Direct medical expenses and its influencing factors of patients with pulmonary tuberculosis in Wuhan / 中华疾病控制杂志

Objective To analyze the direct medical expenses and its influencing factors of patients with pulmonary tuberculosis (TB) from 2011 to 2018 in Wuhan, so as to provide references for improving the TB derating policy. Methods A total of 1 258 953 medical records were studied, the direct medical expenses and its influencing factors were analyzed by rank sum test, multivariable linear regression and generalized estimated equation. Results The average direct medical expense of TB outpatients was 147.51 yuan each time, while that of TB inpatients was 8 849.57 yuan; and the average direct medical expenses of each year was 9 607.01 yuan per person. The average reimbursement ratio for TB outpatients was 6.36%, and 67.56% for inpatients. Analysis on the influencing factors showed that the direct medical expenses were related with patients’ age, sex, year, health care insurance, medical institution and whether they had surgery and Chinese traditional medicine or not (all P<0.01). Conclusions The current direct medical expenses of TB inpatients are relatively affordable, but low-income patients and patients still have heavy financial burden. TB treatment cycle is long and the outpatient medical service B also safficient. Improved derating policy is in need.

A Transcriptomic Analysis of Physiological Significance of Hypoxia-inducible Factor-1α in Myogenesis and Carbohydrate Metabolism of Genioglossus in Mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Chronic intermittent hypoxia is the most remarkable feature of obstructive sleep apnea/hypopnea syndrome and it can induce the change of hypoxia-inducible factor-1α (HIF-1α) expression and contractile properties in the genioglossus. To clarify the role of HIF-1α in contractile properties of the genioglossus, this study generated and compared high-throughput RNA-sequencing data from genioglossus between HIF-1α conditional knockout (KO) mice and littermate wild-type (WT) mice.</p><p><b>METHODS</b>KO mice were generated with cre-loxP strategy. Gene expression profile analysis was performed using gene enrichment analysis. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses of differently expressed messenger RNAs were performed to identify the related pathways and biological functions. Six differentially expressed genes (DEGs) were validated by qualitative reverse transcription polymerase chain reaction.</p><p><b>RESULTS</b>A total of 142 (77 upregulated and 65 downregulated) transcripts were found to exhibit statistically significant difference between the HIF-1α-KO and WT mice. GO and KEGG analyses indicated that DEGs included genes involved in "skeletal muscle cell differentiation," "muscle organ development," "glucose metabolic process," "glycogen biosynthetic and metabolic process," etc.</p><p><b>CONCLUSION</b>This study might provide evidence that HIF-1α affects the expression of multiple genes involved in the myogenesis, muscle development, and carbohydrate metabolism through transcriptome analysis in conditional HIF-1α-KO mice.</p>

Review of Pharmacoeconomic Studies of Adalimumab in the Rheumatoid Arthritis Management / 中国药学杂志

OBJECTIVE: To summarize the pharmacoeconomic studies of adalimumab in the management of Rheumatoid Arthritis, discuss the cost-effectiveness and adverse reaction of combination use of adalimumab and DMARDs, and compare the economic values of TNF-α inhibitors. METHODS: Search Pubmed and MedLINE for pharmacoeconomics studies of adalimumab using in the treatment of RA. All the results are systematically summarized and assessed. RESULTS: Seven studies on pharmacoeconomics assessment of adalimumab were selected and discussed. Compared with conventional DMARDs, adalimumab costs more but obviously extends the QALYs of RA patients. Adalimumab also provides significant improvement in symptom severity with less adverse reaction. The efficacy of combination use of adalimumab and MTX is better than adalimumab alone. In terms of cost and effectiveness, adalimumab has advantages over infliximab and is equal to etanercept. CONCLUSION: Though adalimumab costs higher for the RA patients, it can significantly improve the quality of life when in the combination treatment with DMARDs, as well as reduce adverse reactions. Compared with other TNF-α inhibitors, adalimumab shows superiority both in efficacy and cost. Thus, adalimumab is recommended for RA patients that don't respond to DMARDs.

Palliative local radiotherapy in the treatment of tumor-stage cutaneous T-cell lymphoma/mycosis fungoides / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To determine the efficacy of palliative radiotherapy in treating tumor-stage cutaneous T-cell lymphoma/mycosis fungoides (MF).</p><p><b>METHODS</b>From January 2008 to January 2013, a total of 11 patients with tumor-stage MF were treated with local radiation therapy in Peking Union Medical College Hospital. The median age of these patients was 53.36 ± 14.45 years. Female-male ratio was 1:1.2. The average course of disease was 10.82 ± 3.37 years. All the patients were treated with local electronic beam irradiation with a total median dosage of 48.55 ± 9.51 (40-74) Gy in an average of 24.55 ± 5.57 (20-40) fractions, 5 fractions per week.</p><p><b>RESULTS</b>The median follow-up time was 55.27 ± 29.3 (13-103) months. No severe acute or chronic side effects of irradiation were observed. Complete clinical response (CR) rate of the radiated sites was 54.5% (6/11), partial response (PR) rate was 36.4% (4/11), and the overall response rate (CR+PR) was 90.9%. One patient showed no response.</p><p><b>CONCLUSION</b>Local radiotherapy with psolaren plus ultraviolet A and/or interferon maintaining treatment is an effective palliative therapy in the treatment of tumor-stage MF patients.</p>

Three-dimensional finite element analysis on the effect of posterior cross-bite of individual teeth on temporomandibular joint / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To analyze the stress distribution of temporomandibular joint (TMJ) in posterior cross-bite of individual teeth and in normal occlusion during the intercuspal occlusion (ICO).</p><p><b>METHODS</b>On the basis of the geometric TMJ model of normal occlusion, the TMJ finite element model of posterior cross-bite of individual teeth was reconstructed. The occlusal force and boundary conditions were applied on the model. Using three-dimensional finite element method (FEM), the stress distribution of TMJ in posterior cross-bite of individual teeth was analyzed by simulating the ICO load.</p><p><b>RESULTS</b>No significant differences were found in stress distribution in various TMJ structures between posterior cross-bite of individual teeth and normal occlusion. However, the stress level was higher and the stress distribution was more inhomogeneous in posterior cross-bite of individual teeth than in normal occlusion. In the cross-bite malocclusion of individual posterior teeth, the maximum of von Mises stress was 0.792 MPa, the maximum principal stress was 0.598 MPa and the minimum principal stress was -0.744 MPa. But in normal occlusion, the maximum of von Mises stress was 0.592 MPa, the maximum principal stress was 0.395 MPa and the minimum principal stress was -0.554 MPa.</p><p><b>CONCLUSIONS</b>When the ICO load was applied, the stress distribution of TMJ was more inhomogeneous and the stress level was higher in posterior cross-bite of individual teeth than in normal occlusion.</p>

A new classification of nevus of Ota / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The nevus of Ota, is a common benign pigmentary dermatosis, mainly involve innervation area of first and second branch of trigeminal nerve. The classification of nevus of Ota was proposed by Tanino, based on 26 cases of nevus of Ota from 1937 to 1940. Studies about its classification are rarely seen in last 70 years, while it is still practical today.</p><p><b>METHODS</b>Based on the clinical photographs, 1079 consecutive patients with nevus of Ota were verified and reclassified according to the innervation areas of the trigeminal nerve branches.</p><p><b>RESULTS</b>In these 1079 cases, 866 patients were in line with Tanino's classification (80.26%), and 213 patients were not (19.74%). We put forward a new clinical classification (Peking Union Medical College Hospital classification, PUMCH classification) of nevus of Ota based on the innervation area of the trigeminal nerve branches, composed of 5 types and 14 subtypes. The 5 types were as follows: Type I - pigmentation maculeses involving the innervation area of one of the three trigeminal nerve branches, of which there were 424 cases (39.3%), comprising 6 subtypes; Type II - pigmentation macules involving the innervation area of two branches of the three trigeminal nerve branches, of which there were 221 cases (20.48%), comprising 4 subtypes; Type III - pigmentation macules involving the innervation area of all three trigeminal nerve branches, of which there were 361 cases (33.45%), comprising 2 subtypes; Type IV - bilateral type, in which the pigmentation macules involves the bilateral cheek, of which there were 63 cases (5.84%), comprising 2 subtypes; and Type V - complications occurred in the patient, of which there were 10 cases (0.93%).</p><p><b>CONCLUSION</b>The new classification of nevus of Ota is based on the innervation area of the trigeminal nerve branches, and it covers all types of Tanino's classifications; on that basis, some new types and subtypes are brought in and cover almost every clinical condition.</p>

Magnetic resonance imaging assessment of the lateral pterygoid muscle in Class III malocclusion subjects / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To analyze the relationship between Class III malocclusion and pathological changes in temporomandibular joint (TMJ) structures using magnetic resenonce imaging (MRI).</p><p><b>METHODS</b>Twenty-four Class III malocclusion adult patients and 10 normal control cases were included in the study. The characteristics of lateral pertygoid muscle (LPM) in the sample group and the control group were assessed.</p><p><b>RESULTS</b>More pathological changes of LPM were found in Class III malocclusion adult patients (36 TMJ). The changes included hypertrophy, atrophy and contracture. And there was no relation between the pathological changes of LPM and the symptom of temporomandibular disorders (TMD).</p><p><b>CONCLUSIONS</b>The frequency of pathological changes of LPM was greater in patients with Class III malocclusion than in the control group.</p>

Lupus erythematosus panniculitis: clinical and histopathological analysis of 22 cases / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the clinical and histopathological manifestations, therapy and prognosis of lupus erythematosus panniculitis (LEP).</p><p><b>METHOD</b>We retrospectively reviewed the clinical data and histopathological features of 22 cases of LEP diagnosed at Peking Union Medical College Hospital from January 2008 to February 2010.</p><p><b>RESULTS</b>The lesions appeared as atrophy, erythema, subcutaneous nodules, infiltrated erythema, and ulceration over the scalp, face, upper limbs, and buttock. Histopathological features were lobular panniculitis in the subcutaneous fat; sometimes septal panniculitis could be seen. Hydroxychloroquine sulfate and corticosteroid were effective treatment; most patients responded well to the treatment, while a few experienced recurrence when the treatment tapped or discontinued.</p><p><b>CONCLUSIONS</b>LEP is a rare cutaneous variant of lupus erythematosus. The diagnosis of LEP is mainly based on clinical findings and pathological features. Hydroxychloroquine and low- and middle-dose corticosteroid are effective for the treatment of LEP.</p>

Nipple adenoma in an adolescent.

Nipple adenoma is a rare tumor of the breast which usually appears in middle age women and rarely in adolescents. We describe a 15-year-old female diagnosed with nipple adenoma. Nipple adenoma is a benign neoplasia which should be recognized to avoid confusion with breast cancer.

Effects of estrogen on the expression of phosphofructokinase muscle-specific isoform in genioglossus of chronic intermittent hypoxia rats / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effects of estrogen on the expression of phosphofructokinase muscle-specific isoform (PFK-M) in genioglossus of chronic intermittent hypoxia (CIH) rats.</p><p><b>METHODS</b>Fifty male SD rats were randomly divided into five groups: the normal control group (NC), the chronic intermittent hypoxia group (CIH), and three doses of estrogen plus hypoxia groups (LE, ME, HE). Rats in the latter four groups were used to build CIH models (8 h/d, 5 weeks). In the mean time, rats in the latter three groups were injected with three dose levels of estrogen (0.1, 0.2, 0.3 mg/kg), and rats in NC and CIH groups were injected with sterile olive oil as control. At the end of the treatment, the genioglossus was isolated and quickly removed. The mRNA levels of PFK-M were determined by real-time RT-PCR and the protein content of PFK-M was detected by Western blotting analysis.</p><p><b>RESULTS</b>PFK-M mRNA and protein in CIH group (2.144 ± 0.260, 0.875 ± 0.025) were both higher than those (1.000 ± 0.259, 0.413 ± 0.013) in NC group (P < 0.05). The expression of PFK-M mRNA in LE, ME and HE groups were 1.424 ± 0.193, 1.395 ± 0.251 and 1.310 ± 0.094, respectively. The expression of protein in LE, ME and HE groups were 0.638 ± 0.015, 0.576 ± 0.017 and 0.505 ± 0.021, respectively. Compared with CIH group, the expression of PFK-M mRNA and protein in LE, ME and HE groups were all inhibited significantly (P < 0.05). Among the three treatment groups, decreased protein content of PFK-M was observed only in HE group when compared with LE group (P < 0.05), but no significant difference was detected in the expression of PFK-M mRNA.</p><p><b>CONCLUSIONS</b>CIH exposure could increase the expression of PFK-M mRNA and protein in rat genioglossus, while estrogen administration could dose dependently inhibit the overexpression.</p>

Expressions of CD1a and CD83 of Langerhans cells in the local lesions of epidermodysplasia verruciformis patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the expressions of CD1a and CD83 of Langerhans cells (LC) in the lesions of epidermodysplasia verruciformis (EV) patients.</p><p><b>METHODS</b>We used immunohistochemical method to detect the expressions of CD1a and CD83 in the lesions of 10 patients with EV lesions and in the skins of 10 normal subjects.</p><p><b>RESULTS</b>No CD83 + LCs was detected in all EV patients and normal controls, but CD1a + LC was found in all cases. The quantity of CD1a + LCs in the lesions of EV patients was significantly lower than that in the normal skin (P < 0.01); furthermore, the distribution of LCs in EV lesions was uneven.</p><p><b>CONCLUSION</b>The functions of LCs may be inhibited in EV patients.</p>

Efficacy and safety of 308 nm excimer laser for vitiligo / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the efficacy and safety of the 308 nm excimer laser for the treatment of vitiligo.</p><p><b>METHODS</b>We treated 170 patients with stable vitiligo by using the 308 nm excimer laser. The lesions of vitiligo were treated one to two times per week for 10-30 times. Efficacies were evaluated every 7 days and 3 days after the treatments were completed. Patients were followed up for two months.</p><p><b>RESULTS</b>The rates of "remarkably improved" and "cured" were 67.97% and 32.03% in faces, 54.55% and 27.27% in necks, 63.26% and 26.53% in trunks, 38.84% and 15.70% in limbs, and 0 and 0 in hands and feet. The areas of faces had a better response than those of necks, trunks, or limbs (P < 0.01), and the areas of trunks or limbs had better response than that of hands and feet (P < 0.01).</p><p><b>CONCLUSION</b>The 308 nm excimer laser is safe and effective in treating stable vitiligo and the efficacy varies in different lesion sites.</p>

Treatment of pemphigus with rituximab / 中国医学科学院学报

Pemphigus is a life-threatening autoimmune blistering disease affecting the skin and mucosa. Patients with severe pemphigus require long-term treatment with corticosteroids and other immunosuppressive drugs, which can lead to serious adverse events. Rituximab, a monoclonal antibody directed against the CD20 antigen of B lymphocytes, has been demonstrated to be effective in recalcitrant and life-threatening pemphigus.

Research advances in Köebner phenomenon / 中国医学科学院学报

Köebner phenomenon, also known as isomorphic response, originally refers to the erythemas and scales resulted from skin traumas. The similar phenomenon later was observed in many other diseases. This article reviews classification, etiopathogenisis, pathogenesis, clinical manifestation, and application of KP.

An efficacy comparison between mini-screw implant and transpalatal arch on dentofacial morphology in extraction cases / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To compare the effects between mini-screw implant and transpalatal arch (TPA) on dentofacial morphology in extraction cases.</p><p><b>METHODS</b>Forty-two cases were divided into two groups. One group (n = 19) had been treated with mini-screw implants and the other group (n = 23) treated with TPA as anchorage control. Sliding technique was used to close extraction space in the two groups. Cephalometric analysis was performed before and after the treatment. The data were analyzed by using independent-samples t test.</p><p><b>RESULTS</b>In the mini-screw implant group, the maxillary incisors were retracted (7.05 +/- 1.89) mm and intruded (1.71 +/- 2.33) mm, The maxillary first molars were distalized (0.45 +/- 3.32) mm and intruded (1.74 +/- 2.66) mm. While in the TPA group, the upper incisors were retracted (4.59 +/- 1.78) mm and extruded (0.93 +/- 1.77) mm. The maxillary first molars were moved (1.65 +/- 1.87) mm mesially and extruded (0.52 +/- 1.59) mm. All the relevant results between the two groups were significantly different (P < 0.05).</p><p><b>CONCLUSIONS</b>As orthodontic anchorage, mini-screw implants were different from TPA. Mini-screw implant could not only retract the upper incisors but also slightly intrude upper incisors and upper molars.</p>

Three-dimensional reconstruction of temporomandibular joint with CT and MRI medical image fusion technology / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the method of the three-dimensional reconstruction of temporomandibular joint (TMJ) on the basis of CT and MRI medical image fusion technology, which establishes good foundation for a series biomechanical studies and clinical analysis.</p><p><b>METHODS</b>The geometric data for the TMJ model were obtained from a young and healthy male volunteer. Twelve spherical markers were located on the regions of both TMJ and mental tubercles, where CT and MRI scans can reach. The three-dimensional geometric of the hard and soft tissues of TMJ was reconstructed by CT and MRI scans data, which was based on the registration procedures of spherical markers located on the face of the volunteer.</p><p><b>RESULTS</b>The three-dimensional geometric model of TMJ was obtained, including hibateral articular disc, mandible, glenoid fossa and inferior teeth, and it had better geometric similarity. The results showed that the methods of three-dimensional reconstruction of TMJ with CT and MRI medical image fusion technology can be operated easily and promptly. The constructed model had good morphology.</p><p><b>CONCLUSION</b>It is feasible to construct the three-dimensional model of TMJ on the basis of the registration procedures of spherical markers and CT-MRI medical image fusion technology. It has the advantage of simulating both hard and soft tissues reasonably. The model well expresses the shape of the TMJ.</p>

Effects of estrogen on activity and subunits expression of cytochrome C oxidase in mitochondria from genioglossus of rats subjected to chronic intermittent hypoxia / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effects of estrogen on the activity and subunits expression of cytochrome c oxidase (COX) in mitochondria from genioglossus of chronic intermittent hypoxia (CIH) rat.</p><p><b>METHODS</b>Forty-eight male Sprague-Dawley (SD) rats were randomly divided into three groups: the normal control group (NC), the chronic intermittent hypoxia group (CIH) and estrogen plus hypoxia group (E + CIH). Rats in the latter two groups were used to build CIH models (8 h/d, 5 w). In the mean time, rats in NC group and CIH group were injected with sterile olive oil (0.2 ml each time, twice a week), and rats in E + CIH group were injected with estrogen (0.2 mg/kg, twice a week), respectively. At the end of the treatment, the genioglossus of the rat was removed and the mitochondria were isolated by centrifugation program. COX activity was measured with a spectrophotometer. The protein content of COX subunit I and IV was detected by Western blotting analysis, and mRNA expression levels of COXI and COXIV were determined by real-time polymerase chain action.</p><p><b>RESULTS</b>COX activity in CIH group [(0.143 +/- 0.029) microkat/mg] was lower significantly than that in NC group [(0.273 +/- 0.058) microkat/mg, P < 0.01]; In E + CIH group [(0.203 +/- 0.073) microkat/mg], COX activity was higher than that in CIH group (P < 0.05), but still lower than that in NC group (P < 0.05). Compared with NC group (47.325 +/- 7.502), decreased COXI expression was observed in CIH group (10.789 +/- 8.144, P < 0.01) and E + CIH group (25.593 +/- 11.108, P < 0.01). While in the mean time, the protein content of COXI in E + CIH group was higher than that in CIH group (P < 0.05). There was no significant difference in protein content of COXIV among the three groups (P > 0.05). COXI and COXIV mRNA levels had no significant change among the three groups (P > 0.05).</p><p><b>CONCLUSIONS</b>CIH exposure could decrease mitochondrial COX protein expression and activity in the genioglossus of the rat, while estrogen administration might be beneficial to the recovery of those.</p>

Effects of ovariectomy on electromyography and phenotype in rat genioglossus / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effects of ovariectomy on genioglossus (GG) electromyography and myofibre phenotype in female rats and to explore the proposal mechanisms underling ovarian hormone protecting to the patency of upper airway (UA).</p><p><b>METHODS</b>30 female Sprague-Dawley rats were randomly assigned to three groups: normal group (NORMAL), sham group (SHAM) and ovariectomized group (OVX). Six weeks later, electromyography activity of the genioglossus (EMGgg) was obtained from inserted bipolar electrodes. The integrated EMG (iEMG) was analyed. Genioglossus was stained with ATPase staining. The fibre phenotype composition and cross sectional area (CSA) of type II A and II B/ II X fibres were measured.</p><p><b>RESULTS</b>EMGgg had no significant variety between the normal and sham group (P >0.05). Compared to normal group, iEMG was significantly decreased in OVX group (P < 0.05). GG myofibres were composed of II phenotye, including II A (40.27 +/- 1.01)% and II B/ II X (59.73 +/- 1.01)%, fibres composition and CSA of types II A and II B/II X had no significant variety between the normal and sham group. Compared to normal group, fibres composition had no significant variety in OVX group (P > 0.05), but the CSA of type II A was significantly decreased (P < 0.05).</p><p><b>CONCLUSION</b>The decreased EMGgg of ovariectomized rat maybe relates to the decrease of CSA in type II A fibre. Ovarian hormone may protect the patency of upper airway through affecting muscle function of UA dilator.</p>

Effects of sex hormones on genioglossal muscle activities, estrogen and androgen receptor expression in adult rat / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To explore gene expression of estrogen receptor (ERalpha, ERbeta) and androgen receptor (AR) in genioglossal muscle (GG) of adult male rats, and to investigate the effects of sex hormones on GG activities, ERalpha, ERbeta and AR expression.</p><p><b>METHODS</b>GG samples were collected from 10 healthy adult male rats. Total RNA were extracted and subjected to fluorescent quantitative reverse transcription-polymerase chain reaction (FQ RT-PCR) for quantitative measurement of ERalpha, ERbeta and AR mRNAs. The other 24 male rats were randomly divided into 3 groups: control group, estrogen group (intramuscular injection of estrogen 0.1 mg/kg, twice a week) and androgen group (intramuscular injection of androgen 2.5 mg/kg, twice a week). The electromyographic activities (EMG) and contract tension of GG were investigated after 4-week treatment. The expression of ERalpha, ERbeta and AR was assessed by Western blot.</p><p><b>RESULTS</b>The mRNA expression ratios of AR/GAPDH, ERalpha/GAPDH, ERbeta/GAPDH and ERalpha/ERbeta were (295.80 +/- 127.20), (2042.00 +/- 921.57), (65.96 +/- 29.57) and (36.83 +/- 19.66), respectively. The mRNA level of ERalpha was significantly higher than that of ERbeta (P < 0.01). Compared with the control group, the EMG of GG was intensified in the estrogen group (P < 0.01). GG contractility did not change significantly (P > 0.05), and ERalpha expression in GG was up-regulated by estrogen (P < 0.05); while in the androgen group, the EMG of GG was weakened (P < 0.05). P(t) and P(0) were slightly increased (P > 0.05) and the decline rate of P(0) was markedly quickened (P < 0.05). AR and ERbeta expressions were down-regulated by androgen (P < 0.05).</p><p><b>CONCLUSIONS</b>Both AR and ER were expressed in GG of adult male rats, and ERalpha was expressed more abundantly than ERbeta. Estrogen could greatly improve activities of GG and stimulate the expression of ERalpha. Whereas, androgen could restrain activities of GG, impair its fatigue resistance capacity and inhibit the expression of AR and ERbeta.</p>