20.2% of the respondents (n=70) did not receive any PPVs, and 62.5% (n=173) of those who had PPVs (n=277) did not receive standard PPVs (referring to at least 3 visits). There was no significant difference among different rural areas in terms of the number of PPVs (F=1.514, P=0.211). Multiple regression analyses revealed that enabling factors such as compensation for delivery expense [OR (95% CI)=2.825 (1.331, 5.995)], village type [OR (95% CI)=1.802 (1.021, 3.182)] and service quality [OR (95% CI)=1.847 (1.074, 3.176)] were strongly associated with PPV use. Both enabling factors such as home visits [OR (95% CI)=1.855 (1.085, 3.174)], service quality [OR (95% CI)=1.993 (1.155, 3.439)] and need factors such as low birth weight [OR (95% CI)=4.424 (1.482, 13.203)] were significantly associated with standard PPV use. Our results suggested that the equitable access to PPVs has been considerably improved in rural areas in China. The associations between inequitable factors and PPV use warrant further exploration, and policies aimed at improving quality and patterns of service supply are needed in order to ensure a full equitable access to maternal health services.