Prevalence and risk factors of dry eye patients with corneal epithelial defects: A hospital-based retrospective study / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the characteristics and correlated risk factors of dry eye patients with corneal epithelial defects.METHODS: Outpatient medical records of dry eye patients with corneal epithelial defects at Peking University Third Hospital from July 2018 to June 2019 were retrospectively analyzed. The patients' data including sex, age, visit date, presence of comorbidities, and meteorological indicators at the same period were statistically analyzed.RESULTS: A total of 291 dry eye patients with corneal epithelial defects, of whom 75.3% were female, were retrospectively analyzed. Young patients aged 21-30 made up the most(26.5%), while the proportion of teenagers(<18 years, 5.8%)and the elderly(≥61 years, 17.2%)was low. However, as the largest proportion of this population, young and middle-aged patients tend to experience fewer visits(5.4±12.4). Spring and winter were the main seasons of complaints. The meteorological indicators at the same period including fine-particulate matter with a median aerometric diameter of less than 10μm(PM10), sulfur dioxide(SO2), nitrogen dioxide(NO2), and reduced average relative humidity were found significantly correlated with dry eye corneal epithelial defects(P<0.05). Conjunctivitis, cataracts, blurred vision, and trichiasis ranked the top four comorbidities.CONCLUSION: Dry eye corneal epithelial defects of young and female population cannot be ignored. PM10, SO2, NO2, and reduced humidity are found significantly correlated with dry eye corneal epithelial defects. For dry eye patients with conjunctivitis, cataracts, blurred vision, and trichiasis, more attention should be paid to their corneal conditions.

History and present situation of seromuscular flap anastomosis in proximal gastrectomy / 中华胃肠外科杂志

With the increasing detection rate of early upper gastric cancer and adenocarcinoma of esophagogastric junction, the safety of proximal gastrectomy with clear indications has been verified, and function-preserving proximal gastrectomy has been widely used. However, proximal gastrectomy destructs the normal anatomical structure of esophagogastric junction, resulting in severe postoperative gastroesophageal reflux symptoms and seriously affecting the quality of life. Among various anti-reflux surgery methods, reconstruction of "cardiac valve" has always been the focus of relevant scholars because its similarity with the mechanism of normal anti-reflux. After years of development, evolution and optimization, the designed seromuscular flap anastomosis includes tunnel muscle flap anastomosis, Hatafuku valvuloplasty, single muscle flap anastomosis and double muscle flap anastomosis. The double muscle flap anastomosis has become a research hotspot because it shows good anti-reflux effect in clinical application. This paper reviews the history, research status and hot issues of seromuscular flap anastomosis of esophageal remnant stomach at home and abroad.

Analysis of epidemic characteristics of outbreak of infectious diseases reported in schools of Shanghai， 2014‒2019 / 上海预防医学

Objective:To analyze the epidemiological characteristics of outbreak of infectious diseases reported in schools in Shanghai from 2014 to 2019， and to suggest related strategies for efficient response to public health emergencies. Methods:Descriptive epidemiology method was used to analyze the outbreak of infectious diseases reported in schools in Shanghai from 2014 to 2019. Results:A total of 82 infectious disease emergencies were reported in schools in Shanghai during 2014 and 2019， involving 1 760 disease cases and 2 deaths. The incidence peaks in each year were from March to June and from September to December. The events mainly occurred in kindergartens and primary schools， with 35 and 25 incidences respectively. The main types of events were hand-foot-and-mouth disease and chickenpox， accounting for 48.78% and 46.34% of public health emergencies of infectious diseases in school， respectively. The time it took to report the events was positively correlated to the duration and the scale of the events. The sooner the epidemic was reported， the shorter it lasted． Conclusion:The kindergartens and primary schools are the places with a high incidence of infectious diseases reported in schools. Measures such as regular surveillance， vaccination management， early reporting and effective handling should be executed at the early stage so as to prevent the spread of the epidemics.

Biosafety risk assessment based on the perspective of public health / 上海预防医学

Objective:To assess the biosafety risk from a public health perspective and provide scientific evidence for centers for disease control and prevention to formulate diversified strategies and well-organized resource allocation. Methods:Based on the global summary of pathogenic microorganism which might be used against human beings intentionally， we performed a multi-round consultation to the expert team with a scientific background and professional qualification， using a Delphi method. According to the consultation and reliability test， a consistent evaluation was conducted from seven dimensions， including fatality rate， implementation of biosafety-related events， short-term probability， long-term probability， difficulty of rescue， early detection， and response capacity of the public health system. Results:The overall opinions of the experts tended to be consistent. Bacillus anthracis had been scored the highest in the comprehensive biosafety risk， which was much higher than the second （botulinum toxin） and third places （Yersinia pestis）， raising a significant public health concern. In addition， multiple hemorrhagic fever viruses had a higher biosafety risk. Conclusions:Based on the perspective of public health， the biosafety risk can be evaluated reasonably. Pathogenic microorganisms with zoonotic characteristics and long incubation periods are more difficult to detect in advance in the environment， posing a higher risk. The formulation of disease control and prevention strategies in public health resource-limited areas warrants particular attention to high-risk biosafety events.

Long-term effects of bariatric surgery on cardiovascular risk factors in Singapore

INTRODUCTION@#Bariatric surgery is considered an effective treatment for weight loss and for improving the metabolic profile of patients with obesity. Obesity-related comorbidities such as hyperlipidaemia and type 2 diabetes mellitus (DM) are significant cardiovascular risk factors. Additionally, prospective clinical trials have shown that statins increase the risk of development of DM, and many patients with obesity are on statins. We retrospectively examined the effect of bariatric surgery on lipid profile, DM control and weight loss at the five-year follow-up.@*METHODS@#In total, 104 patients undergoing bariatric surgery from 2008 to 2012 were retrospectively studied. 36 patients were on preoperative statins. Their lipid profile, DM control and weight loss were examined at the one-year and five-year follow-ups.@*RESULTS@#Both high-density lipoprotein and triglyceride levels showed significant improvement at the one-year and five-year follow-ups (p = 0.01). Total cholesterol showed significant improvement at the one-year follow-up (-0.30 mmol/dL, p = 0.0338); however, better control was not sustained at the five-year follow-up (-0.15 mmol/dL, p = 0.133). Low-density lipoprotein did not show any considerable improvement at the one- and five-year follow-ups (-0.27 mmol/dL, p = 0.150 and -0.24 mmol/dL, p = 0.138, respectively). A statistically significant improvement in DM control was observed in these patients and in those on preoperative statins. Weight loss was sustained at one and five years.@*CONCLUSION@#Bariatric surgery does not confer a uniform improvement in lipid profile in the long term. It does, however, induce efficient weight loss and improvement in diabetic profile, even in patients on preoperative statins.

Application of modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy / 中华胃肠外科杂志

Objective: Traditional Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy can greatly decrease the anastomosis-related complications and reduce the incidence of reflux esophagitis, but its complexity limits the wide application. To decrease the complexity of Kamikawa anastomosis, the surgical team of Changzhi People's Hospital of Shanxi Changzhi Medical College improved this technique by using novel notion and reduced surgical procedures. This study aims to evaluate the efficacy and safety of modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy. Methods: A descriptive cohort study was carried out. Case enrollment criteria: (1) upper gastric carcinoma or esophagogastric junction carcinoma without distant metastasis was confirmed by preoperative gastroscopic biopsy and imaging examination; (2) tumor diameter was less than 4 cm; (3) preoperative clinical staging was cT1-3N1M0. Exclusion criteria: (1) patients received preoperative neoadjuvant chemotherapy; (2) patients had severe heart or lung disease, or poor nutritional status so that they could not tolerate surgery. Clinical data of 25 patients with upper gastric carcinoma or esophagogastric junction carcinoma who underwent modified Kamikawa anastomosis in digestive tract reconstruction in Heji Hospital (8 cases) and Changzhi People's Hospital (17 cases) from April 2019 to December 2020 were retrospectively collected. Of 25 patients, 21 were male and 4 were female, with mean age of 63.0 (49 to 78) years; 3 underwent open surgery and 22 underwent laparoscopic surgery. The modified Kamikawa anastomosis was as follows: (1) the novel notion of total mesangial resection of the esophagogastric junction was applied to facilitate the thorough removal of lymph nodes and facilitate hand-sewn anastomosis and embedding; (2) the diameter of the anastomotic stoma was selected according to the diameter of the esophageal stump, between 2.5 and 3.5 cm, to reduce the occurrence of anastomotic stenosis; (3) an ultrasonic scalpel was used to incise the esophageal stump, which could not only prevent bleeding of the esophageal stump, but also closely seal the esophageal mucosa, muscle layer and serosa to prevent esophageal mucosa retraction; (4) barbed suture was used to suture the remnant stomach fundus and esophagus to fix the stomach fundus in order to reduce the cumbersome and difficult intermittent sutures in a small space; (5) two barbed sutures were used to continuously suture the front and back walls of the anastomosis and complete the suture and fixation of the muscle flap. Relevant indicators of surgical safety, postoperative complications (using the Clavien-Dindo classification), esophageal reflux symptoms and the occurrence of esophagitis (using Los Angeles classification) were analyzed. The gastroesophageal reflux disease (GERD) score, gastroscopy, multi-position digestive tract radiography during postoperative follow-up were used to evaluate the residual gastric motility and anti-reflux efficacy. Results: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy was successfully performed in 25 patients. The surgical time was (5.8±1.8) hours, the intraoperative blood loss was (89.2±11.8) ml, and the average hospital stay was (13.8±2.9) days. Three cases (12.0%) developed postoperative anastomotic stenosis as Clavien-Dindo grade III and were healed after endoscopic dilation treatment. Postoperative upper gastrointestinal radiography showed 1 case (4.0%) with reflux symptoms as Clavien-Dindo grade I. Gastroscopy showed no signs of reflux esophagitis, and its Los Angeles classification was A grade. No anastomotic bleeding, local infection and death were found in all the patients. At postoperative 6-month of follow-up, GERD score showed no significant difference compared to pre-operation (2.7±0.6 vs. 2.4±1.0, t=-1.495, P=0.148). Conclusion: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy is safe and feasible with good anti-reflux efficacy.

Effect of neurogenin 3 overexpression on the differentiation of human umbilical cord mesenchymal stem cells into insulin-producing cells / 解剖学报

Objective To investigate whether the overexpression of neurogenin 3 ( Ngn3 ) can promote the induced differentiation of human umbilical cord mesenchymal stem cells ( HUCMSCs) into insulin-producing cells (IPGs). Methods HUCMSCs were isolated and cultured, identified by flow cytometry, and the differentiation potential was identified by adipogenesis and osteogenesis induction. HUCMSCs were induced into IPCs in different stages, including a low glucose induction stage and a high glucose induction stage. The experiment was divided into two groups, the control group was induced by the above scheme, while the experimental group was additionally infected the lentivirus overexpression vector carrying the target gene Ngn3 on the 6th day of the same induction process. After induction, the changes of cell structure were observed by electron microscope ; mRNA and protein was collected and Real-time PCR and Western blotting were used to compare the expressions of insulin and musculoaponeurotic fibrosarcoma oncogene homolog A Mafa in the two groups ; medium supernatant was collected and C-peptide content was determined by ELISA. Results HUCMSCs were successfully isolated with positive expression of CD 105 and CD90 and negative expression of CD34 and CD45, which had adipogenic and osteogenic differentiation ability. Then, HUCMSCs were induced into IPCs by stage induction, and the cells expressed Mafa and insulin positively. Ngn3 was overexpressed in the experimental group during the induction. After induction, electron microscopy showed that the cell structure was more mature in the experimental group. The expression levels of insulin and Mafa in the experimental group were significantly higher than those in the control group. During the induction process, the amount of C-peptide secreted by the experimental group was higher than that of the control group. Conclusion Lentivirus-mediated Ngn3 overexpression improves the differentiation efficiency of HUCMSCs into IPCs.

Advance in Rehabilitation after Lumber Disc Surgery (review) / 中国康复理论与实践

Lumbar disc herniation is an important cause of chronic low back pain, for which surgery has a great effect. However, there remain some residual symptoms, such as pain, disability, etc. It's effective for postoperative rehabilitation to relieve pain, and improve the disability and psychological status. However, the optimal rehabilitation program is controversial. So it's necessary to consider various aspects including time, site, frequency, intensity and pattern for an optimal rehabilitation choice, which needs further study. Psychological factors shall be concerned by medical workers as well.

Clinical analysis of Compound Anisodine Injection combined with Iodized Lecithin Tablets in treatment of central serous chorioretinopathy / 药物评价研究

Objective To discuss the efficacy of Compound Anisodine Injection combined with Iodized Lecithin Tablets in treatment of central serous chorioretinopathy.Methods Totally 60 patients with CSC were selected,and divided into two groups randomly.The patients in control group (29 cases) were given Iodized Lecithin Tablets.The patients in observation group (31 cases) were given Iodized Lecithin Tablets and Compound Anisodine Injection.The efficacy of Compound Anisodine Injection combined with Iodized Lecithin Tablets in treatment of central serous chorioretinopathy was evaluated by efficacy,visual acuity,light sensitivity,and adverse reaction during treatment.Results After treatment,the effective rates of observation and control groups were 93.5％ and 79.3％,and the observation group was significantly higher than control group (P ＜ 0.05).There were no statistical significance on visual acuity between two groups.After treatment,rhe visual acuity of two groups was increased and the visual acuity in the observation group was better (P ＜ 0.05).Before treatment,there were no statistical significance on light sensitivity between two groups.After 2 and 4 weeks treatment,the light sensitivity of two groups were increased and the light sensitivity in the observation group was higher (P ＜ 0.05).During treatment,there was no statistical significance on adverse reaction between two groups.Conclusion Compound Anisodine Injection combined with Iodized Lecithin Tablets has a curative effect on central serous chorioretinopathy.It could increase the visual acuity and improve the light sensitivity of eyes with good security.It is worthy of clinical use.

Study on the effect and mechanism of the dysfunction of CD4(+) T cells in the disease process of chronic cardiac failure

OBJECTIVE@#To study the effect and mechanism of the dysfunction of CD4(+) T cells in the disease process of chronic cardiac failure (CHF).@*METHODS@#According to different group technologies, 100 CHF patients were divided into the following groups: ischemia group and non-ischemia group, heart function Ⅲ-Ⅳ group and heart function Ⅰ-Ⅱ group, event group and non-event group, and 50 healthy volunteers were included in the control group. Real-time PCR was used to detect transcription factors T-bet and GATA-3 of Th1 and Th2; flow cytometry was applied to determine the ratio of Th17 and Treg cells; ELISA was employed to test cytokines IFN-γ, IL-4, IL-17 and IL-10 of peripheral blood Th1, Th2, Th17 and Treg cells, respectively; ultrasonic cardiogram was used to exploit to LVEF and LVEDd; and electrochemilu minescene immunoassay was used to examine plasma BNP. The differences of all indexes of all groups were analyzed and the correlation between CD4 T cells and clinical indexes was analyzed by Pearson correlation analysis.@*RESULTS@#As compared to the control group, the transcription factors T-bet and GATA-3 of Th1 and Th2, the ratio of cytokines Th17 and IFN-γ, cytokines IL-17, T-bet/GATA-3, IFN-γ/IL-4, Th17 cells/Treg cells, IL-17/IL-10 of the ischemia group and non-ischemia group, heart function Ⅲ-Ⅳ group and heart function Ⅰ-Ⅱ group, event group and non-event group were all increased significantly, while their transcription factor GATA-3 of Th2, cytokines IL-4, Treg cells ratio, cytokines IL-10 were decreased obviously. The differences showed statistical significance (P < 0.05). The increase or decrease of the partial CD4+ T cells of the ischemia group, heart function Ⅲ-Ⅳ group and event group was more distinctly. The results of Pearson correlation analysis showed that IFN-γ and IL-17 were significantly positively correlated with LVEDd and BNP, IL-4 and IL-10 were also significantly positively correlated with LVEF, but correlated negatively with BNP, and IL-17 was negatively correlative with LVEF.@*CONCLUSIONS@#There was a correlation between CHF and the dysfunction of CD4(+) T cells showing immune activation phenomenons of deviations from the Th1/Th2 balance towards Th1 and from the Th17/Treg balance towards Th17, which was also related to the types, severity and prognosis of the disease.

Study on the effect and mechanism of the dysfunction of CD4

Objective To study the effect and mechanism of the dysfunction of CD4

Achievement of ABC goals and thrir association with serum creatinine and urea nitrogen among community middle aged and elderly diabetics / 上海预防医学

Objective To investigate the achievement of HbAlc ( A) ,blood pressure ( B) ,and LDL-C ( C) control goals of diabetes and explore their association with indices of renal function among diabetics in community. Methods A total of 388 diabetes patients aged 45 years and older were enrolled who received physical examination in a community.In addition to blood pressure (BP),were measured fasting blood glucose,glycated hemoglobin ( HbAlc) ,serum lipid,creatinine,and urea nitrogen. Results In this investigation only 1.8%of diabetes patients achieved ABC goals.And 34.0% achieved none of the three and 45.9%reached only one of the three.In the 388 diabetes patients,54.6%had HbAlc<7%,25.0%LDL-C <2.6 mmol/L,and 8.2% BP<130/80 mmHg.The levels of serum creatinine and urea nitrogen were elevated with age and not found to have association with the achievement of ABC goals. Conclusion Poor achievement of ABC goals was among diabetics in community.The effective control of blood pressure and LDL contributes to improvement of comprehensive control levels for diabetics.

Estimating risk of stroke in elderly people by use of Framingham Stroke Risk Profile / 上海预防医学

Objective To explore the application of Framingham Stroke Risk Profile in elderly people. Methods A total of 5 148 people aged 55 years and older who received physical examination in a community were enrolled.Information of their healthy status and risk factors were collected by interview using a questionnaire.Height, weight, waist circumference (WC), and blood pressure as well as fasting plasma glucose ( FPG) , and serum lipid were measured. Results The average 10-year probabilities of stroke in elderly people were 9.79% in men and 6.20% in women ( P <0.05).Besides aging factor, higher risk probability in men might be related to their higher proportions of smoking and atrial fibrillation. In addition to blood pressure and FPG which were variables associated with risk profile, WC/height ratio ( WHR) and serum triglyceride level were associated with increased risk of stroke estimated by stroke risk profile (OR=1.598, 95%CI:1.371~1.864;OR=1.487, 95%CI:1.225~1.783), respectively. Conclusion Besides factors which had been included by risk profile, it is important to pay attention to weight control and triglyceride level.For elderly male, to quit smoking is an important measure that decreases their risk of stroke.

Formation and changes of regulated trihalomethanes and haloacetic acids in raw water of Yangtze River, Huangpu River and different treatment processes and pipelines network / 中华预防医学杂志

<p><b>OBJECTIVES</b>To investigate the pollutant levels of regulated disinfection by-products trihalomethanes (THMs) and haloacetic acids (HAAs) in raw water from the Huangpu River, the Yangtze River and different treatment processes and finished water, and to explore the changes tendency in transmission and distribution pipeline network.</p><p><b>METHODS</b>A total of 65 ml water samples with two replicates were collected from different raw water, corresponding treatment processes, finished water and six national surveillance points in main network of transmission and distribution, water source for A water plant and B, C water plant was the Huangpu River and the Yangtze River, respectively. Regulated THMs and HAAs above water samples were detected by gas chromatography.</p><p><b>RESULTS</b>The total trihalomethanes (THM(4)) concentration in different treatment processes of A water plant was ND-9.64 µg/L, dichlorobromomethane was the highest (6.43 µg/L). The THM(4) concentration in B and C water plant was ND to 38.06 µg/L, dibromochloromethane (12.24 µg/L) and bromoform (14.07 µg/L) were the highest in the B and the C water plant respectively. In addition to trichloroacetic acid in A water plant from the raw water, the other HAAs came from different treatment processes. The total haloacetic acids (HAA(6)) concentration of different treated processes in A water plant was 3.21 - 22.97 µg/L, mobromoacetic acid (10.40 µg/L) was the highest. Dibromoacetic acid was the highest both in B (8.25 µg/L) and C (8.84 µg/L) water plant, HAA(6) concentration was ND to 27.18 µg/L. The highest and the lowest concentration of THM(4) were found from the main distribution network of C and A water plant respectively, but the concentration of HAA(6) in the main water pipes network of A water plant was the highest, and the lowest in C water plant. The THMs concentration was 21.11 - 31.18 µg/L in C water plant and 6.72 - 8.51 µg/L in A water plant. The concentration of HAA(6) was 25.02 - 37.31 µg/L in A water plant and 18.69 - 23.32 µg/L in C water plant. The highest concentrations of brominated disinfection by-products in B and C water plant were 54.57 µg/L and 45.38 µg/L respectively, those were higher than A water plant (18.98 µg/L), and higher than the chlorinated disinfection by-products in B and C water plants (30.23 µg/L and 30.60 µg/L).</p><p><b>CONCLUSIONS</b>The THM(4) concentrations of finished water treated from Huangpu River was lower than finished water from the Yangtze River, while the HAAs concentrations in finish water from Huangpu River was higher than the two water plants of Yangtze River. The fluctuations of THMs and HAAs concentration in distribution network were low during transmission and distribution process.</p>

The clinical feature and prognosis predictors associated with outcome for convulsive status epilepticus children / 中华急诊医学杂志

Objective To investigate the clinical manifestation of convulsive status epilepticus (CSE) associated with the outcome of children contracted this illness in order to make an effort to prevent and treat those children. Method The patients with CSE admitted from October 1998 to October 2008 were prospectively and consecutively enrolled. All the patients met the diagnostic criteria set by International Anti-epilepsy Union (ILAE) in 1993. The prognosis predictors of outcome were analyzed with the Rank sum test, Chi-square analysis and Logistic regression analysis. Results A total of 169 patients with CSE were enrolled. Of them, 92 patients were from rural areas (54.4% ). The primary cause was central nervous system infection, and the minor ones were a reduction of dose or withdrawal of the antiepileptics, and cerebral hemorrhage. The duration of CSE before treatment was longer in rural patients than in urban residents ( P < 0.01) . The duration of CSE before treatment and the total persistence time of CSE was significantly associated with the mortality 14.2% . The source of patients, the duration before treatment, and respiratory depression were independent prognostic predictor variables of CSE (P < 0.05) .Conclusions The rural patients account for the major ratio of convulsive status epilepticus. Central nervous system infection is the primary cause. The duration before treatment and total persistence time of CSE are highly related to the mortality and morbidity.

ABNORMAL CHANGE OF p53 GENE IN GASTRIC CANCER AND PRECANCER- OUS LESIONS AND APC GENE IN GASTRIC CARCINOMA AND NEAR TISSUES / 中华消化内镜杂志

p53 gene mutation (exon4 , 5 , 6 . 7 . 8 and intron6) in gastric cancer and precancerous le- sions and p53 gene (exon4 and intron6) .APC gene deletion in gastric carcinomas were studied by PCR/ SSCP and PCR/RFLP. Results showed: mutation rate of p53 in intestinal metaplasia ,dysplasia and gas- tric carcinoma was 37. 5% (3/8) ,42. 1 % (8/19) , 53. 3% (16/30) ,respectively. There was significant dif- ference between groups of metaplasia、dysplasia、cancer and that of normal control. We found there were no exon8 mutation in metaplasia and dysplasia , but 4 cases in cancer group. lt is suggestted that exon8 mutation occurs at the late stage of gastric cancer , but exon 5 , 6 , 7 mutation occur in the course of pre- cancerous lesions to cancer. Loss of heterozygosity (LOH) of exon4 . intron6 . APC was 47. 4 % ( 9/19) . 8. 7%C2/23).16. 7%(3/18) ,respectively. There are some relationship between LOH of exon4 and poor- ly differentiation , lymph node metastas , depth of invasion. LOH of exon4 may be one of prognostic marker of gastric cancer. We concluded that p53 gene mutation is an early event and perhaps has syner- gism with ras oncogene in gastric carcinogenesis