Preliminary application and efficacy analysis of transumbilical single-incision plus one port robotic total mesorectal excision / 中华胃肠外科杂志

Objective: To investigate the feasibility of transumbilical single-incision plus one port (SIPOP) robotic total mesorectal excision. Methods: Clinical data of a 70-year-old male patient with BMI 22.1 kg/m(2) who successfully underwent transumbilical single-incision plus 1 port robotic total mesorectal resection of upper rectal cancer at the General Surgery Department of Daping Hospital of Army Military Medical University on September 18, 2019 were retrospectively analyzed. Preoperative colonoscopy revealed that the distance of upper rectal cancer to anal edge was 14 cm, and the tumor size was 2.5 cm×1.5 cm×1 cm. Pathological result confirmed rectal moderately differentiated adenocarcinoma. The preoperative abdominal CT showed thickened bowel-wall of upper rectum and the blurred perirectal fat, suggesting tumor infiltration. Results: The operation was successful. There were no conversion to laparotomy or abdominal auxiliary incision, and the mesorectum of the specimen was intact. The operation time was 165 minutes, the blood loss was about 20 ml, and there were no complications such as injury to peripheral organs. Postoperative pathology showed ulcerative moderately differentiated adenocarcinoma of the upper rectum with TNM stage IVA (T4N2b). The postoperative recovery was smooth. Patient ambulated on the 1st day, the catheter was removed on the 7th day, and discharged from the hospital on the 8th day. Conclusion: The transumbilical SIPOP robotic total mesorectal excision is safe, effective and feasible.

Incidence and risk factors of anastomotic leak after transanal total mesorectal excision in China: a retrospective analysis based on national database / 中华胃肠外科杂志

Objective: Transanal total mesorectal excision (taTME) was a very hot topic in the first few years since its appearance, but now more introspections and controversies on this procedure have emerged. One of the reasons why the Norwegian Ministry of Health stopped taTME was the high incidence of postoperative anastomotic leak. In current study, the incidence and risk factors of anastomotic leak after taTME were analyzed based on the data registered in the Chinese taTME Registry Collaborative (CTRC). Methods: A case-control study was carried out. Between November 15, 2017 and December 31, 2020, clinical data of 1668 patients undergoing taTME procedure registered in the CTRC database from 43 domestic centers were collected retrospectively. After excluding 98 cases without anastomosis and 109 cases without complete postoperative complication data, 1461 patients were finally enrolled for analysis. There were 1036 males (70.9%) and 425 females (29.1%) with mean age of (58.2±15.6) years and mean body mass index of (23.6±3.8) kg/m(2). Anastomotic leak was diagnosed and classified according to the International Study Group of Rectal Cancer (ISREC) criteria. The risk factors associated with postoperative anastomotic leak cases were analyzed. The impact of the cumulative number of taTME surgeries in a single center on the incidence of anastomotic leak was evaluated. As for those centers with the number of taTME surgery ≥ 40 cases, incidence of anastomic leak between 20 cases of taTME surgery in the early and later phases was compared. Results: Of 1461 patients undergoing taTME, 103(7.0%) developed anastomotic leak, including 71 (68.9%) males and 32 (31.1%) females with mean age of (59.0±13.9) years and mean body mass index of (24.5±5.7) kg/m(2). The mean distance between anastomosis site and anal verge was (2.6±1.4) cm. Thirty-nine cases (37.9%) were classified as ISREC grade A, 30 cases (29.1%) as grade B and 34 cases (33.0%) as grade C. Anastomotic leak occurred in 89 cases (7.0%,89/1263) in the laparoscopic taTME group and 14 cases (7.1%, 14/198) in the pure taTME group. Multivariate analysis showed that hand-sewn anastomosis (P=0.004) and the absence of defunctioning stoma (P=0.013) were independently associated with anastomotic leak after taTME. In the 16 centers (37.2%) which performed ≥ 30 taTME surgeries with cumulative number of 1317 taTME surgeries, 86 cases developed anastomotic leak (6.5%, 86/1317). And in the 27 centers which performed less than 30 taTME surgeries with cumulative number of 144 taTME surgeries, 17 cases developed anastomotic leak (11.8%, 17/144). There was significant difference between two kinds of center (χ(2)=5.513, P=0.019). Thirteen centers performed ≥ 40 taTME surgeries. In the early phase (the first 20 cases in each center), 29 cases (11.2%, 29/260) developed anastomotic leak, and in the later phase, 12 cases (4.6%, 12/260) developed anastomotic leak. The difference between the early phase and the later phase was statistically significant (χ(2)=7.652, P=0.006). Conclusion: The incidence of anastomotic leak after taTME may be reduced by using stapler and defunctioning stoma, or by accumulating experience.

Effect of Physical Activity on the Association Between Dietary Fiber and Constipation:Evidence From the National Health and Nutrition Examination Survey 2005-2010

Background/Aims@#The effect of physical activity on the relationship between dietary fiber intake and constipation has not been comprehensively studied.This study aims to explore the impact of physical activity. @*Methods@#Data were obtained from 3 cycles of the National Health and Nutrition Examination Survey (NHANES) 2005-2010 and included a total of 13 941 participants aged ≥ 20 years. Multiple logistic regression analysis was used to investigate the independent associationbetween dietary fiber and constipation. Interaction analysis was also performed to analyze the relationship between dietary fiber and constipation in different physical activity groups. @*Results@#Among non-active participants, dietary fiber intake did not associate with stool consistency (OR, 1.02; 95% CI, 0.98-1.05; P = 0.407). For physically active participants, 1-gram unit increase in dietary fiber intake reduced the risk of stool consistency by 3% (OR, 0.97; 95% CI, 0.94-0.99; P = 0.020). Moreover, the relationship between dietary fiber intake and stool consistency was significantly different for groups with different levels of physical activity (P interaction = 0.044). However, dietary fiber intake was not related to stool frequency among non-active participants (OR, 0.99; 95% CI, 0.94-1.05; P = 0.767) nor physically active participants (OR, 1.01; 95% CI, 0.97-1.04; P = 0.751). @*Conclusions@#Increasing dietary fiber intake was associated with stool consistency-related constipation among physically active participants, but not among non-active participants. However, increasing dietary fiber intake is not significantly associated with stool frequency in different physical activity groups.

Analysis of risk factors for vasovagal syncope in children / 中国学校卫生

Objective@#To analyze the related factors of the onset of vasovagal syncope (VVS) in children, and to provide basis for the early prevention, early diagnosis and early treatment of VVS.@*Methods@#A total of 126 children with syncope admitted to Department of Pediatric Cardiology, Second Hospital of Lanzhou University from October 2018 to September 2019 were invited in the study. Totally 73 cases of children diagnosed with VVS by HUTT were selected as VVS group, and 53 HUTT negative children were selected as control group. Related factors were retrospectively investigated, and risk factors for VVS were analyzed by univariate and multivariate regression.@*Results@#The VVS group showed statistically significant difference in age distribution with the control group ( χ 2=19.22, P <0.05). The VVS group showed statistically significant differences of proportion in family history, syncope history, prolonged standing, electrocardiogram abnormalities, and vitamin D deficiency (43.84%，31.51%，47.95%，34.25%， 30.14 %) compared with the control group (15.09%，13.21%，20.75%，15.09%，9.43%) ( χ 2=11.71,5.67,9.79,5.83,7.82, P < 0.05 ). Multivariate Logistic regression analysis showed that age and family historywere risk factors for VVS( χ 2=3.13, 11.06, P < 0.05 ).@*Conclusion@#Age and family history may be risk factors for the onset of VVS. Active attention should be paid to the high risk factors of child patient, early identification and diagnosis can prevent the occurrence and development of VVS in children.

Feasibility of using three-dimensional CT reconstruction to evaluate inferior mesenteric artery types before radical resection of rectal cancer / 中国实用外科杂志

OBJECTIVE: To explore the feasibility and value of using three-dimensional CT reconstruction to evaluate the inferior mesenteric artery(IMA) classification and its characteristics in rectal cancer patients.METHODS: The clinical data of 108 rectal cancer patients admitted in Department of General Surgery, Daping Hospital of Army Military Medical University from January 2017 to November 2018 were analyzed retrospectively. The IMA images obtained by three-dimensional CT reconstruction before the operation were reviewed,the IMA was typed according to the different characteristics of IMA branches, and compared and analyzed the differences and characteristics of each IMA type. The length of IMA and the distance from the root of IMA to the bifurcation of the abdominal aorta were measured,and their associations with clinical features were analyzed.RESULTS: Of the 108 cases,60 were male and 48 were female. The IMA was classified into four types, of which 53(49.1%)were type Ⅰ,24(22.2%)were type Ⅱ,18(16.7%)were type Ⅲ,and 13(12%)were type Ⅳ. Univariate ANOVA showed that there were no statistically significant differences in age,BMI,LIMA,DIMA,number of positive lymph nodes,intraoperative blood loss and postoperative hospital stay among the patients with different IMA types(P>0.05). However,there was a statistically significant difference in IMA length between type II and type I or type Ⅲ(P=0.022 and 0.011,respectively). The average IMA length(LIMA)was(5.7±2.0)cm,and the average distance(DIMA)between the root of IMA and the bifurcation of the abdominal aorta was(6.3±2.3)cm.CONCLUSION: Three-dimensional CT angiography can be used before radical resection of rectal cancer to obtain the types of IMA branches and their pathways,so as to provide guidance for the treatment of IMA and preservation LCA in radical resection of rectal cancer.

Prevalence and influencing factors of mild cognitive impairment among the elderly in Zhoushan City / 预防医学

Objective To learn the prevalence, distribution and risk factors of mild cognitive impairment (MCI) among elderly in Zhoushan City, and to provide the reference for MCI control. Methods A total of 1801 elderly people aged 60 to 79 years old from six districts of Zhoushan City were sampled by method of stratified random sampling. After self-evaluated with Ascertain Dementia 8 (AD8) and screened with Screening Scale for Mild Cognitive Impairment (sMCI), the diagnosis by specialists was conducted for that positive to AD8 and sMCI. Results of 1801 respondents, 873 (48.47％) people were male, and the other 928 (51.53％) people were female; 38.65％ of the people selected aged 60-<65; 90.28％ had a primary school education or were illiterate; 78.51％ had legitimate and healthy wives. A total of 122 elderly people were diagnosed with MCI, and the prevalence of MCI was 6.77％. Multivariate logistic regression analysis showed that male elderly people (OR=0.53, 95％CI:0.28-1.00) were less likely to develop MCI compared to the female, and the illiterate (OR=2.09, 95％CI: 1.16-3.77) were more likely to develop MCI compared to the educated . Conclusion The prevalence of MCI among the elderly in Zhoushan was 6.77％; the female and the illiterate were more likely to develop MCI.

Preliminary study of the dose-proportion relation of Tibetan medicine Siwei Jianghuang Prescription on diabetic nephropathy rats induced by STZ / 中成药

AIM To investigate the dose-proportion relation of Tibetan medicine Siwei Jianghuang Prescription (SJP) for protective effects on diabetic nephropathy (DN),and the underlying mechanism.METHODS Diabetes mellitus rats induced by intraperitoneal injection of streptozotocin (STZ) (60 mg/kg) were randomly divided into model group,metformin support group,and eight SJP groups with dose-proportion variation (with reference to the uniform design method) for corresponding drug administration once a day,for four weeks.Measurement of fasting blood glucose (FBG) by a blood glucose meter,the concentrations of blood urea nitrogen (BUN),uric acid (UA),serum creatinine (SCr) and total protein (TP) by chemical methods,serum transforming growth factor-β1 (TGF-β1) and vascular endothelial growth factor (VEGF) by ELISA kits were conducted,the pathological morphology observation and glomerular basement membrane thickness detection by electron microscope were accomplished as well.Principal components analysis (PCA) and multivariate progressive regression analysis (MSRA) were employed to analyze the relationship between the dose-proportion to pharmacodynamics.RESULTS The resultant indexes revealed variant pharmacological improvement in each treatment group.MSRA results showed that the levels of BUN,renal index,FBG,glomerular basement membrane thickness,VEGF,Scr,and UA had correlative relations with a multiple linear or a multiple non-linear in all groups,which regression equation had a statistical significance (P ＜ 0.05);TGF-β1 level and total protein index with the dose-proportion had no linear or non-linear relation,which the regression equation statistical showed non-significance (P ＞ 0.05).In the global optimization comparison around the range of uniform design,the optimal dosage of the rats model was Curcumae Longae Rhizoma ∶ Berberidis dictyophyllae Cortex ∶ Phyllanthi Fructus ∶ Tribuli Fructus =1 ∶ 2 ∶ 1 ∶ 2.CONCLUSION Siwei Jianghuang Prescription shows better therapeutic effects on DN,which may be related to reducing the levels of BUN,renal index,FBG,glomerular basement membrane thickness,VEGF,Scr and UA.

Medication rules for prescriptions containing Pterocephali Herba based on data mining / 中国中药杂志

This study was aimed to discuss and analyze the medication rules for prescriptions containing Pterocephali Herba in Chinese Medical Encyclopedia - Tibetan Medicine, Tibetan Medicine Prescription Modern Research and Clinical Application, and Interpretation of Common Tibetan Medicines based on the collection of Pterocephali Herba and by using the "Traditional Chinese Medicine Inheritance Support system(V2.0.1)",with the use of association rules, apriori algorithm and other data mining methods. The frequency of single drug, the frequency of drug combination, the association rule and the combination of core drugs were analyzed. Through collection of the prescriptions, a total of 215 prescriptions were included, involving a total of 376 herbs. Through the "frequency statistics", the prescriptions containing Pterocephali Herba were commonly used to treat cold fever, distemper virus and arthritis. The highest frequently (frequency≥15) used drugs were Corydalis Herba, Lagotidis Herba, and Gentianae Macrophyllae Radix, et al. The most frequently used drug combinations were "Pterocephali Herba, Corydalis Herba","Pterocephali Herba, Lagotidis Herba", and "Pterocephali Herba, Gentianae Macrophyllae Radix" et al. The prescriptions containing Pterocephali Herba were used to primarily treat disease for Tourette syndrome caused by the dampness heat toxin, fever, arthritis etc, such as pestilent toxicity, pneumonia and influenza, rheumatoid arthritis etc. The drugs in the prescriptions mostly had the effects of heat-clearing and detoxifying, anti-inflammatory, dispelling wind and dampness, often in compatible use with heat-clearing drugs. The drug use was concentrated and reflected the clear thought of prescription statutes.

Pharmacokinetic-pharmacodynamic study on antipyreticeffects of coptisine on endotoxin-induced pyrexia of rats / 中国药理学通报

Aim To establish the pharmacokinetic-pharmacodynamic(PK-PD) modeling to characterize the antipyretic effects of coptisine, an active component in coptis chinensis on rats.Methods Nine healthy male Sprague-Dawley(SD) rats were randomly divided into three groups, each with three.The rats in the first group were injected intravenously with lipopolysaccharide(LPS,100 μg·kg-1) alone.The second and third group rats were given coptisine high-dose(3.87 mg·kg-1) and coptisine low-dose(1.93 mg·kg-1) by tail vein injection at 30 min after LPS injection, respectively.Body temperature was measured at different time points, and blood samples from tail vein were collected simultaneously.The blood concentration of coptisine was determined by ultra performance liquid chromatography.Monolix software was used to model PK-PD of coptisine mean plasma concentration and temperature effects,by population computation with non-covariates.Besides.the model with advantage was selected by the fitting goodness.Results Coptisine could inhibit body temperature of endotoxin-induced fever in rats significantly.Two-compartment linear elimination model was used to describe the final PK model.Gaussian function, an input function of body temperature changes, which was used to depict PD model, the PK and PD models were connected by the Emax model.At last, the final model was fitted better;the fitting results indicated that the EC50 of antipyretic effect of coptisine was 89.7 μg·L-1, and the Emax was 1.88℃.Conclusions Coptisine has a powerful anti-pyretic effect on endotoxin-induced pyrexia of rats with high potency, Low in vivo distribution and quick clearance.

Revisional surgery for nonstandard gastric bypass: a case report / 南方医科大学学报

Bariatric surgery is the most effective treatment for obesity with or without type 2 diabetes mellitus and its complications. With the growing incidence of type 2 diabetes mellitus, the number of hospitals performing bariatric surgery and surgical cases increase substantially. The problems in operation standardization, quality control of operation and postoperative management of the patients cause the failure in weight loss, hypoglycemia and severe complications, and revisional surgery is often required to correct the condition. We report a case of laparoscopic revisional surgery following nonstandard gastric bypass, and the reasons for failure of weight loss in first bariatric surgery, the current situation of bariatric surgery and revisional metabolic surgery were analyzed. This case demonstrates the clinical necessity of revisonal bariatric surgery and the importance of selection of the surgical approaches and indications.

Action mechanism of total flavonoids of Hippophae rhamnoides in treatment of myocardial ischemia based on network pharmacology / 中国中药杂志

In this study, a network pharmacological screening method was adopted to further study the active ingredients and action mechanism of total flavonoids of Hippophae rhamnoides(TFH) for the treatment of myocardial ischemia. Firstly TCMSP database and PubChem database were searched, and then the data were combined with oral bioavailability and drug analysis to screen flavonoids of H.rhamnoides compounds. Then predictive analysis was conducted for the 7 screened compounds by ChemMapper server.The obtained potential targets were imported into MAS 3.0. Database, and KEGG database was also used for targets analysis and pathway analysis. Finally Cystoscope 3.3.0 software was used to draw "compounds-targets-pathway" network diagram. Virtual experiments predicted 68 potential targets and 60 signaling pathways, and 31 targets and 23 pathways of them were directly or indirectly associated with myocardial ischemia. The results showed that TFH played a synergistic rolemainly through the regulation of calcium signaling pathway, VEGF signaling pathway and gap junction signaling pathway, which was consistent with literature reports. These results indicated that it can enhance heart function, protect vascular endothelial cells, and fight against myocardial ischemia probably by regulating platelet aggregation, lipid metabolism, inflammation and other processes.

Pharmacodynamic mechanism of modified Ganlu Yaoyu San intreatment of rheumatoid arthritis based on MAPK signaling pathway / 中国中药杂志

According to the findings, modified Ganlu Yaoyu San has a good anti-inflammatory activity, and can significantly alleviate the degree of arthritis. Its therapeutic effect for rheumatoid arthritis may be related to the regulation of MAPK pathway of synovial cells. In the study, the rat adjuvant arthritis(AA) model was established to further investigate the pharmacodynamic mechanism for regulating MAPK pathway of synovial cells. Enzyme-linked immune assay was used to determine the serum TNF-α level of AA rats administered with drug for two weeks, synovial tissue protein kinases ERK1/2 and p38 content were determined by immunohistochemistry, synovial tissue JNK1, ERK1, p38 gene(mRNA) expression were detected with fluorescence quantitative PCR(RT-PCR) method. According to the results, after administration for two weeks, the levels of serum TNF-α of AA rat was significantly decreased(P<0.05). After administration for four weeks, the protein expressions of p38 and ERK1/2 in synovial tissue were reduced(P<0.05 or P<0.01), the gene expressions of JNK1, p38 and ERK1 in knee joint synovial tissue were reduced(P<0.05 or P<0.01). In conclusion, modified Ganlu Yaoyu San can effectively treat rheumatoid arthritis. Its mechanism might be related to the reduction of TNF-α levels in serum, protein expression of p38 and ERK1/2 in synovial tissue, and JNK1, p38 and ERK1 gene expressions, and regulation of MAPK pathway.

A study on the epidemiological characteristics and risk factors of severe fever with thrombocytopenia syndrome in Zhoushan City / 预防医学

Objective To learn the epidemiological characteristics and risk factors of severe fever with thrombocytopenia syndrome(SFTS)in Zhoushan City from 2011 to 2015. Methods The descriptive epidemiological analysis was used to analyze the epidemiological characteristics and a case - control study was applied to analyze the risk factors. Results A total of 95 SFTS cases including 9 dead cases were reported in Zhoushan City from 2011 to 2015. All of the 4 counties had cases reported,and the county with the highest reported rate was Daishan(91. 58% ). SFTS was seasonal obviously and the epidemic peak presented from May to July. The range of age for these SFTS cases was 40 to 88 years old,and over 50 years old were accounted for 92. 53% . The sex ratio of male to female was 1∶ 1. 88,and the incidence density of SFTS in female was significantly higher than male(P ﹤ 0. 01). The main occupation were domestic unemployed(43. 16% )and farmers(35. 79% ). While using multivariate unconditional logistic regression analysis to filter the influencing factors,only working in the fields/ vegetable plots(OR = 2. 542,95% CI:1. 364 - 5. 621)and the outdoor sanitation(OR = 2. 873,95%CI:1. 462 - 5. 025)entered the final model. Conclusion The incidence of SFTS was mainly sporadic in Zhoushan City from 2011 to 2015 ,having obvious regional aggregation . The popular seasons were spring and summer . Working in the fields/ vegetable plots and the poor outdoor sanitation could be the risk factors of SFTS.

Effect of curcumin-micelles adopting vitamin E-TPGS and Solutol HS 15 as carriers on solubility and oral bioavailability of curcumin / 中草药

Objective: To prepare curcumin-micelles adopting vitamin E-TPGS (VE-TPGS) and Solutol HS15 (SHS15) as carriers, and study the effect on solubility and oral bioavailability of curcumin (Cur). Methods: Cur was loaded into micelles between VE-TPGS and SHS15 by thin film dispersion method. Particle size, loading efficiency, entrapment efficiency, and in vitro release were carried on to estimate the influence of micelles on Cur; Moreover, oral bioavailability in rats was also evaluated. Results: The particle size was (35.79 ± 1.23) nm with polydispersity index (PDI) of 0.12 ± 0.03 when the optimized micelles ratio was at 3:7 of VE-TPGS and SHS15, which increased the solubility of Cur to 2.03 mg/mL in water. The entrapment efficiency and drug loading were 90.03% and 9.34%, respectively. The in vitro release profile showed a sustained release property compared with that of Cur. In addition, the relative bioavailability of micelles (AUC0~∞) compared with that of Cur (AUC0~∞) was 303.5% (P < 0.01). Conclusion: The Cur-micelles combined use of VE-TPGS and SHS15 shows great potential clinical application.

A study on the fists size related to height,weight and body mass index among adults / 预防医学

Objective To explore the relationship of height,weight and body mass index with fists size among adults,and to compare the regression coefficient of different models.Methods Adults aged 20 -80 years were selected by stratified cluster sampling methods.T -test and univariate analysis of variance were used to compare the height,weight and fists size stratified by gender and BMI group.Regression model for fists volume was established.The regression coefficients were compared through covariance interaction analysis.Results The height,weight,BMI and fists size of male were higher than that of female (P <0.01 ).The regression model for fists size(Y)of BMI(X)for male,female and total population were Y=1 67.603 +9.445X,Y =1 1 1 .1 83 +7.779X and Y =77.1 57 +1 1 .028X(R2 =0.324,0.322,0.271 ,P <0.05).Fists size of different BMI groups were related to their height (R2 =0.501 ,0.432,0.624,0.692,P <0.05),respectively, and their regression coefficients have no statistically differences (P =0.07).The fists sizes of different BMI groups were different(P <0.01 ).Fists size of overweight or obesity groups (365.641 ±68.51 4,365.641 ±68.51 4,respectively)were larger than that of the normal and slim groups(P <0.01 ),and fists size of normal body (31 4.261 ±59.590)was larger than that of slim body(261 .081 ±59.478).Conclusion The fists sizes of male were higher than that of female.Fists size was positively related to their BMI.The height had the some impact on fists size among people in different BMI groups.

A study on influence factors of ability of emotional and behavior management among the elderly / 预防医学

Objective To investigate the status of the ability of emotion and behavior management and to explore the influence factors among the elderly in Zhoushan City.Methods Self -designed questionnaires of Activity of Daily Living Scale and Emotion -Behavior Assessment were used to investigate the elderly in Lincheng District,Zhoushan.The incidence of emotion and behavior abnormities were statistically analyzed.The influence factors were analyzed by chi -square test,rank -sum test and the ordinal regression.Results A total of 1 260 valid questionnaires were collected,the incidence of emotion and behavior abnormities among the elderly was 5.56% and the number of mild,moderate,and severe abnormity were 40,19 and 11,which accounted for 3.17%,1.51% and 0.87%.Univariate analysis showed that there were significant differences in emotion and behavior among age,education,marital status,living situation, prevalence,income and the daily living skills.Ordinal regression analysis showed that the major influence factors were living situation,income and the daily living skills.The ordinal regression analysis also showed the risk of emotional and behavior disorders of the elderly in nursing homes were 17.05 times higher than those who live with spouse (95%CI =4.31-67.35),and the elderly with monthly income below 465 yuan were 9.37 times higher than those who with monthly income over 1 160 yuan (95%CI =1.63 -53.79),and the severe,moderate and mild dependent elderly were 236.28, 32.29 and 13.79 times higher than the elderly who were independent.Conclusion Psychological care for the elderly with low income,poor self -care ability and living in nursing homes should be highly focused on.

The circular distribution analysis on peak changes of hand-foot-mouth disease in Zhoushan City / 预防医学

Objective Todescribethemonthlyincidencedistributionofhand-foot-mouthdisease(HFMD)from2010to 2012inZhoushancityandtoanalyzetheseasonaltrendandthecausesofpeakchanges.Methods Circulardistribution method was used to identify the peak period of HFMD incidence.Watson -William test and Watson's U2 test were applied for comparing the peak periods respectively.Chi -square test was conducted to analyze and compare the distribution of HFMDpathogenindifferentyearsandBonferronimethodwasusedformultiplecomparisons.Results Therewasseasonal centralized tendency of HFMD incidence during 2010 to 2012 (P<0.01).The peak period occurred between 8th of May and 1st of September which showed a significant difference among three years (P<0.01).Specifically,the peak period in 2012 was earlier than that in 2010 and 201 1 (both P<0.01 ).Among the 356 reported cases with laboratory confirmed, there was significant difference between the distribution of HFMD pathogen by Chi -square test (P <0.01 ).The predominant strain was EV71 in 2010 and 2011 accounting for 58.46%and 64.62%respectively and other enteric viruses in 2012 accounting for 48.84%.The ratio of pathogens in 2012 was statistically different from that in 2010 and 201 1 respectively(bothP<0.01).Conclusion HFMDcasesoccurwithobviouspeakseason,regionalandgeographic differences.The major pathogens of EV71 in 2010 and 2011 were changed into other enteric viruses in 2012.

Efficacy of early treatment on 52 patients with preneoplastic hepatitis B virus-associated hepatocellular carcinoma by compound Phyllanthus Urinaria L / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the change in the number of antibodies of preneoplastic hepatocellular carcinoma (HCC) using early treatment by Compound Phyllanthus Urinaria L. (CPUL) on patients with preneoplastic hepatitis B virus (HBV)-associated HCC.</p><p><b>METHODS</b>A total of 102 cirrhosis patients with regenerative or dysplastic nodules whose sera were tested positive for at least one of these six proteins (five up-regulated genes URG4, URG7, URG11, URG12 and URG19, and one down-regulated gene DRG2) were assigned randomly to two groups using continual random codes by SPSS software. Fifty-two patients were in the treatment group and 50 patients were in the control group. CPUL was used in the treatment group for 3 years, while the control group did not receive any treatment. The changes in HBV-DNA level, number of antibodies, and hepatocarcinogenesis occurred were observed. Patients who did not develop HCC were followed up for another 2 years.</p><p><b>RESULTS</b>HBV-DNA levels decreased ⩾2log in 22.2% (10/45) of patients in the treatment group in contrast to only 5.0% (2/40) of patients in the control group (P=0.0228). The number of antibodies that were tested positive in the treatment group (1.08±1.01) was significantly lower compared with the control group (2.11±1.12) after 24 months of drug treatment (P<0.01). Both the positive rates of anti-URG11 (33/52) and anti-URG19 (31/52) were over 60% at baseline in the two groups, and were decreased to 48.1% (25/52) and 46.2% (24/52) respectively at 36 months of drug treatment, while the rates increased to 68.0% (34/50) and 66.0% (33/50) respectively (P=0.0417, P=0.0436) in the control group. The positive rate of anti-DRG2 was increased to 55.8% (29/52) at 36 months of drug treatment, while in the control group was decreased to 36.0% (18/50, P=0.0452). Among the 102 patients who developed HCC, 2 were in the treatment group and 9 were in the control group, meaning that a significant difference between the two groups (P=0.0212). In 11 patients who developed HCC, anti-URG11 and anti-URG19 were always positive, while anti-DRG2 was negative. Patients newly developing HCC were 6 (20.0%) in the control group, and only one (2.5%) in the treatment group (P=0.0441) during 2-year follow-up after the end of the treatment.</p><p><b>CONCLUSIONS</b>Anti-URG11, anti-URG19 and anti-DRG2 could be used as early markers in the prediction of the therapeutic efficacy of CPUL in treating preneoplastic HCC. CPUL is useful in preventing or delaying the development of HBV-associated cirrhosis to HCC.</p>

Pathophysiology of slow transit constipation / 中华胃肠外科杂志

Slow transit constipation(STC)is the common type of chronic idiopathic constipation. Due to failure of routine conservative treatment, laxatives abuse is the most choice for majority of the patients, which could damage the enteric nervous system and result in aggravation of constipation. Resection of the slow transit colon is the ultimate option for some patients. It is hard to prevent and treat STC clinically because of the unknown pathophysiologic mechanism. Abnormalities of enteric neurotransmitters such as VIP, SP, NOS and decreased number of interstitial cells of Cajal have been described in the colon of the patients with STC. However, long term application of stimulant laxatives can also result in the almost same changes in the colon. Exploration of the potential relationship among the above reported abnormalities is the direction of future study.

Efficacy of ursodeoxycholic acid combined with Tongdan Decoction () on immunological indices and histopathological changes in primary biliary cirrhosis patients / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the efficacy of ursodeoxycholic acid (UDCA) combined with Tongdan: Decoction () on immunological indices and histopathological changes in patients with primary biliary cirrhosis (PBC) of IIor III histological stage.</p><p><b>METHODS</b>Sixty PBC patients were assigned randomly and equally: to the control group treated with UDCA alone and the treatment group treated with UDCA combined with Tongdan Decoction. The immunological indices and histopathological changes were detected before and after 24-week treatment, and the follow-up lasted for 1-3 years.</p><p><b>RESULTS</b>After 24-week treatment, CD4(+)CD28(-) in the peripheral blood was lowered and CD4(+)CD25(+) was increased in both groups, and better effect was shown in the treatment group (P<0.01). The levels of IgM, IgG, and IgA decreased markedly after 96-week treatment in the treatment group (P< 0.05, P< 0.01), while in the control group, only the latter two showed significant decrease after 148 week (all P<0.05). At the end of the 3-year follow-up, the medians of histopathological <inflammation grading and fibrosis staging declined to a lower rank, and the effect on inflammation was superior in the treatment group to the control group shown by non-parameters Wilcoxon paired symbols test ( Z=2.761,P=0.006).</p><p><b>CONCLUSION</b>Combined therapy of Tongdan Decoction and UDCA showed a better therapeutic effect: than UDCA monotherapy on PBC, especially in improving immunological indices and histopathological hepatic changes.</p>