Association between urinary arsenic level and serum testosterone in Chinese men aged 18 to 79 years / 中华预防医学杂志

Objective: To investigate the association between the urinary arsenic level and serum total testosterone in Chinese men aged 18 to 79 years. Methods: A total of 5 048 male participants aged 18 to 79 years were recruited from the China National Human Biomonitoring (CNHBM) from 2017 to 2018. Questionnaires and physical examinations were used to collect information on demographic characteristics, lifestyle, food intake frequency and health status. Venous blood and urine samples were collected to detect the level of serum total testosterone, urine arsenic and urine creatinine. Participants were divided into three groups (low, middle, and high) based on the tertiles of creatinine-adjusted urine arsenic concentration. Weighted multiple linear regression was fitted to analyze the association of urinary arsenic with serum total testosterone. Results: The weighted average age of 5 048 Chinese men was (46.72±0.40) years. Geometric mean concentration (95%CI) of urinary arsenic, creatinine-adjusted urine arsenic and serum testosterone was 22.46 (20.08, 25.12) μg/L, 19.36 (16.92, 22.15) μg/L and 18.13 (17.42, 18.85) nmol/L, respectively. After controlling for covariates, compared with the low-level urinary arsenic group, the testosterone level of the participants in the middle-level group and the high-level group decreased gradually. The percentile ratio (95%CI) was -5.17% (-13.14%, 3.54%) and -10.33% (-15.68%, -4.63). The subgroup analysis showed that the association between the urinary arsenic level and testosterone level was more obvious in the group with BMI<24 kg/m2 group (Pinteraction<0.05). Conclusion: There is a negative association between the urinary arsenic level and serum total testosterone in Chinese men aged 18-79 years.

Value of EZSCAN for Screening Mild Renal Impairment / 中山大学学报(医学科学版)

ObjectiveAutonomic dysfunction is a common and serious complication in patients with early chronic kidney disease （CKD）. Sweat gland dysfunction is an initial sign of autonomic dysfunction. Electrochemical skin conductance （ESC） measurement by reverse iontophoresis and chronoamperometry to assess sweat gland function may detect patients with mild renal insufficiency in healthy population for early intervention and treatment to delay further deterioration of renal function. MethodsAn EZSCAN score （0~100） was calculated using a proprietary algorithm based on the chronoamperometry analysis. A total of 6 661 subjects who received physical examination from the physical examination center of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to October 2020 were enrolled， including 2 075 （31.15%） subjects with reduced renal function （eGFR < 90 mL·min-1·1.73 m-2） as the case group and 4 586 （68.85%） subjects with normal renal function （90 mL·min-1·1.73 m-2≤ eGFR ≤120 mL·min-1·1.73 m-2） as the control group. Lasso regression was used to screen covariates， and the relationship between the risk score and eGFR was analyzed by loess curve and logistic regression. ResultsAfter multivariate adjustment， the risk score was correlated with the risk of eGFR decline. Compared with the group with the lowest risk value （Q1<24）， the OR（95%CI ）of Q2 （25-27）， Q3 （28-47）， and Q4 （48-75） were 1.85 （1.55， 2.21）， 2.53 （2.13， 3.00）， 2.49 （2.13， 2.93）， respectively. The maximum area under the ROC curve is 0.75（0.74，0.76）， the sensitivity is 73.98%， the specificity is 63%， the positive predictive value is 47.49%， the negative predictive value is 84.25%， and the Youden index is 0.369 72， the optimal cutoff value is 25. ConclusionsEZSCAN could be a useful screening tool to identify healthy individuals at increased risk of renal function decline， and the one with an EZSCAN score of more than 25% should undergo diagnostic laboratory testing.

Risk factors and misdiagnosis of intraductal carcinoma of prostate (IDC-P)in patients with metastatic prostate cancer / 中华泌尿外科杂志

Objective:To investigate the risk factors and missed diagnosis of intraductal carcinoma of prostate (IDC-P) in patients with metastatic prostate cancer.Methods:The preoperative PSA, prostate MRI, bone scans and lung CT of all patients who underwent prostate biopsy in Department of Urology, Xiangya Hospital, Central South University from January 2018 to July 2020 were reviewed. A total of 261 patients with high suspicion of metastatic prostate cancer were screened for inclusion. Two full-time senior pathologists of urogenital tumors in Xiangya Hospital independently reviewed their pathological sections and detected IDC-P according to the 2016 WHO tumor classification. Diagnostic criteria are defined as malignant epithelial cells filling large acini and prostatic ducts, with preservation of basal cells and solid or dense cribriform pattern/loose cribriform or micropapillary pattern with either marked nuclear atypia or non-focal comedonecrosis.Results:The detection rate of IDC-P was 29.12%(76/261), while the actual reporting rate was only 9.96%(26/261). The results of subgroup analysis including age, PSA level, Gleason score as well as different metastatic sites showed that detection rate of IDC-P was 33.69% in the PSA≥50 ng/ml subgroup, much higher than 17.57% in the PSA <50 ng/ml subgroup ( P=0.0039); And it was 32.33% in the Gleason score ≥ 8 subgroup, much higher than 3.45% in the Gleason score < 8 subgroup ( P<0.01). It was not significantly different in different age subgroups as well as different metastatic site subgroups. These data suggest that PSA ≥ 50 ng/ml as well as Gleason score ≥ 8 may be risk factors of IDC-P.157 samples were stained by immunohistochemistry. The detection rates of IDC-P were 84.21% (16/19) in P63 (+ ) samples, 36.00% (9/25) in ERG (+ ) samples. There were 3 samples with both P63 (+ ) and ERG (+ ), all of which had IDC-P. Conclusions:There is misdiagnosis of IDC-P on prostate needle biopsy in patients with metastatic prostate cancer currently. PSA ≥ 50 ng/ml and Gleason score ≥ 8 are risk factors of IDC-P. Thus, attention should be paid to the possibility of IDC-P in such patients. When the diagnosis is difficult, immunohistochemical staining for ERG and P63 is helpful in IDC-P determination.

The impact of amygdala glutamate receptors on cardiovascular function in rats with post-traumatic stress disorder / 生理学报

Post-traumatic stress disorder (PTSD) has been reported to be associated with a higher risk of cardiovascular disease. The amygdala may have an important role in regulating cardiovascular function. This study aims to explore the effect of amygdala glutamate receptors (GluRs) on cardiovascular activity in a rat model of PTSD. A compound stress method combining electrical stimulation and single prolonged stress was used to prepare the PTSD model, and the difference of weight gain before and after modeling and the elevated plus maze were used to assess the PTSD model. In addition, the distribution of retrogradely labeled neurons was observed using the FluoroGold (FG) retrograde tracking technique. Western blot was used to analyze the changes of amygdala GluRs content. To further investigate the effects, artificial cerebrospinal fluid (ACSF), non-selective GluR blocker kynurenic acid (KYN) and AMPA receptor blocker CNQX were microinjected into the central nucleus of the amygdala (CeA) in the PTSD rats, respectively. The changes in various indices following the injection were observed using in vivo multi-channel synchronous recording technology. The results indicated that, compared with the control group, the PTSD group exhibited significantly lower weight gain (P < 0.01) and significantly decreased ratio of open arm time (OT%) (P < 0.05). Retrograde labeling of neurons was observed in the CeA after microinjection of 0.5 µL FG in the rostral ventrolateral medulla (RVLM). The content of AMPA receptor in the PTSD group was lower than that in the control group (P < 0.05), while there was no significant differences in RVLM neuron firing frequency and heart rate (P > 0.05) following ACSF injection. However, increases in RVLM neuron firing frequency and heart rate were observed after the injection of KYN or CNQX into the CeA (P < 0.05) in the PTSD group. These findings suggest that AMPA receptors in the amygdala are engaged in the regulation of cardiovascular activity in PTSD rats, possibly by acting on inhibitory pathways.

Association between urinary arsenic level and serum testosterone in Chinese men aged 18 to 79 years / 中华预防医学杂志

Objective: To investigate the association between the urinary arsenic level and serum total testosterone in Chinese men aged 18 to 79 years. Methods: A total of 5 048 male participants aged 18 to 79 years were recruited from the China National Human Biomonitoring (CNHBM) from 2017 to 2018. Questionnaires and physical examinations were used to collect information on demographic characteristics, lifestyle, food intake frequency and health status. Venous blood and urine samples were collected to detect the level of serum total testosterone, urinary arsenic and urinary creatinine. Participants were divided into three groups (low, middle, and high) based on the tertiles of creatinine-adjusted urinary arsenic concentration. Weighted multiple linear regression was fitted to analyze the association of urinary arsenic with serum total testosterone. Results: The weighted average age of 5 048 Chinese men was (46.72±0.40) years. Geometric mean concentration (95%CI) of urinary arsenic, creatinine-adjusted urinary arsenic and serum testosterone was 22.46 (20.08, 25.12) μg/L, 19.36 (16.92, 22.15) μg/g·Cr and 18.13 (17.42, 18.85) nmol/L, respectively. After controlling for covariates, compared with the low-level urinary arsenic group, the testosterone level of the participants in the middle-level group and the high-level group decreased gradually. The percentile ratio (95%CI) was -5.17% (-13.14%, 3.54%) and -10.33% (-15.68%, -4.63). The subgroup analysis showed that the association between the urinary arsenic level and testosterone level was more obvious in the group with BMI<24 kg/m2 group (Pinteraction=0.023). Conclusion: There is a negative association between the urinary arsenic level and serum total testosterone in Chinese men aged 18 to 79 years.

Clinical analysis of selective tracheostomy necessary for patients undergoing head and neck surgery with free flap reconstruction / 北京大学学报(医学版)

OBJECTIVE@#To discover the factors that may affect the use of selective tracheostomy among patients who have undergone head and neck surgeries with free flap reconstruction, so that the patients will not need tracheostomy nor receive the unnecessary treatment.@*METHODS@#Five hundred and thirty-three patients who had undergone head and neck surgery with free flap reconstruction operated by the same team of surgery at Department of Oral and Maxillofacial Surgery at Peking University School of Stomatology from 2015 to 2016 were reviewed. Three hundred and twenty-one (60.2%) of these patients underwent selective tracheostomy. All the patients' demographic information, operation-related information, prior treatments, comorbidities and complications were recorded and analyzed.@*RESULTS@#The patients with defects of the tongue, mouth floor, oropharynx and bilateral mandible, who underwent neck dissection and with previous radiotherapy and smoking habit were more likely to get selective tracheostomy. Usage of bulky soft tissue flap might also add to the risk of airway obstruction and the need of selective tracheostomy, while other factors were not significantly related to the risk of postoperative airway obstruction and the patients could be kept safe without selective tracheostomy. Most cases without tracheostomy were kept safe except one case, while 8.39% of the patients with tracheostomy suffered from tracheostomy related complications, mainly pneumonia and hemorrhage of the tracheostomy wound, yet none led to serious consequences or even death.@*CONCLUSION@#Selective tracheostomy is not necessary for patients who have undergone head and neck surgeries with free flap reconstruction except that there are defects at the tongue, oropharynx and mandible. Neck dissection, bulky soft tissue flap reconstruction, previous radiotherapy and smoking habit may also add to the risk of postoperative airway obstruction, while a favorable decision would involve a combination of all the above factors to assure the safety of the postoperative airway for the patients undergone head and neck surgeries with free flap reconstruction.

Application value and difficulty analysis of fluorescence laparoscopy in lymphadenectomy of gastric cancer / 中华胃肠外科杂志

Gastric cancer is one of the most common gastrointestinal malignancies, and the incidence and mortality of gastric cancer remain high in China. In recent years, with the rapid popularization of laparoscopic technology, fluorescent laparoscopic technology is increasingly getting mature, providing a new method for accurate clinical tracing of lymph nodes and prediction of tumor metastasis lymph nodes. A large number of scientific research experiments and clinical trials have shown that, laparoscopic lymph node diagnosis technology based on the fluorescent indocyanine green (ICG) can significantly improve the efficiency of lymphadenectomy and prediction accuracy of lymph node metastasis, and can reveal a more accurate scope of lymphadenectomy in gastric cancer for surgeons, so as to avoid excessive adenectomy as well as iatrogenic injuries on patients. Although the status of the technology in gastric cancer surgery mentioned above continues improving, the overall operation process details of ICG fluorescence imaging, standardized fluorescence detecting equipment, and postoperative pathological examination process still need to be further optimized.

Association of blood lead and blood selenium with serum high-sensitivity C-reactive protein among Chinese adults aged 19 to 79 years / 中华流行病学杂志

Objective: To investigate the association of blood lead and blood selenium with serum high-sensitivity C-reactive protein (hs-CRP) among Chinese adults aged 19 to 79 years. Methods: The participants were enrolled from the first wave of China National Human Biomonitoring (CNHBM) conducted from 2017 to 2018. 10 153 participants aged 19 to 79 years were included in this study. Fasting blood samples were obtained from participants. Lead and selenium in whole blood and hs-CRP in serum were measured. Individuals with hs-CRP levels above 3.0 mg/L were defined as elevated hs-CRP. Generalized linear mixed models and restricted cubic spline models were used to analyze the association of blood lead and blood selenium with elevated hs-CRP. Logistic regression models were used to analyze the multiplicative scale and additive scale interaction between blood lead and blood selenium on elevated hs-CRP. Results: The age of participants was (48.91±15.38) years, of which 5 054 (61.47%) were male. 1 181 (11.29%) participants were defined as elevated hs-CRP. After multivariable adjustment, results from generalized linear models showed that compared with participants with the lowest quartile of blood lead, the OR (95%CI) of elevated hs-CRP for participants with the second, third, and highest quartiles were 1.14 (0.94-1.37), 1.25 (1.04-1.52) and 1.38 (1.13-1.68), respectively. When compared with participants with the lowest quartile of blood selenium, the OR (95%CI) of elevated hs-CRP for participants with the second, third and highest quartiles were 0.86 (0.72-1.04), 0.91 (0.76-1.11), and 0.75 (0.61-0.92), respectively. Results from the interaction analysis showed no significant interaction between lead and selenium on elevated hs-CRP. Conclusion: Blood concentration of lead was positively associated with elevated serum hs-CRP, and blood concentration of selenium was inversely related to elevated hs-CRP, while blood lead and selenium did not present interaction on elevated hs-CRP.

Analysis of chemical constituents in ethyl acetate extract of Taxilli Herba by UPLC-Q-Exactive-MS and screening of potential xanthine oxidase inhibitors / 中国中药杂志

The present study analyzed and identified the chemical constituents from ethyl acetate(EA) extract of Taxilli Herba with UPLC-Q-Exactive-MS and screened active xanthine oxidase(XO) inhibitors with HPLC. The analysis was performed on an Hypersil GOLD C_(18) reversed-phase column(2.1 mm×50 mm, 1.9 μm), with the mobile phase of water containing 1% formic acid(A) and methanol(B) under gradient elution, the flow rate of 0.3 mL·min~(-1), and the injection volume of 5 μL. ESI source was used for MS and the compounds were collected in positive and negative ion modes. Xcalibur 4.1 was used to analyze the retention time, accurate relative molecular weight, and fragmentation of the compounds. The inhibitory activity of some known compounds on XO was screened by HPLC. Thirty chemical constituents were identified, including phenolic acids and flavonoids by experimental data combined with information of standards, data reported previously, and databases, such as MzCloud and ChemSpider. The activities of 10 chemical components were screened. Gallic acid and naringenin chalcone had strong inhibitory activities on XO with IC_(50) of 57 μg·mL~(-1) and 108 μg·mL~(-1). UPLC-Q-Exactive-MS allows the accurate, rapid, and comprehensive identification of main chemical constituents from Taxilli Herba. Gallic acid and naringenin chalcone may be the active components of XO inhibitors.

Clinical implications of 3D printing technology in preoperative evaluation of partial nephrectomy / 中南大学学报(医学版)

OBJECTIVES@#Renal cancer is a common malignancy of the urinary system, and the partial nephrectomy is a common surgical modality for early renal cancer. 3D printing technology can create a visual three-dimensional model by using 3D digital models of the patient's imaging data. With this model, surgeons can perform preoperative assessment to clarify the location, depth, and blood supply of the tumor, which helps to develop preoperative plans and achieve better surgical outcomes. In this study, the R.E.N.A.L scoring system was used to stratify patients with renal tumors and to explore the clinical application value of 3D printing technology in laparoscopic partial nephrectomy.@*METHODS@#A total of 114 renal cancer patients who received laparoscopic partial nephrectomy in Xiangya Hospital from June 2019 to December 2020 were enrolled. The patients were assigned into an experimental group (n=52) and a control group (n=62) according to whether 3D printing technology was performed, and the differences in perioperative parameters between the 2 groups were compared. Thirty-nine patients were assigned into a low-complexity group (4-6 points), 32 into a moderate-complexity group (7-9 points), and 43 into a high-complexity group (10-12 points) according to R.E.N.A.L score, and the differences in perioperative parameters between the experimental group and the control group in each score group were compared.@*RESULTS@#The experimental group had shorter operative time, renal ischemia time, and postoperative hospital stay (all P<0.05), less intraoperative blood loss (P=0.047), and smaller postoperative blood creatinine change (P=0.032) compared with the control group. In the low-complexity group, there were no statistically significant differences between the experimental group and the control group in operation time, renal ischemia time, intraoperative blood loss, postoperative blood creatinine changes, and postoperative hospital stay (all P>0.05). In the moderate- and high- complexity groups, the experimental group had shorter operative time, renal ischemia time, and postoperative hospital stay (P<0.05 or P<0.001), less intraoperative blood loss (P=0.022 and P<0.001, respectively), and smaller postoperative blood creatinine changes (P<0.05 and P<0.001, respectively) compared with the control group.@*CONCLUSIONS@#Compared with renal tumor patients with R.E.N.A.L score<7, renal cancer patients with R.E.N.A.L score≥7 may benefit more from 3D printing assessment before undergoing partial nephrectomy.

The effect of ultrasound-guided stellate ganglion block on serum immune inflammatory response, PGE 2, SP, 5-HT expression and brain protection in patients undergoing radical mastectomy for breast cancer / 中国医师杂志

Objective:To investigate the effect of ultrasound-guided stellate ganglion block (SGB) in patients undergoing radical mastectomy, and to provide an effective reference for the selection of clinical anesthesia.Methods:A total of 86 patients undergoing radical mastectomy for breast cancer in the First Affiliated Hospital of Hunan Traditional Chinese Medicine College from January 2018 to December 2019 were selected as the research objects and randomly divided into two groups, with 43 cases in each group. On the basis of conventional general anesthesia, the observation group was treated with ultrasound-guided SGB intervention at the level of the sixth cervical vertebra on the left, and 0.5% ropivacaine was injected with 7 ml. The control group was treated with ultrasound-guided injection of equal volume normal saline at the same site. The hemodynamics and serum inflammatory factors, cellular immunity, prostaglandin E 2 (PGE 2), substance P (SP), serotonin (5-HT) expression, cerebral oxygen metabolism indexes before anesthesia induction (T 1), before intubation (T 2), immediately after intubation (T 3), during skin incision (T 4) and extubation (T 5), and cognitive function score before and after surgery of the two groups were measured respectively. Results:⑴ Hemodynamics: the heart rate (HR) and mean arterial pressure (MAP) of the observation group at T 2, T 3, T 4 were lower than those of the control group ( P<0.05), and there was no significant difference between the two groups at T 1, T 5 ( P>0.05). ⑵ Inflammation and immune status: there was no significant difference in interleukin (IL)-2, IL-18, tumor necrosis factor-α (TNF-α), CD3 + , CD4 + and CD8 + between the two groups at T 1, T 5 ( P>0.05); the IL-2, IL-18, TNF-α and CD8 + at T 2, T 3 and T 4 in the observation group were lower than those in the control group, while the CD3 + and CD4 + were higher than that in the control group ( P<0.05). ⑶ Pain mediators and cerebral oxygen metabolism indexes: there was no significant difference in the levels of PGE 2, SP, 5-HT, SjvO 2, Da-jvO 2 and CEO 2 between the two groups at T 1 and T 5 ( P>0.05); The levels of PGE 2, SP, 5-HT, Da-jvO 2 and CEO 2 in the observation group at T 2, T 3 and T 4 were lower than those in the control group, and the SjvO 2 was higher than those in the control group ( P<0.05). ⑷ Cognitive function: there was no significant difference in Mini Mental State Examination (MMSE) scores between the two groups at 1 day before and 5 days after operation ( P>0.05). At 1 and 3 days after operation, the MMSE score of the observation group was higher than that of the control group ( P<0.05). Conclusions:Ultrasound-guided SGB has a good application effect in patients undergoing radical mastectomy and can reduce the fluctuation of intraoperative hemodynamics, intraoperative inflammatory stress and immunosuppressive effects of the body, reduce the release of pain mediators, and at the same time improve cerebral oxygen metabolism, and promote postoperative cognitive function recovery.

Writing and editing of both contributed papers and publications in the first half year of 2020 from Shanghai Journal of Preventive Medicine / 上海预防医学

objective:To analyze the contributed papers and publications in the first half year of 2020 from Shanghai Journal of Preventive Medicine， especially the COVID-19 papers， to provide basis for the academic journals to win out during the public hot points. Methods:All the papers contributed in the first half year of 2020 from Shanghai Journal of Preventive Medicine， were collected to analyze the sources parameters， editing parameters. All published papers were collected to analyze the sources parameters， editing parameters and their usages （downloads and citations）. Results:There were 450 papers contributed in the first half year of 2020， 129 papers were accepted accounting for 28.67%. Among them， 116 papers were COVID-19 papers accounting for 25.78%， and 32 papers were accepted accounting for 24.81%. the March was the highest month of contribution， also for COVID-19 papers. Many academic domains such as infectious disease， women and children health， clinic science， chronic disease， social medicine， public hygiene and others were predominated among those papers. COVID-19 papers dominated in domains of infectious disease and social medicine. According to the non-COVID-19 papers， the COVID-19 papers had higher numbers of peer reviewers， lower days for back improvement， lower days for refusals or acceptance， also had lower copy percentages by plagiarism check （all P<0.05）. there were 106 papers published in the first half year of 2020. Published COVID-19 papers had higher number of authors， higher numbers of references in term of governments reports， foreign references and less than 5 years references （all P<0.05）. Those published COVID-19 papers had better usages than those no-COVID-19 papers， adjusted downloads were 2 077.37/year vs 111.53/year， adjusted citations were 12.99/year vs 0.49/year. It was obvious that the published COVID-19 papers had very excellent social influences and academic influences （P<0.001）. Conclusion:Publication in the first half year of 2020 from Shanghai Journal of Preventive Medicine is high-qualified and is good for the journal’s improvement in social influences and academic influences. It is important for academic journals to pay more attention to the hot points of public health accordingly.

Expression profile of circRNA and construction of ceRNA regulatory network in tuberous sclerosis related renal angiomyolipoma (TSC-RAML) / 中华泌尿外科杂志

Objective:To comprehensively analyze the expression profile of circular RNA (circRNA) and construct competing endogenous RNA (ceRNA) regulatory networks in tuberous sclerosis complex related renal angiomyolipoma (TSC-RAML).Methods:According to the diagnostic criteria of TSC determined by the international consensus group on tuberous sclerosis in 2012, tumor tissues and paired normal renal tissues of 3 patients with TSC-RAML who were diagnosed in our hospital from January 2017 to January 2019 were collected. The circRNA, miRNA and mRNA of 3 paired samples were detected by circRNA, miRNA chip technology and next generation sequencing respectively, and the differential molecules were determined. Gene Ontology(GO) functional enrichment analysis and Kyoto Encyclopedia of genes and genomes(KEGG) pathway enrichment analysis were performed based on differential mRNA molecules and host genes of circRNA. Based on differential circRNA, miRNA and mRNA, up-regulated and down-regulated ceRNA regulatory networks were established.Results:A total of 330 up-regulated and 336 down-regulated differential circRNA, 8 up-regulated and 7 down-regulated miRNA, 800 up-regulated and 1130 down-regulated mRNA were screened. Through GO and KEGG enrichment analysis, many pathways including lipid metabolism, focal adhesion and mineral absorption were abnormally altered. Finally, the up-regualted ceRNA network led by hsa_circ_0092022, hsa_circ_0076859 and hsa_circ_0033388 and down-regulated network led by hsa_circ_0000374, hsa_circ_0000141, hsa_circ_0072665, hsa_circ_0009503 and hsa_circ_0000009 were constructed.Conclusions:There were many differentially expressed circRNA between TSC-RAML and paired normal renal tissues. ceRNA regulatory networks may be involved in the occurrence and development of TSC-RAML.

Media convergence of comprehensive preventive medical journals / 上海预防医学

Media convergence is the combination and convergence of every element of media in forms of breakdown of traditional classification, formats and distribution etc. It means the blending of its contents, consumers and operations in full and a new media was developed named as new media. The paper tries to explore the media convergence by starting from the paper-printed media, especially from the scientific journals. It is obvious that the basement is the electronization of media, comprehensive use of multi-technology is the fundamental tools, and it made the results of the inevitability of deep changes in term of thoughts, mindset and managerial principles as well. At the same time, the adverse effect of media convergence consequently coming from the freedom and openness of media convergence will be considered and avoided, so the surveillance of administrative functions and technicals should be adopted or developed accordingly.

Analysis of prescription regularity of traditional Chinese medicine for colorectal cancer based on data mining / 中国中药杂志

The tumor prescriptions contained in Dictionary of Tumor Formulas, Compendium of Good Tumor Formulas, Chinese Pharmacopoeia, Ministry of Health Drug Standards for Chinese Medicine Formulas and National Compilation of Standards for Proprietary Chinese Medicines were selected and organized to construct a database for tumor prescriptions, and the data mining techniques were applied to investigate the prescription regularity of colorectal cancer prescriptions. The formula data were extracted after screening in strict accordance with the inclusion and exclusion criteria, and were then analyzed with Microsoft Excel 2010 for frequency statistics, Apriori block provided by SPSS Clementine 12.0 software for correlation rule analysis, and arules and arulesViz packages in R 4.0.2 software for correlation rule visualization. In addition, SPSS 18.0 software was used for cluster analysis and factor analysis, in which cluster analysis was performed by Ochiai algorithm with bicategorical variables in systematic clustering method and factor analysis was performed mainly with principal component analysis. A total of 285 prescriptions were included in the statistical analysis, and the frequency statistics showed that 43 herbs had been used more than 16 times. The association rules analysis showed that 26 high-frequency me-dicine pair rules were obtained, and the association rules for those dispelling evil spirits, strengthening the body, resolving stasis, dispelling dampness, etc. were visualized. In the cluster analysis, we generated a dendrogram from which 7 groups of traditional Chinese medicines with homogeneity were extracted. 10 common factors were obtained in the factor analysis. The types of herbal medicines involved in the colorectal cancer prescription included anti-cancer antidotes, strengthening and tonifying medicines, blood-regulating medicines, and expectorant medicines, corresponding to the treatment for eliminating evil spirits, strengthening, resolving stasis, and expectorating dampness. The prescriptions for anti-cancer detoxification were normally based on the pairs composed of Scutellaria barbata-Hedyotis diffusa and Sophora flavescens, Sargentodoxa cuneata, S. barbata, often combined with stasis relieving drug and dampness eliminating drug, reflecting the characteristics of treatment for both toxicity and stasis, dampness and toxicity simultaneously. The prescriptions for strengthening the righteousness and tonifying the deficiency were composed of Astragalus membranaceus and Atractylodes macrocephala mainly, exerting the effect of benefiting Qi, strengthening the spleen and drying dampness, tonifying kidney and essence, tonifying blood and invigorating blood. Meanwhile, anti-cancer detoxification medicines shall be reduced as much as possible. The compatibility of the medicines for the intestinal tract reflected the principle of using the right medicine for the right condition and eliminating evil spirits or strengthening the body, as appropriate.

The value of lymph node No.8a metastatic status in determining extent of lymph node dissection in pancreaticoduodenectomy for pancreatic head cancer / 中华肝胆外科杂志

Objective:To study the value of metastatic positivety in lymph nodes group 8a in deciding on extended lymph node dissection in pancreaticoduodenectomy(PD) for pancreatic head cancer.Methods:A retrospective study on 165 patients with pancreatic head cancer treated with PD at the Department of Pancreas and Spleen Surgery, Hepatobiliary Hospital of Hunan Provincial People's Hospital between January 2014 to June 2019 was performed. There were 101 males and 64 females with ages ranging from 38 to 75 (median 57) years. Patients who underwent standard lymph node dissection were included in the standard group ( n=88), and extended lymph node dissection in the extended group ( n=77). These patients were further divided into 4 subgroup. Subgroup A (standard PD in patients with negative nodes in group 8a, n=61), Subgroup B (extended PD in patients with negative nodes in group 8a, n=47), Subgroup C (standard PD in patients with positive nodes in group 8a, n=27), and Subgroup D (extended PD in patients with positive nodes in group 8a, n=30). The operation time, intraoperative blood loss, postoperative survival rates, complications were compared among the groups and subgroups. Results:The operation time and intraoperative blood loss of the standard group were (456.8±30.4) min and (264.28±101.14) ml, respectively, which were significantly lower than the extended group of (507.1±45.7) min and (388.9±155.3) ml (all P<0.05). The incidence of postoperative complications in the extended group (31.2%, 24/77) was significantly higher than that in the standard group (14.8%, 13/88) ( P<0.05). When compared with subgroup B, the cumulative survival rate of patients in subgroup A was not significantly different ( P>0.05). However, the cumulative survival rate of patients in subgroup C was significantly lower than that in subgroup D ( P<0.05). The cumulative survival rate of subgroup A was also significantly better than that of subgroup C ( P<0.05). There was no significant difference in the cumulative survival rates between group B and group D ( P>0.05). Conclusions:PD with extended lymph node dissection improved the survival rates in patients with cancer of the head of the pancreas with positive lymph nodes in group 8a. For these patients, extended lymph node dissection is recommended. With negative lymph nodes in group 8a, standard lymph node dissection is recommended.

Therapeutic effect of chondroitin sulfate combined with triptolide liposome on arthritic rats / 中国药理学通报

Aim To compare the therapeutic effects of free triptolide (TP), free triptolide-chondroitin sulfate ( TP-CS-Lips ) , triptolide liposome ( TP-Lips ) and triptolide combined with chondroitin sulfate liposome (TP-CS-Lips) on collagen-induced arthritis (CIA) rats. Methods A total of 48 SD SPF rats were select ed in the study, 8 of which were randomly treated as controls and the remained 40 rats were injected with complete Frederik's adjuvant -chicken type II collagen to establish CIA. The 48 rats successfully modeled were randomly divided into five groups; model group, TP group, TP-CS group, TP-Lips group and TP-CS-Lips group. The treatment groups were intraperitoneally injected with corresponding drugs (TP:30 jig • kg"1, CS:100 mg • kg"1) every day, while the control group and model group were intraperitoneally injected with an equal volume of 0. 9% sodium chloride solution once a day, with a treatment cycle of 28 days. Before administration (0 d) and at 7 d, 14 d, 21 d and 28 d , the body mass index and arthritis index of rats were evaluated; thymus index and splenic index of each group were analyzed. HE staining was used to observe the pathological changes of cartilage. The expressions of inflammatory cytokines IL-1, TNF- and 1L-6 in serum were detected by ELISA. Results Compared with model group, TP-CS-Lips significantly increased the body mass of arthritic rats (P <0. 05) , and the arthri-tis index score was also significantly induced ( P < 0. 05) ; thymus and spleen indexes of rats significantly decreased (P<0. 05) ; pathological injury of cartilage of knee joint was significantly reduced; the IL-l, TNF- and IL-6 levels of serum also significantly decreased (P <0.05). Furthermore, the therapeutic effect of TP-CS-Lips was superior to that of TP, TP-CS and TP- Lips in arthritic rats. Conclusions TP-CS-Lips could significantly enhance the therapeutic effect of CIA, which provides experimental basis for the development of nano-agents for the treatment of arthritis.

Effect of Early Weight-bearing on Appropriate Population with Intertrochanteric Fracture after Surgery / 中国康复理论与实践

Objective:To observe the effect of early weight-bearing on the appropriate population with intertrochanteric fracture after surgery. Methods:From April, 2017 to December, 2018, a total of 45 patients with Evans-Jensen type II intertrochanteric fracture and fracture reduction as positive medial cortex support (PMCS) after proximal femoral nail anti-rotation (PFNA) fixation were randomly divided into control group (n = 22) and experimental group (n = 23). Weight-bearing as tolerated (WBAT) was initiated from six weeks after surgery in the control group, and within 48 h after surgery in the experimental group. The frequency of WBAT in two groups increased gradually from three times a day for ten minutes a time to five times a day for 20 minutes a time until clinical healing of fracture. The length of stay, hospital cost, the fracture healing time and the complication incidence were compared between two groups, as well as the scores of Visual Analogue Scale (VAS) and Harris Hip Score at six weeks, three months and six months after surgery. Results:Compared with the control group, the length of stay was shorter (t = 3.716, P < 0.01), the hospital cost was lower, but no significant difference was found (t = 1.540, P > 0.05), and the fracture healing time was shorter (t = 6.248, P < 0.001) in the experimental group. The complication incidence was lower in the experimental group, but there was no significant difference (χ2= 2.198, P > 0.05). Six weeks, three months and six months after surgery, there was no significant difference in the score of VAS between two groups (t < 1.330, P > 0.05). The score of Harris Hip Score was significantly higher in the experimental group than in the control group six weeks after surgery (t = -5.115, P < 0.001), however, no significant difference was found in other time points (|t| < 1.799, P > 0.05). Conclusion:Early weight-bearing within 48 h after PFNA fixation for Evans-Jensen type II intertrochanteric fractures and reduction with PMCS could shorten the length of stay, shorten the bony healing time and promote early recovery of hip function.

Classification and surgical management of chronic calcifying pancreatitis / 中华消化外科杂志

Objective:To investigate the classification and surgical management of chronic calcifying pancreatitis.Methods:The retrospective and descriptive study was conducted. The clinical data of 121 patients with chronic calcifying pancreatitis who were admitted to Hunan Provincial People′s Hospital from January 2015 to December 2019 were collected. There were 99 males and 22 females, aged from 10 to 78 years, with a median age of 43 years. The patients with type Ⅰ chronic calcifying pancreatitis underwent pancreaticoduodenectomy, duodenum-preserving pancreatic head total resection, or duodenum-preserving pancreatic head spoon-type resection respectively, and external drainage when combined with peripancreatic pseudocyst. Patients with type Ⅱ chronic calcifying pancreatitis underwent resection of pancreatic body and tail combined with splenectomy or dissection of pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis. Patients with type Ⅲ chronic calcifying pancreatitis underwent pancreaticoduodenectomy or duodenum-preserving pancreatic head spoon-type resection, and external drainage when combined with peripancreatic pseudocyst. Patients with type Ⅳ chronic calcifying pancreatitis underwent basin-type internal drainage. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the recurrence of pain or chronic pancreatitis, the data of blood glucose, the morbidity of diabetes and diarrhea after surgery up to January 2020. Measurement data with normal distribution were represented as Mean± SD and measurement data with skewed distribution were described as M (range). Count data were represented as absolute numbers. Results:(1) Surgical situations: of the 48 patients with type Ⅰ chronic calcifying pancreatitis, 15 patients underwent pancreaticoduodenectomy with the operation time of (6.8±1.9)hours and volume of intraoperative blood loss of (398±110)mL, 8 patients underwent duodenum-preserving pancreatic head total resection due to no dilation of pancreatic duct with the operation time of (3.7±0.8)hours and volume of intraoperative blood loss of (137±62)mL, 25 patients underwent duodenum-preserving pancreatic head spoon-type resection due to dilation of pancreatic duct with the operation time of (3.9±1.5)hours and volume of intraoperative blood loss of (123±58)mL. Of the 8 patients with type Ⅱchronic calcifying pancreatitis, 2 patients underwent resection of pancreatic body and tail combined with splenectomy with an average operation time of 5.1 hours and an average volume of intraoperative blood loss of 200 mL, 6 patients underwent dissection of pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis with the operation time of (2.7±0.8)hours and volume of intraoperative blood loss of (145±39)mL. Of the 49 patients with type Ⅲ chronic calcifying pancreatitis, 4 patients were underwent pancreaticoduodenectomy with the operation time of (7.2±1.4)hours and volume of intraoperative blood loss of (415±98)mL, 45 patients underwent duodenum-preserving pancreatic head spoon-type resection due to dilation of pancreatic duct with the operation time of (4.3±1.1)hours and volume of intraoperative blood loss of (135±47)mL. Sixteen patients with type Ⅳ chronic calcifying pancreatitis underwent basin-type internal drainage with the operation time of (3.3±1.3)hours and volume of intraoperative blood loss of (150±27)mL. (2) Postoperative situations: 15 of the 48 patients with type Ⅰ chronic calcifying pancreatitis who underwent pancreaticoduodenectomy had the time to first anal flatus of (2.9±1.1)days, time to initial fluid diet intake of (3.5±1.1)days, and duration of hospital stay of (14.8±2.7)days, respectively. Of the 3 patients who had postoperative complications, 2 had gastrointestinal hemorrhage (1 case was cured after hemostasis under gastroscope and the other was cured after interventional therapy), 1 with grade A pancreatic fistula was cured after delaying the time of extubation, no biliary fistula occurred. Eight patients undergoing duodenum-preserving pancreatic head total resection had the time to first anal flatus of (2.0±0.5)days, time to initial fluid diet intake of (2.5±0.4)days, and duration of hospital stay of (9.5±2.5)days, respectively. One case with postoperative grade A pancreatic fistula was cured after delaying the time of extubation. Twenty-five patients undergoing duodenum-preserving pancreatic head spoon-type resection had the time to first anal flatus of (2.4±0.8)days, time to initial fluid diet intake of (2.5±1.3)days, and duration of hospital stay of (9.8±3.1)days, respectively. One case with postoperative gastrointestinal hemorrhage was cured after interventional therapy and 1 case with grade A pancreatic fistula was cured after delaying the time of extubation. Two of the 8 patients with type Ⅱ chronic calcifying pancreatitis who underwent resection of pancreatic body and tail combined with splenectomy had an average time to first anal flatus of 3.0 days, an average time to initial fluid diet intake of 3.5 days, and an average duration of hospital stay of 14.0 days, respectively.There was no complication during perioperative period. Six of the 8 patients with type Ⅱ chronic calcifying pancreatitis who underwent dissection of the pancreatic duct combined with pancerato-jejunum Roux-en-Y anastomosis had the time to first anal flatus of (2.5±0.5)days, time to initial fluid diet intake of (2.5±0.7)days, and duration of hospital stay of (8.5±1.5)days, respectively. Two cases with postoperative grade A pancreatic fistula were cured after delaying the time of extubation. Four of the 49 patients with type Ⅲ pancreatic duct stone who underwent pancreaticoduodenectomy had the time to first anal flatus of (3.2±0.8)days, time to initial fluid diet intake of (4.1±1.2)days, and duration of hospital stay of (15.3±2.4)days, respectively. One case with postoperative grade A pancreatic fistula was cured after delaying the time of extubation without hemorrhage or biliary fistula. Forty-five of the 49 patients with type Ⅲ chronic calcifying pancreatitis who underwent duodenum-preserving pancreatic head spoon-type resection had the time to first anal flatus of (2.5±1.6)days, time to initial fluid diet intake of (2.8±0.9)days, and duration of hospital stay of (10.1±2.8)days, respectively. One case with postoperative anastomotic bleeding was cured after reoperation. One case with grade A pancreatic fistula was cured after delaying the time of extubation and 1 case with postoperative grade B pancreatic fistula was cured after puncture-duct-douch treatment. Sixteen patients with type Ⅳ chronic calcifying pancreatitis who underwent basin-type internal drainage had the time to first anal flatus of (2.6±0.7)days, time to initial fluid diet intake of (3.3±0.5)days, and duration of hospital stay of (10.4±3.0)days respectively. One case with intraperitoneal hemorrhage which represented as small amount of dark red liquid in the drainage tube of jejunum loop was cured after puncture-duct-douch treatment with noradrenaline sodium chloride solution. (3) Follow-up: Of the 121 patients, 113 (44 of type Ⅰ, 7 of type Ⅱ, 46 of type Ⅲ, 16 of type Ⅳ) were followed up for 3-58 months, with an average time of 34 months. During the follow-up, 13 patients (5 of type Ⅰ, 1 of type Ⅱ, 6 of type Ⅲ, 1 of type Ⅳ) had the recurrence of pain or pancreatitis, 55 patients (15 of type Ⅰ, 40 of type Ⅲ) with abdominal pain were improved significantly, and 45 patients (24 of type Ⅰ, 6 of type Ⅱ, 15 of type Ⅳ) did not have abdominal pain. Of the 37 patients (13 of type Ⅰ, 2 of type Ⅱ, 17 of type Ⅲ, 5 of type Ⅳ) with diabetes , 20 (6 of type Ⅰ, 2 of type Ⅱ, 12 of type Ⅲ) had blood glucose returned to normal and 17 (7 of type Ⅰ, 5 of type Ⅲ, 5 of type Ⅳ) needed controlling blood sugar with medicine. There were 5 patients (4 of type Ⅰ, 1 of type Ⅲ) diagnosed with diabetes and 3 patients (1 of type Ⅱ, 2 of type Ⅲ) with diarrhea postoperatively. Two patients of type Ⅲ chronic calcifying pancreatitis died, including 1 died of pancreatic cancer at 18 months after pancreaticoduodenectomy and 1 died of severe acute pancreatitis at 5 months after duodenum-preserving pancreatic head spoon-type resection.Conclusions:Chronic calcifying pancreatitis is a benign disease and should be treated to preserve functional tissues. Different surgical procedures should be adopted to treat different types of calcifying pancreatitis.

A new type of adjustable weight bearing rehabilitation brace for lower limbs in postoperative rehabilitation of proximal femoral nail anti-rotation / 中国骨伤

OBJECTIVE@#To study and analyze the clinical effect of the self-developed new adjustable weight-bearing rehabilitation brace in the rehabilitation of the femoral intertrochanteric fracture after the operation of PFNA.@*METHODS@#From July 2015 to June 2017, 62 patients with typeⅡ (Evans-Jensen classification) intertrochanteric fracture of femur were treated with PFNA internal fixation. There were 11 males and 19 females in the routine rehabilitation group, with an average age of (70.73± 6.09) years;17 males and 15 females in the brace rehabilitation group, with an average age of (71.25±6.60) years. Among them, the patients in the routine rehabilitation group recovered according to the routine method, and the patients in the support rehabilitation group used the self-developed new adjustable weight-bearing rehabilitation support of lower limbs to assist the early rehabilitation. The pain intensity(VAS score), weight-bearing of affected limb, clinical healing time of fracture, Harris score and complications were recorded and analyzed.@*RESULTS@#Nine patients lost their visit half a year later, the other 53 patients were followed up for 9 to 18 months. The VAS score at 1, 3, 6 months after operation of brace rehabilitation group was lower than that of routine rehabilitation group(<0.05). The weight bearing of the limbs in the rehabilitation group was significantly higher than that in the conventional rehabilitation group(<0.05), but the clinical healing time of fracture in the brace rehabilitation group was shorter than that in the routine rehabilitation group(<0.05). In addition, the Harris score of the postoperativebrace rehabilitation group was better than that of the conventional rehabilitation group(<0.05). The incidence of complications was lower than that of the conventional rehabilitation group(=0.048).@*CONCLUSION@#In the rehabilitation of Evans Jensen typeⅡintertrochanteric fracture after PFNA internal fixation, the new self-developed adjustable weight-bearing rehabilitation brace can significantly relieve postoperative pain, regulate and moderately increase the stress stimulation at the fracture end, so as to promote fracture healing, accelerate the recovery of hip joint function, reduce the incidence of complications, and its clinical effect is safe and reliable.