Quality assessment of pharmacoeconomic evaluation literature in China from 2018 to 2022 / 中国药房

OBJECTIVE To analyze existing problems of pharmacoeconomic evaluation research in China and to improve the standardization and scientificity of research， so as to provide more high-quality evidence for government decision-making. METHODS Retrieved from CNKI， Wanfang database， VIP， PubMed， Web of Science from 2018 to 2022， the literature related to pharmacoeconomic evaluation in China was collected； Excel 2016 software was used to extract the key information of the included literature which met inclusion criteria. The Quality of Health Economic Studies （QHES） scale was used to evaluate the quality of the included literature. RESULTS A total of 113 pieces of literature were included in this study， involving 85 pieces of Chinese literature and 28 pieces of English literature. The overall score of QHES included literature was 65.7， of which the average score of Chinese literature was 62.0 and English literature was 76.9. The median quality scores for the literature in 2018， 2019， 2020， 2021 and 2022 were 62.0， 70.5， 59.3， 71.0， and 73.0， respectively. Of these， 65 pieces of literature reported the research perspective； 36 reported the discount rate indistinctly； 25 provided unclear definitions of thresholds； and 53 used two sensitivity analysis methods. Among different items of the QHES scale， item 2 （research perspective）， item 8 （time range and discount rate）， item 14 （potential bias） and item 16 （sources of funding） had low percentage of scores. CONCLUSIONS From 2018 to 2022， pharmacoeconomic evaluation literature published by Chinese academics has generally shown a fluctuating upward trend in terms of quality， but there is still some room for improvement. The main problems in current pharmacoeconomics research in China include unclear understanding of the research perspective， single measurement of cost and health outcomes， unreasonable design of time horizon， indistinct description of the threshold or discount rate， and lack of sensitivity analysis.

Performance of rural practitioners of endoscopic cleaning and disinfection on the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers / 中华消化内镜杂志

Objective:To evaluate the performance of rural practitioners of endoscopic cleaning and disinfection participating in the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers and to analyze the influencing factors.Methods:The questionnaires for skill assessment were designed based on the skill scheme and clinical practice of the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China, and the App Early diagnosis, Early treatment was used as the examination platform. The practitioners in 539 county hospitals from 25 provinces participating in the program in 2019 were assessed for techniques and skills for endoscopic cleaning and disinfection and the excellence rate was calculated. Multivariate logistic regression model was used to analyze the influencing factors for the examination. Results:A total of 1 671 endoscopic cleaning and disinfection practitioners participated in the assessment with the score of 73.41±16.60. The passing rate was 85.82%, and the excellence rate was 44.94%. Among all questions, the correct rate of "opportunistic screening flow chart" was the highest (98.21%), and that of "the evaluation index for mass screening" was the lowest (57.89%). The multivariate logistic regression analysis showed that the excellence rate was high in practitioners who had a bachelor degree or above ( OR=1.627,95% CI:1.319-2.007, P<0.001), the career for 5 to <15 years (5 to <10 years: OR=1.329,95% CI:1.045-1.689, P=0.020; 10 to <15 years: OR=1.384,95% CI:1.026-1.867, P=0.033), working in eastern and central regions (eastern regions: OR=3.476,95% CI:2.368-5.103, P<0.001;central regions: OR=4.028,95% CI:2.679-6.057, P<0.001) and with full understanding of the screening scheme ( OR=1.547,95% CI:1.246-1.921, P<0.001) . Conclusion:Practitioners on the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China have mastered the basic screening scheme and skills for endoscopic cleaning and disinfection. The education background, duration of the career, area and understanding of screening scheme are influencing factors for the excellence rate of endoscopic cleaning and disinfection.

Teaching practice of professional master of clinical medicine in the rotation training of thoracic surgery / 中华医学教育探索杂志

Objective:To explore the value of competency-oriented training mode in the training of professional postgraduate students of thoracic surgery.Methods:A total of 71 professional postgraduate students, who entered thoracic surgery department for rotation training, were divided into experimental group and control group. Among them, 33 students in experimental group accepted competency-oriented training, including medical theoretical knowledge, clinical skills, clinical thinking, scientific information and interpersonal communication, while 38 students in control group received traditional training. Before leaving the department, the two groups of students had a unified assessment, and their results were compared and analyzed. SPSS 19.0 was used to make statistical analysis on the students' assessment results, and the comparison of the two groups of students' results was made by two independent samples t test. Results:The experimental group performed better in theoretical knowledge, clinical skills, clinical thinking and total scores than control group [(14.21±2.03) points vs. (12.97±2.06) points, (24.30±2.35) points vs. (22.37±3.10) points, (24.00±1.85) points vs. (22.71±3.17) points, (78.09±3.53) points vs. (73.34±5.25) points], with significant differences (all P<0.05). Conclusion:Competency-oriented training model can significantly enhance the training quality of professional postgraduates of thoracic surgery. We should make rational use of new media means and various teaching platforms, and give full play to the characteristics and advantages of the discipline, which facilitates to improving the clinical post competence of trainees.

Clinical observation on the evolution of fundus lesions in different subtypes of serpiginous choroiditis / 中华眼底病杂志

Objective:To observe the clinical evolution process and imaging characteristics of choroidal lesions in different subtypes of serpiginous choroiditis (SC), and to explore the clinical significance of subtype classification.Methods:A retrospective, uncontrolled and observational study. A total of 45 eyes of 25 SC patients diagnosed in Yunnan Eye Hospital from May 2009 to September 2021 were included in the study. According to the initial location of the lesion and fundus images, including fundus color photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and other examination results. SC was divided into peripapillary serpiginous choroiditis, macular serpiginous choroiditis and ampiginous choroiditis. According to the shape of the lesions at the first diagnosis, it can be divided into new lesions with only infiltrating edema, old lesions with only atrophy and recurrent lesions with coexistence of edema and atrophy. the imaging features, development and complications of different subtypes of ocular lesion were observed.Results:Among the 45 eyes of 25 cases, 15 cases were male and 10 cases were female, 20 cases of binocular and 5 cases of monocular, age was 42.3±5.7 years old. There were 21 eyes with active lesions, of which 5 eyes were new lesions and 16 eyes with recurrent lesions; 24 eyes were old lesions. Concurrent optic disc edema occurred in 3 eyes; mild vitreitis occurred in 5 eyes; retinal occurred vasculitis in 3 eyes; choroidal neovascularization occurred in 3 eyes. Among the 16 cases (64%, 16/25) of the peripapillary serpiginous choroiditis, 2 cases (2 eyes) were monocular, and 14 cases (28 eyes) were binocular. Active lesions were found in 16 eyes, of which patients with binocular lesions only one had active lesions. The choroidal lesions that were close to the optic disc or around the optic disc, expanded outwards centrifugally with the prolongation of the disease course, and can progress to the macula. The edge of the lesion was tortuous, with a geographic-like, amoeboid-like and finger-like, polypoid or propeller-like shape. Active lesions in FFA showed weak fluorescence in the early stage and strong fluorescence in the late stage; the old lesions showed weak fluorescence in the early stage and mottled fluorescence in the late stage, and mostly strong fluorescence on the edge. OCT showed thickening of active lesions and thinning of old lesions. Among the 4 cases (16.0%, 4/25) of macular type, 2 cases (2 monocular eyes) had active lesions; 2 cases (4 eyes) had lesion in both eyes, among them, 1 case (2 eyes) had old lesion, and the other case had alternate active lesions. The initial lesions were all located in the off-center of the macula, and most of them were disk-shaped and progressing centrifugally to the periphery. The FFA and OCT imaging findings of the lesions were similar to those of the peridisc type. Among the 5 cases (20.0%, 5/25) of ampiginous choroiditis, 1 case (1 eye) was monocular and 4 cases (8 eyes) were binocular. These lesions were multiple old lesions of varying sizes, gray-white with pigmentation, with clear borders in the posterior pole. Among them 4 eyes have new active lesions appeared near the old lesions. The old lesions showed weak fluorescence with clear borders, and the fluorescein leakage at the late edge formed a strong fluorescence ring; the active lesions showed weak fluorescent spots with blurred edges, and the fluorescence was slightly enhanced in the late stage. In old lesions, atrophy of the photoreceptor layer, RPE and choroid can be seen, and RPE hyperplasia in some areas.Conclusions:SC subtype is a classification of the location of the first lesion, but the characteristics of the repeated attack of this disease can lead to the annihilation of each subtype due to the continuous expansion of the lesion. The phenomenon that the fundus active lesions only occur in one eye that can explain the clinical manifestations of asymmetric morphology of binocular lesions. The characteristics of binocular subtype warn that the predilection site of the healthy eye should be paid attention to.

Analysis of the correlation between MRI features and HER-2 expression inductal carcinoma in situ / 中国辐射卫生

Objective To investigate the correlation between the features of multimodal magnetic resonance imaging (MRI) and the expression of human epidermal growth factor receptor-2 (HER-2) in ductal carcinoma in situ (DCIS). Methods A total of 53 patients with DCIS confirmed by surgery and pathology in Dezhou Second People’s Hospital from September 2018 to June 2021 were analyzed retrospectively. The patients were divided into HER-2 positive group (29 cases) and HER-2 negative group (24 cases). MRI features were compared between the two groups. Results There were significant differences in the internal enhancement characteristics, microvascular sign, and time-intensity curve type between the two groups (P < 0.05). There were no significant differences in lesion morphology, non-mass-like enhancement pattern, and apparent diffusion coefficient value (P > 0.05). The HER-2 positive group showed clumped enhancement (65.5%), type Ⅱ (48.1%) andtype Ⅲ (29.6%) time-intensity curves, and microvascular sign (89.7%). The HER-2 negative group showed clusteredring enhancement (50.0%), type Ⅱ (45.8%) and type I (54.2%) time-intensity curves, and microvascular sign (54.2%). A combination of clumped enhancement, microvascular sign, and type Ⅲ time-intensity curve showed 100% specificity and 100% positive predictive value for the diagnosis of HER-2 positive DCIS. Conclusion Clumped enhancement, microvascular sign, and type Ⅱ or Ⅲ time-intensity curve on MRI can largely reflect the expression of HER-2 in DCIS. The three can be used in combination to improve the diagnostic efficiency of HER-2 positive DCIS.

Effect of intercostal nerve block on postoperative analgesia and outcome of fast track surgery after thoracoscopic surgery: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective     To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery. Methods     China National Repository, Wanfang Database, VIP, China Biomedical Literature Database, Web of Science, Clinicaltrials.gov, Cochrane Library, EMbase and PubMed were searched from establishment of each database to 10 Febraray, 2022. Relevant randomized controlled trials (RCTs) of intercostal nerve block in thoracoscopic surgery were collected, and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. Results     A total of 21 RCTs and one semi-randomized study were identified, including 1 542 patients. Performance bias was the main bias risk. Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery. The visual analogue scale (VAS) score at 12 h after surgery (MD=–1.45, 95%CI –1.88 to –1.02, P<0.000 01), VAS score at 24 h after surgery (MD=–1.28, 95%CI –1.67 to –0.89, P<0.000 01), and VAS score at 48 h after surgery  significantly decreased (MD=–0.90, 95%CI –1.22 to –0.58, P<0.000 01). In exercise or cough state, VAS score at 24 h after surgery (MD=–2.40, 95%CI –2.66 to –2.14, P<0.000 01) and at 48 h after surgery decreased significantly (MD=–1.89, 95%CI –2.09 to –1.69, P<0.000 01). In the intercostal nerve block group, the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced (SMD=–0.78, 95%CI –1.29 to –0.27, P=0.003). In addition to the analgesic pump, the amount of additional opioids significantly reduced (SMD=–2.05, 95%CI –3.65 to –0.45, P=0.01). Postoperative patient-controlled intravenous analgesia was reduced (SMD=–3.23, 95%CI –6.44 to –0.01, P=0.05). Patient satisfaction was significantly improved (RR=1.31, 95%CI 1.17 to 1.46, P<0.01). Chest tube indwelling time was significantly shortened (SMD=–0.64, 95%CI –0.84 to –0.45, P<0.001). The incidence of analgesia-related adverse reactions was significantly reduced (RR=0.43, 95%CI 0.33 to 0.56, P<0.000 01). Postoperative complications were significantly reduced (RR=0.28, 95%CI 0.18 to 0.44, P<0.000 01). Two studies showed that the length of hospital stay was significantly shortened in the intercostal nerve block group, which was statistically different (P≤0.05), and there was no statistical difference in one report. Conclusion     The relief of acute postoperative pain and pain in the movement state is more prominent after intercostal nerve block. Intercostal nerve block is relatively safe and conforms to the concept of enhanced recovery after surgery, which can be extensively utilized in clinical practice.

Protective effect and mechanism of cx3cr1 antibody intravitreal injection in microcirculation of retinal ischemia-reperfusion injury in mice / 中华实验眼科杂志

Objective:To investigate the protective effect of C-X3-C motif chemokine receptor 1 (cx3cr1) antibody, a microglia activation inhibitor, on microcirculation during retinal ischemia reperfusion (RIR) and its possible mechanism.Methods:One hundred and fifty healthy adult C57BL/6 mice were randomized into blank control group, model group and cx3cr1 injection group by random number table method, with 50 mice in each group.The RIR model was established by anterior chamber infusion to elevate intraocular pressure in this study.Mice in the blank control group were intravitreally injected with 2 μl of sterile water.In the cx3cr1 injection group, the RIR model was established at 4 hours after the intravitreal injection (2 μl) of 0.2 μg/μl cx3cr1 antibody.Immunofluorescence staining of frozen eyeball sections was performed to assess the microglia activation by observing the Iba-1 positive expression in different retinal layers three days following the model establishment.Retinal preparation vascular staining was carried out to observe the changes in the density of deep and shallow retinal blood vessels and the number of activated microglia to evaluate the changes in retinal microcirculation.FITC-dextran contrast method was used to determine the retinal vascular leakage area.Real-time fluorescent quantitative polymerase chain reaction (qPCR) method was employed to detect the mRNA expression changes of hypoxia-related factors and inflammatory factors in the mice retina.The study protocol was approved by an Ethics Committee of Kunming Medical University (No.20180106). The use and care of the animals complied with the Regulations of the Administration of Affair Concerning Experimental Animals.Results:The immunofluorescence staining result of eyeball frozen section showed that in the blank control group, Iba-1 positive microglial cells were sparsely distributed in the retinal ganglion cell layer and inner plexiform layer, presenting branched state.In the model group, Iba-1 positive microglial cells were increased and moved outward to the outer retinal plexiform layer and outer nuclear layer obviously, showing globular or amoeba-like.The number of globular or amoeba-like Iba-1 positive cells was significantly reduced in the cx3cr1 injection group in comparison with the model group ( P<0.05). The number of activated microglial cells in different retinal layers of the model group was significantly larger than that of the cx3cr1 injection group and the blank control group (both at P<0.05). Compared with the model group, the number of activated microglial cells around the retinal blood vessels was reduced significantly in the cx3cr1 injection group.The double fluorescence result of retinal vascular staining and activated microglial cells showed that the density of deep blood vessels in the blank control group and cx3cr1 injection group was significantly higher than that of the model group, and the number of microglial cells around superficial and deep retinal vessels was significantly larger in the model group than that of the cx3cr1 injection group (all at P<0.05). The relative vascular leakage rate of the blank control group, model group and cx3cr1 injection group were (100.0±4.7)%, (162.1±10.6)% and (130.5±9.5)%, respectively, and the overall difference was statistically significant ( F=128.66, P<0.01). The relative vascular leakage rate in the cx3cr1 injection group was significantly lower than that in the model group ( P<0.05). The qPCR result showed that the relative expression levels of vascular endothelial growth factor-A (VEGF-A), hypoxia inducible factor-1a (HIF-1α), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) mRNA were significantly reduced in the retina of the cx3cr1 injection group in comparison with the model group (all at P<0.05). Conclusions:Intravitreal injection of cx3cr1 can protect the vascular integrity of the retinal microcirculation system in RIR mice.

Nosocomial infection prevention and control of hospitals within a medical alliance: status and development strategies / 中华医院管理杂志

Objective:To investigate the current management of nosocomial infection at medical institutions of all levels in Changzhou, so as to provide basis for standardizing nosocomial infections control of hospitals within a medical alliance.Methods:An electronic questionnaire was customized for online survey of 91 hospitals affiliated to eight regional medical alliances in Changzhou city in March 2019. The survey covered such aspects as general conditions of the hospital, profile of nosocomial infection control administrators and other staffing, supervision of hospital nosocomial infection programs, and training needs, as well as outstanding problems and suggestions.Frequency number and percentage represent enumeration data, and χ2 test was used to analyze the in-group differences of medical institutions of three levels. Results:Tertiary public hospitals were superior to the secondary and primary hospitals in organizational structure, professional staffing and target monitoring, with the differences of statistical significance( P<0.05). The most urgent training needs of medical institutions at all levels were knowledge in determination and reporting of infectious diseases/nosocomial infection/infection outbreaks; top imperatives and recommendations were development of operation rules for primary medical institutions and standardization of workflows. Conclusions:Staff of primary medical institutions need capacity building in nosocomial infection control; primary hospitals are equipped with incomplete nosocomial infection control information platform; key departments in general lack homogenous management. Tertiary hospitals are encouraged to play leadership in medical alliances in achieving standardized, homogenous and informationized nosocomial infection control within the medical alliances.

The clinical and imaging characteristics of acute idiopathic maculopathy / 中华眼底病杂志

Objective:To observe the clinical and imaging characteristics of acute idiopathic macular degeneration (AIM).Methods:A retrospective clinical study. From March 2016 to January 2018, 5 eyes (5 AIM patients) in The Second People's Hospital of Yunnan Province were included in the study. Among them, there were 4 males (4 eyes) and 1 female (1 eye); all patients were monocular with the average age of 34.2 years. The course of illness from onset of symptoms to treatment was 4-22 days. All affected eyes were examined by BCVA, fundus color photography, OCT, FAF, and FFA. Among 5 eyes, 1 eye with optic disc vasculitis was given oral glucocorticoid treatment; 4 eyes were not interfered after the diagnosis.Results:The follow-up time was 6 months. During follow-up, BCVA, fundus color photography, and OCT examination were performed. The results were all a sudden decrease in monocular vision, accompanied by visual distortion or central dark spots. At the first visit, the BCVA was 0.1, 0.2, 0.2, 0.05, and 0.5; at the last follow-up, the BCVA of the affected eye was 0.8, 0.6, 0.5, 0.5, and 1.0, respectively. Fundus color photography showed that at the first diagnosis, all the affected eyes showed irregular round yellow-white lesions in the macular area, including 1 eye with small patches of hemorrhage and 1 eye with pseudopyous changes in the macular area. Two to three weeks after the initial diagnosis, the yellowish-white lesions and bleeding in the macular area were basically absorbed. The center of the lesion showed weak pseudopod-like fluorescence, and the surrounding area was surrounded by strong fluorescence in FAF examination. The irregular and strong fluorescence in the early macular area and accumulation of late fluorescein in FFA examination. One eye was receivied glucocorticoid therapy. The upper layer of the retinal nerve in the macular area was detached, and the inferior space showed focal strong reflective material in 3 eyes in OCT examination. At the first diagnosis, the retinal neuroepithelial layer was detached, the top of the RPE layer was irregular with strong reflective material, and the structure of the ellipsoid zone and the chimera zone was unclear; as the course of the disease prolonged, the outer retinal structure recovered.Conclusions:AIM is characterized by inflammatory exudative changes in the outer layer of the retina in the macular area; FFA is characterized by strong subretinal disc-like fluorescence or multifocal weak fluorescence in the macular area; OCT mainly manifests as neuroepithelial detachment and changes in the outer retina and RPE, The structure can be restored by itself.

Optical coherence tomography angiography features of angioid streaks / 中华眼底病杂志

Objective:To analyze the OCT angiography (OCTA) features of eyes affected with angioid streaks.Methods:Retrospective analysis of 26 patients (52 eyes) diagnosed as angioid streaks by multimodal imaging in Ophthalmology Department of Yunnan Second People’s Hospital from May 2017 to February 2019 were included in this study. There were 18 males and 8 females, with the mean age of 50.8±6.9 years. All the patients were binocular. There were 34 eyes in 20 patients with CNV. Among them, 13 eyes had a course of disease within 1 month, 16 eyes had a course of disease over 1 month, and 5 eyes were treated with anti-VEGF drugs. All patients were examined by ultra-wide-angle fundus photography, infrared fundus imaging (IR), spectral-domain OCT, FAF and FFA. At the same time, the Heidelberg OCTA instrument was used for OCTA examination. The central wavelength was 840 nm, the acquisition speed was 85,000 times/s, and the width was 45 nm. A 3 mm × 3 mm scan was obtained. Each cube consisted of two 304 B scans of repeated volumes, and motion correction was performed using two orthogonally captured image volume registration. The results of fundus color photography, IR, FAF, FFA, OCT and OCTA were compared and analyzed to summarize the image features of AS and its secondary CNV in OCTA.dus color photography, IR, FAF, FFA, OCT and OCTA were compared and analyzed to summarize the image features of AS and its secondary CNV in OCTA.Results:Among 52 eyes, 40 eyes showed choroidal capillary shadows in OCTA, and no obvious abnormal OCTA images in 12 eyes. Ten eyes OCTA showed a vascular network beseide the optic disc, FFA showed fluorescent staining instead of fluorescein leakage. Among the 52 eyes, 34 eyes had secondary macular CNV, and 34 eyes had different forms of CNV. Different forms had a certain correlation with the length of medical history and treatment history. Among them, 13 eyes with short course of disease (less than 1 month) and untreated patients had smaller flower-ring morphology, 16 eyes with longer course (more than 1 month) but no treatment had larger fan-shaped segments, and 5 eyes with anti-VEGF therapy were trimmed after the dendritic shape.Conclusions:AS streaks appeared no blood flow signal area in OCTA, and repairing vascular network beside the optic disc can be observed in some AS patients. The CNV performance with different disease course and treatment experience is different.

Investigation on abnormalities of adult thyroid structure of Heilongjiang Province / 中华地方病学杂志

Objective:To investigate the adult thyroid structural abnormalities and epidemiological characteristics in different regions of Heilongjiang Province.Methods:From December 2017 to November 2018, 30 survey sites were selected in 13 prefecture-level cities under the jurisdiction of Heilongjiang Province by the population probability sampling (PPS) method, and 120 local residents aged 20 to 70 who lived for more than 1 year in the local area were selected from each survey site for thyroid ultrasound examination. The occurrence of thyroid structural abnormalities in different genders, ages and regions were analyzed.Results:A total of 3 870 residents were investigated, including 1 248 males and 2 622 females, aged (48.3 ± 12.6) years; 2 075 urban residents and 1 795 rural residents. A total of 2 144 cases of thyroid structural abnormalities were detected, with a total detection rate of 55.40% (2 144/3 870); among them, 1 476 cases of thyroid focal nodular lesions, 359 cases of diffuse lesions, and 309 cases of diffuse lesions with focal nodules, the detection rates were 38.14%, 9.28%, and 7.98%, respectively. The detection rate of thyroid structural abnormalities was 61.25% (1 606/2 622) in women and 43.11% (538/1 248) in men, the difference was statistically significant (χ 2=111.899, P < 0.01). There was significant difference in the total detection rate of thyroid structural abnormalities among different age groups (χ 2=185.959, P < 0.01); and with the increase of age, the total detection rate of thyroid structural abnormalities showed an upward trend (χ 2trend=173.576, P < 0.01). There was significant difference in the total detection rate of thyroid structural abnormalities in adults among different prefecture-level cities (χ 2=108.487, P < 0.01); but there was no significant difference in the total detection rate of thyroid structural abnormalities between urban and rural (χ 2=0.103, P > 0.05). Conclusions:The main thyroid structural abnormalities in Heilongjiang Province are focal nodular lesions. The detection rate of women is higher than that of men, and the older the age, the higher the detection rate. There are differences in the detection rate of thyroid structural abnormalities in adults of different prefecture-level cities, but there is no significant difference between urban and rural.

Optical coherence tomography angiography imaging features of choroidal neovascularization with different activity in age-related macular degeneration / 中华眼底病杂志

Objective To observe the OCT angiography imaging features of choroidal neovascularization (CNV) with different activity in age-related macular degeneration (AMD).Methods A retrospective case analysis.Forty-two eyes of 33 patients (21 males and 12 females,aged 65.3 ± 8.61 years) who were diagnosed with AMD by multi-mode fundus imaging examination at the Ophthalmology Department of Yunnan Second People's Hospital during January 2017 and October 2018 were enrolled in this study.All patients underwent BCVA,slit-lamp biomieroscopy,indirect ophthalmoscopy,fundus colorized photography,FAF,FFA and OCT examinations.The patients were divided into active CNV (27 eyes of 19 patients) and inactive CNV (15 eyes of 14 patients) by comprehensive analysis of fundus imaging characteristics and treatment process.The imaging features of OCTA in the two groups were compared.The number of eyes of each active or inactive indicator in the active CNV group and the inactive CNV group was calculated,and the composition ratio of each group of the indicators was subjected to the x2 test.Results Among the 27 eyes of active CNV,22 eyes (81.5％) of OCTA showed abundant small capillary branching structure,while 13 eyes (13.3％) of 15 eyes of inactive CNV showed more coarse blood vessel.Among the 27 eyes of active CNV,26 eyes (96.3％) of OCTA showed that the marginal vascular end points of CNV lesions were "arcaded" or "ring",while 12 eyes (80.0％) of 15 eyes of inactive CNV showed the presence of isolated branches of peripheral vessels.Among the 27 eyes with active CNV lesions,there were no large feeder vessels inside the lesions,and 8 (53.3％) of the 15 inactive CNV lesions showed feeder vessels in the center of the lesion.Among the 27 eyes with active lesions,23 eyes (85.2％) of OCTA showed a low-reflection "halo" around the CNV lesion,and no low-reflection "halo" structure was observed in the 5 eyes of the inactive CNV lesion.The statistical results showed that there were abundant small blood vessel branches (x2=22.759,P=0.000),annular anastomosis around the lesion (x2=31.704,P=0.000),lowreflection halo (x2=32.327,P=0.000),and large nourishing blood vessels (x2=26.063,P=0.000),dilated choroidal vessels (x2=32.912,P=0.000).All the above indicators were statistically different between the two groups.Conclusion The abundant small vessel branches in OCTA,the surrounding anastomosis in a ring structure and the low reflex halo around the lesion are markers of active CNV,while the large feeding vessels and dilated choroidal vessels are indicators of inactive CNV.

Diffuse Intrinsic Pontine Gliomas Exhibit Cell Biological and Molecular Signatures of Fetal Hindbrain-Derived Neural Progenitor Cells / 神经科学通报·英文版

Diffuse intrinsic pontine glioma (DIPG) is the main cause of brain tumor-related death among children. Until now, there is still a lack of effective therapy with prolonged overall survival for this disease. A typical strategy for preclinical cancer research is to find out the molecular differences between tumor tissue and para-tumor normal tissue, in order to identify potential therapeutic targets. Unfortunately, it is impossible to obtain normal tissue for DIPG because of the vital functions of the pons. Here we report the human fetal hindbrain-derived neural progenitor cells (pontine progenitor cells, PPCs) as normal control cells for DIPG. The PPCs not only harbored similar cell biological and molecular signatures as DIPG glioma stem cells, but also had the potential to be immortalized by the DIPG-specific mutation H3K27M in vitro. These findings provide researchers with a candidate normal control and a potential medicine carrier for preclinical research on DIPG.

The association of Bcl-2 gene polymorphism with the esophageal cancer and gastric cardia adenocarcinoma in Hebei Province / 中华预防医学杂志

Objective@#To investigate the association between the promoter region-938 polymorphism of B-cell lymphoma/leukemia-2 (Bcl-2) gene and the esophageal cancer (EC) and gastric cardia adenocarcinoma (GCA) in Hebei Province. @*Methods@#From 2007 to 2010, 145 esophageal cancer patients and 169 cardiaccancer patientsfrom the outpatient department of the Fourth Hospital of Hebei Medical Universitywereselected in a case group, and 195 non-tumor patients were selected in a control group during the same period. A questionnaire survey was used to collect information of research subjects. Pathological tissues were collected to extract genomic DNA and detect the genotype of bcl-2 gene -938. A multivariate logistic regression model was used to analyze the association between the bcl-2 gene locus 938 CC genotype and the EC and GCA. The interaction between age, gender, smoking, drinking, upper gastrointestinal family history and the bcl-2 gene locus 938 CC genotype was analyzed by likelihood ratio test. @*Results@#The age of the esophageal and cardiac cancer groups was (56.3±8.3) and (57.1±8.4) years old, and that of the control group was (54.7±7.1) years old. The proportion of the bcl-2 gene locus 938 CC genotype in the esophageal group [48.3% (70/145)] and the cardiac cancer group [48.5% (82/169)] was higher than that in the control group [33.8% (66/195)] (both P values<0.05).Compared with the AA genotype, the risk of esophageal cancer and cardiac cancerin people with the CC genotype was 2.386 (1.20-4.76) and 2.564 (1.27-5.18) respectively. In the population with CC genotype, compared with the positive family history, drinking, and male, the negative family history, non-drinking, and female had a higher risk of esophageal cancer; compared with the non-smoking, negative family history, non-drinking and male, the smoking, positive family history, drinking, and female had a higher risk of cardiac cancer (all the P interaction values were <0.05). @*Conclusion@#People with bcl-2 gene locus 938 CC genotype in Hebei Provincewere more likely to suffer from the esophageal and gastric cardia adenocarcinoma.

Status of non-steroidal anti-inflammatory drugs use in areas with a high incidence of upper gastrointestinal cancer in China: a multi-center cross-sectional survey / 中华预防医学杂志

Objective@#To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. @*Methods@#This study was based on the National Key Research and Development Program of "National Precision Medicine Cohort of Esophageal Cancer" and "Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ2 test and Cochran-Armitage trend analysis method. @*Results@#Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). @*Conclusion@#The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.

The learning curve of laparoscopic pancreaticoduodenectomy based on the initial 112 patients / 中华肝胆外科杂志

Objective@#To study the learning curve of laparoscopic pacreaticoduodenectomy (LPD) with a view to find an appropriate way to develop LPD step by step.@*Methods@#112 consecutive patients who completely underwent LPD in a single surgery center at the First People’s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum (CUSUM) and the risk-adjusted CUSUM (RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way.@*Results@#The learning curve could be divided into three phases: Phase 1, the initial period (the initial 45 patients); Phase 2, the enhancement period (the subsequent 31 patients); Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448.4±75.0), (381.3±74.3), and (336.2±52.1) min, respectively (P<0.05). The intraoperative blood losses were (373.3±250.1), (332.3±211.6), and (265.3±253.2) ml, respectively (P<0.05). The times to oral intake were 6.0(5.0, 8.0), 5.0(3.0, 6.0), and 3.0(3.0, 5.0) days, respectively (P<0.05). The number of lymph nodes harvested were (10.0±7.0), (8.8±4.3), and (13.3±6.2), respectively (P<0.05). All these showed significant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pancreatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study.@*Conclusions@#The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier.

The learning curve of laparoscopic pancreaticoduodenectomy based on the initial 112 patients / 中华肝胆外科杂志

Objective To study the learning curve of laparoscopic pacreaticoduodenectomy ( LPD) with a view to find an appropriate way to develop LPD step by step. Methods 112 consecutive patients who completely underwent LPD in a single surgery center at the First People ' s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum ( CUSUM) and the risk-adjusted CUSUM ( RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way. Results The learning curve could be divided into three phases:Phase 1, the initial period (the initial 45 patients);Phase 2, the enhancement period (the subsequent 31 patients);Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448. 4 ± 75. 0), (381. 3 ± 74. 3), and (336. 2 ± 52. 1) min, respectively (P<0. 05). The intraoperative blood losses were (373. 3 ± 250. 1), (332. 3 ± 211. 6), and (265. 3 ± 253. 2) ml, respectively (P<0. 05). The times to oral intake were 6. 0(5. 0,8. 0), 5. 0 (3. 0,6. 0), and 3. 0(3. 0,5. 0) days, respectively (P<0. 05). The number of lymph nodes harvested were (10. 0 ± 7. 0), (8. 8 ± 4. 3), and (13. 3 ± 6. 2), respectively (P<0. 05). All these showed signifi-cant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pan-creatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study. Conclusions The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier.

Multimodal imaging characteristics of choroidal metastasis / 中华眼底病杂志

Objective To observe the multimodal imaging characteristics ofchoroidal metastasis.Methods A retrospective clinical observation study.From January 2016 to November 2018,28 patients with choroidal metastasis diagnosed in Department of Ophthalmology in the Second People's Hospital of Yunnan Province were included in the study.There were 12 males and 16 females,with the mean age of 50.8±6.9 years.There were 18 unilateral patients and 10 bilateral patients.The lesion of choroidal metastasis was regressed after systemic antitumor therapy in 3 patients (4 eyes).All patients underwent ultra-wide-angle fundus photography,infrared fundus imaging,fundus autofluorescence,FFA,frequency-domain OCT,and B-ultrasound examinations.Results In the ultra-wide-angle fundus photography,metastatic tumors were located in the posterior or middle part of the retina,of which 26 were isolated lesions and 12 were multifocal.A yellow-white bulge lesion with (11 eyes) or without pigmentation (27 eyes).There were 12 eyes with exudative retinal detachment.Infrared photography of the fundus showed that the tumor area showed varying degrees of mottled brightness change,and the infrared photograph of the exudative retinal detachment area was relatively low.Fundus autofluorescence showed that 14 eyes had plaque-like strong autofluorescence in the tumor,13 eyes had a mottled autofluorescence formed by strong and weak fluorescence in the tumor;3 eyes of old lesions showed "leopard-like" autofluorescence.Among the 38 eyes in the fluorescein angiography,32 eyes of the early lesions showed low fluorescence,and the venous phase showed a needle-like high fluorescence point,and the post-leakage fluorescence gradually increased.Two eyes with old lesions showed a "leopard-like" change.In 38 eyes,OCT showed wavy ridges of the choroid and pigment epithelium,and a large number of fine-grained or cluster-like high-reflector accumulations were observed between the retinal neuroepithelial layer and the pigment epithelial layer.B-ultrasound showed substantial lesions in the posterior pole and uniform internal echo.There were 23 eyes with flat shape,12 eyes with flat hemisphere,and 3 eyes with irregular shape.Conclusions Color photography of the fundus showed the size,location,pigmentation and peripheral retinopathy of the metastatic lesions.Infrared photography showed different reflex signals in the tumor,exudation,and atrophy.The autofluorescence of the fundus showed the damage of pigment epithelium in the lesion.In the fluorescein angiography,the fresh tumor showed fluorescence leakage,while the atrophic tumor showed transmitted fluorescenc.OCT reflected the height of the lesion and the change of pigment epithelium.

Overview of Keshan disease surveillance and trend analysis in China / 中华地方病学杂志

Objective To analyze the situation of Keshan disease in China and provide a scientific basis for adjustment of the control strategies.Methods Relying on the Keshan disease surveillance in 2014 and the "Twelfth Five-Year Plan" Final Assessment Project in 2015 and 2016,in each surveillance site of the 12 provinces including Hebei,Shanxi,Inner Mongolia,Liaoning,Jilin,Heilongjiang,Shandong,Chongqing,Sichuan,Yunnan,Shaanxi,and Gansu,the residents were investigated by face-to-face questionnaire interviews,physical measurements and electrocardiography.Echocardiographic examination and chest X-ray examination were conducted for those patients with suspected Keshan disease.Results In 2014,the data of a total of 171 838 individuals were included in the analyses.A total of 749 cases of Keshan disease were detected in all the survey sites of 12 provinces.The detection rate was 43.6/10 000.Among them,160 cases were chronic,the detection rate was 9.3/10 000;the potential type was 589 cases,the detection rate was 34.3/10 000.In 2015 and 2016,the data of a total of 396 977 individuals were included in the analyses.A total of 2 127 cases of Keshan disease were detected in 12 provinces.The detection rate was 53.6/10 000.Among them,377 cases (9.5/10 000) were chronic,and the potential type was 1 750 cases (44.1/ 10 000).Conclusion There are still natural chronic Keshan disease cases in the endemic area,therefore the prevention and treatment tasks cannot be ignored.

Structural changes of retinal microcirculation in mouse model of ischemia-reperfusion injury / 中华实验眼科杂志

Objective To study the structural changes of retinal microcirculation in mouse model of ischemia reperfusion injury(RIR).Methods Ninty healthy male C57BL/6 mice were devided into normal group and RIR group by using random number table method,45 mice for each group.The left eyes in both groups were used in this study.The mouse model of RIR was established by perfusion of saline solution in the anterior chamber.The damage of microcirculation was analyzed from different levels of vascular structure and function by retinal blood vessel staining,FITC angiography,histopathological examination,and ultrostructure of retinal vessels was observed with transmission electron microscope.The experimental animals and experimental conditions complied with the Regulations on the Management of Laboratory Animals of Kunming Medical University.Results There was no significant difference in retinal arterioles diameter in the RIR group compared to the normal control group (P=0.350).The small veins were obviously dilated in comparison with normal control group (P =0.03) and were in hyper-congestive state.The artery/vein value was 0.76±0.03 in the RIR group,and that in the normal control group was 0.97±0.01,with significant difference between them (P=0.000).The main changes were capillary occlusion,non-perfusion zone formation and other structural changes,accompaning by blood-retinal barrier damage;the destruction of capillary endothelial cells and pericytes and basement membrane thickening were seen under the transmission electron microscope.Conclusions RIR mainly results in capillary damage,including capillary barrier damage,capillary occlusion and non-perfusion area formation.