Effects of hydrogen gas on NOD-like receptor protein 3 inflammasomes in the cerebral cortex of rats with traumatic brain injury / 中华危重病急救医学

OBJECTIVE@#To investigate the effect of hydrogen gas on NOD-like receptor protein 3 (NLRP3) inflammasomes in the cerebral cortex of rats with traumatic brain injury (TBI).@*METHODS@#120 adult male Sprague-Dawley (SD) rates were randomly divided into 5 groups (n = 24): sham operation group (S group), TBI model group (T group), TBI+NLRP3 inhibitor MCC950 group (T+M group), TBI+hydrogen gas group (T+H group), TBI+hydrogen gas+MCC950 group (T+H+M group). TBI model was established by controlled cortical impact. NLRP3 inhibitor MCC950 (10 mg/kg) was intraperitoneally injected for 14 consecutive days before TBI operation in T+M and T+H+M groups. 2% hydrogen inhalation was given for 1 hour at 1 hour and 3 hours after TBI operation in T+H and T+H+M groups. At 6 hours after TBI operation, the pericontusional cortex tissues were obtained, the content of Evans blue (EB) was detected to evaluate the permeability of the blood-brain barrier. Water content in brain tissue was detected. The cell apoptosis was detected by TdT-mediated dUTP nick end labeling (TUNEL) and the neuronal apoptosis index was calculated. The expressions of Bcl-2, Bax, NLRP3, apoptosis-associated speck-like protein containing CARD (ASC) and caspase-1 p20 were detected by Western blotting. The levels of interleukins (IL-1β, IL-18) were detected by enzyme-linked immunosorbent assay (ELISA).@*RESULTS@#Compared with the S group, the content of EB in cerebral cortex, water content in brain tissue, apoptosis index and the expressions of Bax, NLRP3, ASC, caspase-1 p20 in T group were significantly increased, the expression of Bcl-2 was down-regulated, the levels of IL-1β and IL-18 were increased [the content of EB (μg/g): 87.57±6.89 vs. 10.54±1.15, water content in brain tissues: (83.79±2.74)% vs. (74.50±1.19)%, apoptotic index: (62.66±5.33)% vs. (4.61±0.96)%, Bax/β-actin: 4.20±0.44 vs. 1, NLRP3/β-actin: 3.55±0.31 vs. 1, ASC/β-actin: 3.10±0.26 vs. 1, caspase-1 p20/β-actin: 3.28±0.24 vs. 1, Bcl-2/β-actin: 0.23±0.03 vs. 1, IL-1β (ng/g): 221.58±19.15 vs. 27.15±3.27, IL-18 (ng/g): 87.26±7.17 vs. 12.10±1.85, all P < 0.05]. Compared with the T group, the T+M, T+H and T+H+M groups had significant reductions in the content of EB and water content in brain tissue, apoptotic index of the cerebral cortex, the expressions of Bax, NLRP3, and caspase-1 p20 in the brain tissue and the levels of IL-1β and IL-18, significant increases in the expression of Bcl-2. However, there was no significant difference in ASC expression. Compared with the T+H group, the content of EB in the cerebral cortex, water content in brain tissue, and apoptotic index, and the expressions of Bax, NLRP3 and caspase-1 p20 were further down-regulated in T+H+M group, the expression of Bcl-2 was further up-regulated, the levels of IL-1β and IL-18 were further decreased [the content of EB (μg/g): 40.49±3.15 vs. 51.96±4.69, water content in brain tissue: (76.58±1.04)% vs. (78.76±1.16)%, apoptotic index: (32.22±3.44)% vs. (38.54±3.89)%, Bax/β-actin: 1.92±0.16 vs. 2.56±0.21, NLRP3/β-actin: 1.94±0.14 vs. 2.37±0.24, caspase-1 p20/β-actin: 1.97±0.17 vs. 2.31±0.19, Bcl-2/β-actin: 0.82±0.07 vs. 0.52±0.04, IL-1β (ng/g): 86.23±7.09 vs. 110.44±10.48, IL-18 (ng/g): 40.18±3.22 vs. 46.23±4.02, all P < 0.05], but there were no statistical significance in all the indicators between T+M group and T+H group.@*CONCLUSIONS@#The mechanism by which hydrogen gas alleviates TBI may be related to inhibiting NLRP3 inflammasomes in the cerebral cortex of rats.

Sociality and infectious disease prevention and control of sexual and gender minorities in China / 上海预防医学

Sexual and gender minorities have social behavioral characteristics such as aggregation， mobility， exclusivity， and concealment， which may be associated with the transmission of infectious diseases in this group. This paper aims to explore the relationship between the sociality of this group and its transmission and prevention and control of infectious diseases， emphasize the importance of paying attention to the transmission of sexually transmitted diseases and respiratory diseases in sexual and gender minorities. This paper puts forward some thoughts for infectious disease prevention and control of this group in the future.

Current status and influencing factors of chronic disease self-management behavior of middle-aged and elderly deaf people aged 50 years and over in Shanghai / 上海预防医学

ObjectiveTo investigate the current status and influencing factors of chronic disease self-management behavior of middle-aged and elderly deaf people aged 50 years and over in Shanghai， and to provide reference for improving their chronic disease self-management behavior. MethodsDuring September 2021 to February 2022， 271 middle-aged and elderly deaf people aged 50 years and over in Shanghai were investigated face-to-face by general questionnaire， chronic disease self-management study measures， self-efficacy scale， social capital questionnaire， hospital anxiety and depression scale， health disturbance scale. ResultsThe mean score of chronic disease self-management behavior was 32.107±7.527. Gender， frequency of searching health knowledge by mobile phone， whether to eat fruit， self-efficacy and social capital were influencing factors of chronic disease self-management behaviors， which could explain 37.04% of the variance. ConclusionThe chronic disease self-management behavior of the middle-aged and elderly deaf people aged 50 years and over is low and needs to be improved. We can promote the middle-aged and elderly deaf people to form the good self-management behavior by improving their self-efficacy， improving their level of social capital and forming good living habits.

The resistance dynamics of Blattella germanica in Yangpu District of Shanghai from 2014 to 2020 / 上海预防医学

Objective To investigate the resistance dynamics of Blattella germanica to commonly used insecticides in Yangpu District of Shanghai during 2014‒2020， and to provide the basis for the rational use of insecticides against cockroaches. Methods Blattella germanica was captured in two farmer’s markets in 2014， 2017 and 2020. The residual film method recommended by WHO was used to test resistance of Blattella germanica to the insecticides. Results In 2014， 2017 and 2020， the resistance ratio of Blattella germanica in Yangpu District was 6.96， 4.39， 7.26 to beta-cypermethrin， 10.41， 6.71， 5.24 to permethrin， and 2.28， 3.16， 1.01 to propoxur. Conclusion The resistance of Blattella germanica to permethrin and propoxur decreases， and the resistance to beta-cypermethrin keeps at low level. Comprehensive management and rotation of insecticides should be implemented to delay the increase of resistance.

Effects of hydrogen-rich saline on acute lung injury in rats with traumatic brain injury and role of Nrf2/HO-1 signaling pathway / 中华麻醉学杂志

Objective:To evaluate the effects of hydrogen-rich saline on acute lung injury in rats with traumatic brain injury (TBI) and the role of nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase-1 (HO-1) signaling pathway.Methods:Forty-eight adult male Sprague-Dawley rats, weighing 220-250 g, were divided into 4 groups ( n=12 each) using a random number table method: sham operation group (S group), TBI group (T group), TBI plus hydrogen-rich saline group (T+ H group), and TBI plus hydrogen-rich saline plus brusatol group (T+ H+ B group). TBI model was developed by controlled cortical impact.Nrf2 inhibitor brusatol 0.4 mg/kg was intraperitoneally injected every other day starting from 10 days before development of TBI model in T+ H+ B group.Hydrogen-rich fluid 10 ml/kg was intraperitoneally injected at 1 and 6 h after development of TBI model in T+ H group and T+ H+ B group.At 24 h after development of TBI model, the bronchoalveolar lavage fluid (BALF) was collected to detect the concentration of protein, blood samples from the right common carotid artery were collected and lung tissues were obtained for determination of the levels of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10) and high-mobility group box 1 protein (HMGB1) in serum and lung tissues (by enzyme-linked immunosorbent assay), wet to dry lung weight ratio (W/D ratio), expression of nuclear-Nrf2, total-Nrf2 and HO-1 in lung tissues (by Western blot), and expression of HO-1 mRNA (by real-time polymerase chain reaction) and for microscopic examination of histopathologic changes (by haematoxylin and eosin staining) which were scored. Results:Compared with S group, the concentrations of protein in BALF, W/D ratio of lung tissues and lung injury score were significantly increased, the levels of TNF-α, HMGB1 and IL-10 in serum and lung tissues were increased, and the expression of nuclear Nrf2, total Nrf2 and HO-1 protein and mRNA in lung tissues was up-regulated in T and T+ H groups ( P<0.05). Compared with T group, the concentrations of protein in BALF, W/D ratio of lung tissues and lung injury score were significantly decreased, the levels of TNF-α and HMGB1 in serum and lung tissues were decreased, the level of IL-10 in serum and lung tissues was increased, and the expression of nuclear Nrf2, total Nrf2 and HO-1 protein and mRNA in lung tissues was up-regulated in T+ H group ( P<0.05), and no significant changes were found in the parameters mentioned above in T+ H+ B group ( P>0.05). Compared with T+ H group, the concentrations of protein in BALF, W/D ratio of lung tissues and lung injury score were significantly increased, the levels of TNF-α and HMGB1 in serum and lung tissues were increased, the level of IL-10 in serum and lung tissues was decreased, and the expression of nuclear Nrf2, total Nrf2 and HO-1 protein and mRNA in lung tissues was down-regulated in T+ H+ B group ( P<0.05). Conclusions:Hydrogen-rich solution can alleviate acute lung injury in rats with traumatic brain injury, and the mechanism is related to activation of Nrf2/HO-1 signaling pathway and inhibition of the inflammatory responses.

SETD7 mediates the vascular invasion in articular cartilage and chondrocytes apoptosis in osteoarthriis.

The pathological characteristics of osteoarthritis are cartilage matrix degradation, chondrocytes apoptosis, and low-grade inflammation of the joint. Recent studies have shown that blood vessels grow from the subchondral bone to the articular cartilage. However, the relationship among inflammation, angiogenesis, and chondrocyte apoptosis is still unclear. We found that chondrocytes could secrete chemokines and VEGF to promote the migration of vascular endothelial cells in response to TNF-α stimulation. The invasion of blood vessels leads to increased oxygen tension in the local environment, which increased the expression of SETD7 in chondrocytes by activating the JAK-STAT5 pathway. The bond of phosphorylated STAT5 and the specific locus in the promoter of SETD7 directly increased the transcription of SETD7. On the one hand, SETD7-regulated chemokine expression by forming a positive loop; on the other hand, SETD7-mediated chondrocyte apoptosis by inhibiting the nuclear localization of HIF-1α. In this study, we discovered a novel function of chondrocytes as mediators of inflammation and angiogenesis. Our study demonstrates that SETD7 is a potential molecular target to prevent OA development and progression.

Nutritional support strategies for patients with intra-abdominal infection / 中华消化外科杂志

Intra-abdominal infection is often secondary to the injury or lesion of various organs in the abdominal cavity, or after abdominal surgery. With the continuous development of its concept and technology, nutritional support has gradually become one of the important means for the treatment of patients with intra-abdominal infection. The comprehensive treatment of abdo-minal infection includes controlling of infection source, reasonable antimicrobial therapy, supporting of organ function, nutritional treatment, regulating of immune function, etc. Combined with their clinical experiences, the authors review the relevant researches at home and abroad and analyze and expound the nutritional support strategies for patients with intra-abdominal infection.

A Large-Scale Clinical Validation Study Using nCapp Cloud Plus Terminal by Frontline Doctors for the Rapid Diagnosis of COVID-19 and COVID-19 pneumonia in China

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has become a global pandemic acute infectious disease, especially with the features of possible asymptomatic carriers and high contagiousness. It causes acute respiratory distress syndrome and results in a high mortality rate if pneumonia is involved. Currently, it is difficult to quickly identify asymptomatic cases or COVID-19 patients with pneumonia due to limited access to reverse transcription-polymerase chain reaction (RT-PCR) nucleic acid tests and CT scans, which facilitates the spread of the disease at the community level, and contributes to the overwhelming of medical resources in intensive care units. GoalThis study aimed to develop a scientific and rigorous clinical diagnostic tool for the rapid prediction of COVID-19 cases based on a COVID-19 clinical case database in China, and to assist global frontline doctors to efficiently and precisely diagnose asymptomatic COVID-19 patients and cases who had a false-negative RT-PCR test result. MethodsWith online consent, and the approval of the ethics committee of Zhongshan Hospital Fudan Unversity (approval number B2020-032R) to ensure that patient privacy is protected, clinical information has been uploaded in real-time through the New Coronavirus Intelligent Auto-diagnostic Assistant Application of cloud plus terminal (nCapp) by doctors from different cities (Wuhan, Shanghai, Harbin, Dalian, Wuxi, Qingdao, Rizhao, and Bengbu) during the COVID-19 outbreak in China. By quality control and data anonymization on the platform, a total of 3,249 cases from COVID-19 high-risk groups were collected. These patients had SARS-CoV-2 RT-PCR test results and chest CT scans, both of which were used as the gold standard for the diagnosis of COVID-19 and COVID-19 pneumonia. In particular, the dataset included 137 indeterminate cases who initially did not have RT-PCR tests and subsequently had positive RT-PCR results, 62 suspected cases who initially had false-negative RT-PCR test results and subsequently had positive RT-PCR results, and 122 asymptomatic cases who had positive RT-PCR test results, amongst whom 31 cases were diagnosed. We also integrated the function of a survey in nCapp to collect user feedback from frontline doctors. FindingsWe applied the statistical method of a multi-factor regression model to the training dataset (1,624 cases) and developed a prediction model for COVID-19 with 9 clinical indicators that are fast and accessible: Residing or visiting history in epidemic regions, Exposure history to COVID-19 patient, Dry cough, Fatigue, Breathlessness, No body temperature decrease after antibiotic treatment, Fingertip blood oxygen saturation [≤]93%, Lymphopenia, and C-reactive protein (CRP) increased. The area under the receiver operating characteristic (ROC) curve (AUC) for the model was 0.88 (95% CI: 0.86, 0.89) in the training dataset and 0.84 (95% CI: 0.82, 0.86) in the validation dataset (1,625 cases). To ensure the sensitivity of the model, we used a cutoff value of 0.09. The sensitivity and specificity of the model were 98.0% (95% CI: 96.9%, 99.1%) and 17.3% (95% CI: 15.0%, 19.6%), respectively, in the training dataset, and 96.5% (95% CI: 95.1%, 98.0%) and 18.8% (95% CI: 16.4%, 21.2%), respectively, in the validation dataset. In the subset of the 137 indeterminate cases who initially did not have RT-PCR tests and subsequently had positive RT-PCR results, the model predicted 132 cases, accounting for 96.4% (95% CI: 91.7%, 98.8%) of the cases. In the subset of the 62 suspected cases who initially had false-negative RT-PCR test results and subsequently had positive RT-PCR results, the model predicted 59 cases, accounting for 95.2% (95% CI: 86.5%, 99.0%) of the cases. Considering the specificity of the model, we used a cutoff value of 0.32. The sensitivity and specificity of the model were 83.5% (95% CI: 80.5%, 86.4%) and 83.2% (95% CI: 80.9%, 85.5%), respectively, in the training dataset, and 79.6% (95% CI: 76.4%, 82.8%) and 81.3% (95% CI: 78.9%, 83.7%), respectively, in the validation dataset, which is very close to the published AI model. The results of the online survey Questionnaire Star showed that 90.9% of nCapp users in WeChat mini programs were satisfied or very satisfied with the tool. The WeChat mini program received a significantly higher satisfaction rate than other platforms, especially for availability and sharing convenience of the App and fast speed of log-in and data entry. DiscussionWith the assistance of nCapp, a mobile-based diagnostic tool developed from a large database that we collected from COVID-19 high-risk groups in China, frontline doctors can rapidly identify asymptomatic patients and avoid misdiagnoses of cases with false-negative RT-PCR results. These patients require timely isolation or close medical supervision. By applying the model, medical resources can be allocated more reasonably, and missed diagnoses can be reduced. In addition, further education and interaction among medical professionals can improve the diagnostic efficiency for COVID-19, thus avoiding the transmission of the disease from asymptomatic patients at the community level.

Validity and reliability of the Perceived Stress Scale among cancer survivors / 中国心理卫生杂志

Objective:To test the validity and reliability of the Perceived Stress Scale-14 items (PSS-14) applied in cancer survivors.Methods:Totally 652 cancer survivors (patients who had finished active treatments and were in convalescence) were selected and a field questionnaire survey was conducted among them.Exploratory factor analysis and confirmatory factor analysis were performed to test the construct validity of PSS-14.Correlation between the two dimensions (discriminant validity) and correlation between stress and quality of life were analyzed to further test its validity.The intemal consistency reliability,split-half reliability,retest reliability and sensitivity analysis were adopted to test the reliability of PSS-14.Results:Two common factors were extracted in the exploratory factor analysis.The cumulative percentage of variance explained was 60.8％.The index of confirmatory factor analysis were:TLI =0.92,CFI =0.93,SRMR =0.07,RMSEA =0.08.The correlation coefficient between the two dimensions of PSS-14 was-0.16 (P ＜0.001).The correlation coefficients between the score of PSS-14 and each dimension of EORTC QLQ-C30 were 0.24-0.55 (P ＜ 0.001).The Cronbach α coefficients of the whole scale and the two dimensions named "perceived coping ability" and "perceived distress" were 0.78,0.91 and 0.88 respectively.After the scale was split into two parts,the Cronbach α coefficients of each part were 0.66 and 0.60.The Spearman-Brown coefficient was 0.79.The Guttman split-half coefficient was 0.79.After one item was removed from the scale each time,the Cronbach a coefficients of the remaining items varied from 0.75 to 0.77.The retest reliability of the whole scale and the two dimensions were 0.89,0.86 and 0.85 respectively.Conclusion:PSS-14 shows favorable validity and reliability,suggesting the utility to assess stress of cancer survivors as a self-administered inventory.

Advances on research of nutrition literacy and nutrition literacy assessment tools / 中华预防医学杂志

Health literacy has become a vibrant area of research, and the nutrition literacy and health literacy were closely related as well as a growing number of inquiries have focused on direct measures of nutrition literacy. In this paper, we summarized some features such as the structure, the content, the reliability, the validity and the application of the general nutrition literacy assessment tools and the health literacy assessment tools related to nutrition literacy, furthermore the evaluation contents were listed as the understanding capacity, numeracy capacity, household food measurement, food group, and basic nutrition knowledge. In addition, the briefly the nutrition information readability assessment tools were also summarized. The research results of nutritional literacy and its assessment tools would provide reference for the development of nutrition literacy assessment tools and evaluation work in China.

Influencing factors and interventions of sexual health in female breast and gynecologic cancer survivors / 中华全科医师杂志

Female breast and gynecologic cancer affect sexual health of the survivors due to the disease itself and related treatment,resulting in sexual dysfunction and the reduced quality of life.The sexual dysfunction of patients is often overlooked,and the related interventions are less frequently mentioned.This article reviews the classification,influencing factors and interventions of sexual dysfunction in survivors of female breast cancer and gynecologic cancer,and also proposes the effective interventional strategies.

The coping styles and its relationship with quality of life among 1 968 female breast cancer patients in Shanghai in 2014 / 中华预防医学杂志

Objective@#To study the coping styles and its relationship with quality of life among part of the female breast cancer patients in Shanghai in 2014.@*Methods@#In August of 2014, 1-3 block groups affiliated to Shanghai Cancer Rehabilitation Club were selected from each of the 17 districts of Shanghai by convenient sampling method. Respondents were recruited from these block groups via putting up posters in the community or top three hospitals nearby. The inclusion criteria were as follows: female, aged from 18 to 80 years old; the initial diagnosis or primary tumor was breast cancer, and active treatments including surgery, radiotherapy and chemotherapy were finished; capable of basic reading and comprehension, and there was no communication disorder; daily activities were not limited, and with no mental disorder or dysgnosia. Totally 2 205 respondents were included. Questionnaire survey was conducted to collect the information of demographic characteristics, disease characteristics, result of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and result of the Ways of Coping Inventory-Cancer Version (WOC-CA). 1 968 valid questionnaires were withdrawn. The results of respondent characteristics and WOC-CA were under descriptive analysis, and the differences of coping styles among groups of different demographic characteristics were compared using t test. In addition, we analyzed the correlation between respondents' coping styles and quality of life using partial correlation analysis.@*Results@#The average age of the 1 968 respondents was (58.7±7.4) years old, and BMI was (24.4±5.4) kg/m2. The score of positive coping styles was 2.04±0.41, and the score of negative coping styles was 1.79±0.33. The scores of Physical Functioning (PF), Role Functioning (RF), Cognitive Functioning (CF), Emotional Functioning (EF), Social Functioning (SF), and Global Health (GH) were 83.40±12.18, 90.80±15.92, 80.72±16.29, 84.67±15.19, 80.99±20.91, 65.27±21.21, respectively. Positive coping styles correlated with PF, EF, and GH positively, and the correlation coefficients were separately 0.581 (P=0.046), 0.593 (P=0.045), 0.770 (P<0.001). Negative coping styles correlated with RF, CF, EF, and SF negatively, and the correlation coefficients were separately-0.672 (P=0.021),-0.815 (P=0.005),-0.121 (P<0.001),-0.123 (P<0.001).@*Conclusion@#Part of the female breast cancer patients in Shanghai in 2014 mainly adopted positive coping styles, and in general the positive coping styles correlated with quality of life positively and negative coping styles correlated with quality of life negatively.

Value of the ultrasonography in guiding closed reduction and intramedullary nail fixation for femoral shaft fractures / 中华超声影像学杂志

Objective To study the ultrasonic image characteristics of the displaced femoral shaft fracture before and post reduction,and to explore its clinical significance in guiding the closed reduction and intramedullary nail fixation.Methods Ultrasonic imaging features of 21 cases of femoral shaft fractures were observed.Closed reduction was completed under ultrasound monitoring,and the characteristics of ultrasonic imaging after fracture reduction were observed.Fixation of femoral fractures with intramedullary nails after closed reduction was completed.Results On the long axis of the femoral shaft,the ultrasonograms displayed a gap between two hyperechoic bands(step sign).On the cross section,two short arc hyperechoic bands can be seen(double short arc sign).After the completion of closed reduction,the step sign and double short arc sign disappeared.In the front and rear of the femoral shaft,there were 2 echo lines connected to a straight line.The line in front of the femoral parallel to the rear(continuous parallel sign).Continuous parallel sign indicated that reduction was achieved,the intramedullary nail guide pin could be successfully inserted into the femoral shaft,to complete the intramedullary nail fixation.Conclusions Ultrasound imaging shows step sign and double short arc syndrome when femoral shaft fracture displaced.Post fracture reduction,the imaging shows continuous parallel sign.Observing ultrasonic image characteristics of the displaced femoral shaft fracture is effective in assisting closed reduction and intramedullary nailing for femoral shaft fractures.

Treatment of open comminuted intra-articular calcaneal fractures with extensible gimbaled bilateral triangle external fixators / 中华创伤骨科杂志

Objective To report the clinical outcomes of the patients with open comminuted intra-articular calcaneal fracture who were treated with our self-designed bilateral triangle external fixators which are extensible and gimbaled.Methods Between January 2011 and June 2014,12 patients with open comminuted intra-articular calcaneal fracture were treated and followed up.They were 8 men and 4 women,aged from 23 to 58 years (average,36.8 years).According to the Sanders classification,the fractures were type Ⅱ in 4 cases,type Ⅲ in 7,and type Ⅳ in one.According to the Gustilo classification,the soft tissue injury was type Ⅱ in 2 cases,type ⅢA in 7,and type Ⅲ B in 3.All the patients were treated with immediate debridement and preventive intravenous antibiotics.First stage wound closure or temporary coverage with vacuum sealed drainage was chosen according to the condition of soft tissue injury.Our self-designed bilateral triangle external fixators were applied together with cannulated screws or Kirschner wire in all the patients after Kirschner wire poking.Of them,7 received emergency treatment and 5 were treated 3 to 5 days after injury.After no wound infection was observed for sure,6 cases received selective open reduction and internal fixation via a lateral incision while 6 continued external fixation with Kirschner wire for 8 to 10 weeks (average,9.1 weeks).Results The 12 patients were followed up for 6 to 36 months (average,18.5 months).Their AOFAS scores averaged 84.6 points (range,from 74 to 94 points).One case required tissue transfer for wound coverage.Wound shallow infection developed in 3 cases.No deep infection or amputation happened.No wound infection or necrosis occurred in the 6 cases that had undergone open reduction and internal fixation at the second stage.Conclusion Application of our self-designed extensible gimbaled bilateral triangle external fixators in the treatment of open comminuted intra-articular calcaneal fractures may help effectively reduce the deep infection or incidence of osteomyelitis after operation as long as early debridement is thorough,internal fixation is timely applied,and indications for internal fixation are properly followed.

Effects of fatty acid binding protein-5 silencing on proliferation, apoptosis, invasion of human glioma cells and expressions of CD44+and CD133+ / 中国组织工程研究

BACKGROUND:It has been demonstrated that there are different expressions of fatty acid binding proteins (FABPs) in most malignant tumors such as breast cancer, prostate cancer, liver cancer, lung carcinoma and bladder carcinoma;therefore, FABPs are closely related to the occurrence, metastasis, invasion and drug resistance of malignant tumors. OBJECTIVE:To investigate the effects of fatty acid binding protein-5 (FABP-5) silencing on the proliferation, invasion and apoptosis of U251 cel s (human glioma cel s). METHODS:siRNA molecules targeting the mRNA of FABP-5 was designed and chenical y synthesized, which was transiently transfected into U251 cel s. U251 cel s were divided into three groups:Lv-shRNA-FABP-5 was added into FABP-5-shRNA group, LV-shRNA-NC added into negative control group, and blank control group underwent normal culture. mRNA and protein expressions of FABP-5 were detected by RT-PCR and western blot assay, respectively. The cel proliferation in vitro was determined by cel counting kit-8 assay, the cel cycle, apoptosis and expressions of CD44+and CD133+were detected by flow cytometry, and the apoptosis was observed using TUNEL staining. RESULTS AND COUNCLUSION:mRNA and protein expressions of FABP-5 in the FABP-5-shRNA group were significantly lower than those in the negative control and blank control groups. Compared with the negative control and blank control groups, the cel growth rate was significantly decreased, the cel cycle arrested in the G0/G1 phase, and the cel number in the S phase was decreased, and moreover, the proportion of CD44+/CD133+expression was significantly decreased in the FABP-5-shRNA group (P<0.05). Besides, compared with the negative control and blank control groups, the apoptosis rate was significantly increased, and the cel proliferation and invasiveness were significantly decreased in the FABP-5-shRNA group (P<0.05). In conclusion, it is possible that FABP-5 directly or indirectly regulates the cel cycle and apoptosis of glioma cel s, and its expression changes share a close relationship with the invasiveness of tumor cel s.

A Chinese multi-center study on the significance of monitoring imatinib plasma concentration in patients with gastrointestinal stromal tumor before and after administration / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the factors which may influence the imatinib plasma concentration in Chinese patients with gastrointestinal stromal tumor(GIST), and to illuminate the significance of monitoring imatinib plasma concentration in adjuvant therapy for patients with GIST.</p><p><b>METHODS</b>A cross-sectional study with 60 GIST patients who accepted the imatinib therapy after surgery was conducted. They were respectively administrated in 10 domestic hospitals from December 2014 to April 2016, including The First Affiliated Hospital of Nanjing Medical University(n=28), The Affiliated Hospital of Nantong University(n=9), The Affiliated Hospital of Xuzhou Medical College(n=6), Nanjing Drum Tower Hospital(n=5), The Second Affiliated Hospital of Nanjing Medical University (n=2), Jingling Hospital (n=2), The Second People's Hospital of Lianyungang(n=2), Shandong Provincial Hospital(n=2), Jiangsu Province Tumor Hospital(n=2), and The First Affiliated Hospital of Zhejiang University(n=2). Some specific time points for collecting blood sample before and after taking imatinib were determined, then liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was used for monitoring imatinib plasma concentration in patients with GIST. Linear regression analysis was used for the correlation analysis of imatinib plasma concentration with dosage, clinicopathologic feature and side effect.</p><p><b>RESULTS</b>Patients who could not tolerate 400 mg imatinib per day(n=3) received 300 mg per day. There was no significant difference in imatinib plasma concentration between patients with 300 mg and those with 400 mg imatinib(n=53)(P=0.527). However, the imatinib plasma concentration in patients with 600 mg imatinib per day (n=4) was significantly higher as compared to those with 400 mg(P=0.000). Linear regression analysis indicated a negative correlation between the imatinib plasma concentration in patients with 400mg imatinib per day for 90 days continuously and body surface area(R=0.074, P=0.035), but no significant correlations of with age, creatinine clearance and serum albumin concentration were observed (all P>0.05). The differences in imatinib plasma concentration were not statistically significant between patients of different gender and those taking proton-pump inhibitor (PPI) or not (both P>0.05). Difference in imatinib plasma concentration between patients with different surgery was significant (P=0.026). Compared to patients who underwent wedge resection, enterectomy and other surgeries, the imatinib plasma concentration of patients with subtotal gastrectomy or total gastrectomy decreased significantly (all P<0.05). After 90 days of taking imatinib continuously, linear regression analysis revealed a negative correlation between imatinib plasma concentration in patients with 400 mg imatinib per day and white blood cell count (R=0.103, P=0.013), and a positive correlation with serum alanine aminotransferase (ALT) concentration (R=0.076, P=0.033).</p><p><b>CONCLUSIONS</b>The imatinib plasma concentration in patients with larger body surface area, subtotal gastrectomy or total gastrectomy may be lower. For these patients, dosage of imatinib should be considered to increase in order to achieve effective plasma concentration. Excessive imatinib plasma concentration can result in some side effects, such as decrease of white blood cells and liver damage. Therefore, it is significant for receiving optimal clinical therapeutic efficacy to monitor imatinib plasma concentration, adjust imatinib dosage timely and keep imatinib plasma concentration in effective and safe range.</p>

A literacy-addressing training model to improve doctor-patient communication between community healthcare professional and patients with diabetes / 中华医学教育探索杂志

Diabetes patients in China is large in number, low level of health literacy, and their self management mainly relies on community doctor's health propaganda and education, as a result, it is very important to train community healthcare professionals to improve their communication skills with patients.Guided by the Social Cognitive Theory (SCT), the researchers developed a literacy-addressing training model specifically through: 1) low literacy healthcare education materials written in plain language, simple text, maximal white space, and behavior-oriented images or pictograms;2) a standardized health communication curriculum to promote simple communication with decreased jargon usage, teach teach back, and enhance shared goal-setting;3) use of standardized patients to enhance doctor-patient communication training;and 4) MOOC and a series of videos demonstrating doctor-patient communication scenarios.The novel training model can be used in continuing medical education through traditional on-site classes or by E-learning platform.It is expected to improve the communication skills of community doctors and patients, improve the satisfaction of both doctors and patients, and the effect of patients' self-management.

Advances in psychosocial interventions on quality of life of cancer survivors / 中华预防医学杂志

In recent years, there has been increasing recognition of the importance of psychosocial interventions' studies on quality of life in cancer survivors because of improving cancer survival rate. This paper was an integrative literatures review of various psychosocial interventions including cognitive behavioral therapy, group-based supportive therapy, counseling or psychotherapy, education or psychoeducation and music therapy et al, and analyzing the complexity of psychosocial interventions' RCTs in oncology and the current characteristic of these studies in China.

Cluster analysis on the blood pressure control rate and related factors of hypertensive outpatients in China / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the blood pressure (BP) control rate and related factors in different parts of China.</p><p><b>METHODS</b>This cross-sectional survey was performed between March and May 2011 in 132 tertiary or secondary hospitals from 31 cities across China. Five consecutive hypertensive patients consulted to individual physician in these hospitals were included and a total of 4 110 patients aged ≥ 18 years were included, and 3 682 patients finished the follow-up protocol. All objects underwent questionnaire survey and physical examination. Cities were divided into 3 categories.</p><p><b>RESULTS</b>Among included hypertensive outpatients, the prevalence of coronary heart disease was the highest (37.4%, 1 368/3 662) comorbidity. The most commonly used antihypertensive medication was calcium channel blocker (51.3%, 1 861/3 628). Blood control rate was the highest in city category II(37.0%) and the lowest in city category I (9.1%). Accordingly, body mass index (BMI, (25.7 ± 0.6) kg/m(2)) and waist circumference ( (90.6 ± 3.1 ) cm) were the largest and the prevalence of coronary heart disease (60.8%) and stroke (19.0%) were the highest in hypertensive outpatients from city categoryI.</p><p><b>CONCLUSION</b>Blood pressure control rate varies among various cities in China. High BMI and co-morbidities of coronary heart disease and stroke are related to poor blood pressure control rate.</p>

Comparison of effect between duloxetine combined with small-dose of mirtazapine and duloxetine in treatment of refractory depression in elder patients / 中国生化药物杂志

Objective To compare effect and security between duloxetine combined with small-dose of mirtazapine and duloxetine alone in treatment of refractory depression in elder patients.Methods A total of 100 cases elder refractory depression patients were randamly divided into study group (duloxetine+mirtazapine, 50 cases) and control group(duloxetine, 50 cases).Compared HAMD,HAMA and CGI-SI between two groups, as well as the side reactions and TESS.Regression analysed mirtazapine blood concentration and HAMD subtraction rate.Results The effective rate of study group was 92.00%, while in control group was 76.00%, the difference was statistically significant(P<0.05).After treatment, the HAMD, HAMA and CGI-SI of each group significantly increased, and the difference of HAMD, HAMA and CGI-SI at 2w, 4w and 8w between two groups were statistically significant(P<0.05).The TESS and side reaction of two groups had no statistical difference.Conclusion Effect of duloxetine combined with small-dose of mirtazapine in treatment of refractory depression is better than duloxetine alone use, without significant side reaction.