Prostate cancer-secreted CCN3 uses the GSK3ß and ß-catenin pathways to enhance osteogenic factor levels in osteoblasts.

Prostate cancer osteoblastic bone metastases are incurable and associated with chronic bone pain and a high mortality rate. Osteoclast-targeting drugs intended to prevent skeletal-related events associated with prostate cancer bone metastases do not prolong overall survival. Improved understanding of the bone-derived factors that contribute to prostate cancer osteoblastic bone metastases is required to design treatments that will improve morbidities and overall survival. Activated osteoblasts stimulate prostate cancer growth in bone. In this study, we report that prostate cancer conditioned medium (CM) promoted bone morphogenetic protein (BMP)-2, -4 and -7 production and the expression of osteogenic transcription factors Runx2 and osterix in osteoblasts. Treating the prostate cancer CM with antibody against CCN3 (nephroblastoma-overexpressed), a cysteine-rich protein that belongs to the CCN family, reduced all of these increases. Incubation of osteoblasts with CCN3 facilitated phosphorylation of GSK3ß and ß-catenin. GSK3ß and ß-catenin inhibitors or siRNAs all abolished CCN3-induced promotion of BMPs, Runx2 and osterix expression in osteoblasts. Our results indicate that prostate cancer-secreted CCN3 enhances BMP, Runx2 and osterix expression in osteoblasts via the GSK3ß and ß-catenin signaling pathways. This understanding of the role played by CCN3 in osteoblastic prostate bone metastasis may lead to more efficient targeted therapies.

Topical Timolol Combined Intralesional Injection of Diprospan in the Treatment of Elevated Localized Mixed Infantile Hemangiomas and a Discussion for Proper Timing for Injection.

BACKGROUND: Although infantile hemangiomas (IHs) are usually self-limiting, residual elevated appearance may remain. Topical beta-blockers are effective in superficial IHs management, while intralesionally injected diprospan is effective at treating deep, localized IHs. A single application of topical timolol or injected diprospan has obvious limitations. Therefore, for elevated, localized mixed IHs, we applied topical timolol combined with intralesionally injected diprospan, using their respective advantages to maximize benefits. PURPOSE: To evaluate the clinical efficacy and safety of topical timolol combined with intralesionally injected diprospan for the treatment of elevated, localized mixed IHs and identify the optimal injection time. METHODS: Infants with elevated, localized mixed IHs in the proliferative phase were treated with injected diprospan combined with topical timolol between March 2018 and March 2020. The injection was administered only when the tumor surface was higher than that of the surrounding tissue. The patients were asked to return every 4 weeks for a treatment response evaluation, and complications were recorded. RESULTS: Thirty-six patients with elevated, localized mixed IHs (thickness >3 mm on Doppler ultrasound) were recruited. The mean age at treatment initiation was 3.58 ±â€Š1.50 months (range: 1.00-6.00 months). The follow-up period ranged from 9 to 24 months. Considering the size of the IH at the end of treatment, regression was observed in 31 (86.1%) cases, stabilization was observed in 5 (13.9%) cases, and no treatment failure was observed. All the IHs improved in color and height after treatment. CONCLUSION: Topical timolol combined with intralesionally injected diprospan is an effective and safe treatment for elevated, localized mixed IH. The injection is needed only when we forecast the elevated tissue may remain after regression.

Making Smarter Decisions Faster: Systems Engineering to Improve the Global Public Health Response to HIV.

PURPOSE OF REVIEW: This review offers an operational definition of systems engineering (SE) as applied to public health, reviews applications of SE in the field of HIV, and identifies opportunities and challenges of broader application of SE in global health. RECENT FINDINGS: SE involves the deliberate sequencing of three steps: diagnosing a problem, evaluating options using modeling or optimization, and providing actionable recommendations. SE includes diverse tools (from process improvement to mathematical modeling) applied to decisions at various levels (from local staffing decisions to planning national-level roll-out of new interventions). Contextual factors are crucial to effective decision-making, but there are gaps in understanding global decision-making processes. Integrating SE into pre-service training and translating SE tools to be more accessible could increase utilization of SE approaches in global health. SE is a promising, but under-recognized approach to improve public health response to HIV globally.

Emergency Palliative Care: Early Assessment of an Older Adult With a Fall and Hip Fracture.

In this segment of the emergency department (ED) palliative care case series, we present a patient who arrives to the ED after a fall resulting in a hip fracture. He is also found to have hypernatremia and an acute kidney injury and develops delirium while in the ED awaiting an inpatient bed. The ED-based integrated geriatric palliative care program is consulted and performs a multidimensional assessment. The geriatric palliative care clinician facilitates discussion with his daughter about surgical intervention based on the patient's goals and values, diagnoses delirium, and worsening depression, creates a plan for delirium and pain management, and accelerates postdischarge planning.

A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program.

BACKGROUND: As a third of all community dwellers aged 65+ fall each year, falls are common reasons for older adults to present to an Emergency Department (ED). Although EDs should assess patients' multifactorial fall risks to prevent future fall-related injuries, this frequently does not occur. We describe our protocol to determine the feasibility, acceptability, and safety of a pilot ED Virtual Observation Unit (VOU) Falls program. METHODS: To ensure standardized conduct and reporting, the Standard Protocol Items for Intervention Trials (SPIRIT) guidelines will be used. The VOU is a program where patients are sent home from the ED but are part of a virtual observation unit in that they can call on-call ED physicians while they are being treated for conditions such as cellulitis, congestive heart failure, or pneumonia. A paramedic conducts daily visits with the patient and facilitates a telemedicine consult with an ED physician. VOU nursing staff conduct daily assessments of patients via telemedicine. The ED VOU Falls program is one of the VOU pathways and is a multi-component fall prevention program for fall patients who present after an ED visit. The paramedic conducts a home safety evaluation, a Timed Up and Go Test (TUG). During the VOU visit, the ED physician conducts a telemedicine visit, while the paramedic is visiting the home, to review patients' fall-risk-increasing drugs and their TUG test. We will determine feasibility by calculating rates of patient enrollment refusal, and adherence to fall-risk prevention recommendations using information from 3-month follow-up telephone calls, as well as qualitative interviews with the paramedics. We will determine the acceptability of the ED VOU Falls program based on patient and provider surveys using a Likert scale. We will ask VOU nursing staff to report any safety issues encountered while the patient is in the ED VOU Falls program (e.g., tripping hazards). We will use the chi-square test or Fisher's exact test for categorical variables, Student's t-test for continuous variables, and Mann-Whitney for nonparametric data. We will review interview transcripts and generate codes. Codes will then be extracted and organized into concepts to generate an overall theme following grounded theory methods. This is a pilot study; hence, results cannot be extrapolated. However, a definite trial would be the next step in the future to determine if such a program could be implemented as part of fall prevention interventions. DISCUSSION: This study will provide insights into the feasibility and acceptability of a novel ED VOU Falls program with the aim of ultimately decreasing falls. In the future, such a program could be implemented as part of fall prevention interventions.

Improved location technology of perforators of anterolateral thigh flap for Chinese patients.

BACKGROUND: The anterolateral thigh (ALT) flap has been widely used in reconstruction of soft tissue defects. The anatomic variations of perforators increase the difficulties of flap elevation. The ABC system has been described for locating the most common three perforators in Western populations. Less evidence has been found regarding whether it is suitable for Chinese population. The purpose of this study is to explore the improvement of preoperative location technology and flap design for Chinese people. METHODS: Detection for perforator signals on the bilateral thigh surface was perfromed on 50 Chinese adults using handheld Doppler. Define the A-P line as the line between the anterior superior iliac spin (ASIS) and the superolateral corner of the patella (P). We defined a coordinate system on the thigh surface to record the data of each signal point. The A-P line was y-axis in this coordinate system, and the midpoint of the line was the zero point. The data of these signals were recorded in the form of coordinates. Statistics and mathematic methods were used to analyze the regularity of signal distribution and the correlation between body mass index (BMI) and signal distribution. The findings were applied in five patients who underwent the ALT flap transplantation to confirm its clinical value. RESULTS: The results showed that most of the signals appeared near the A-P line. Most signals were located 1 cm lateral (mean 0.5 cm lateral) to the A-P line. The mean vertical distance between perforator B and perforators A and C was 4 cm. More perforator signals were detected at the two horizontal level (as shown in the picture above) than other horizontal levels. The rate of accurate preoperative detection was 40% (6 of 15 perforators) and the error rate was 20% (3 of 15 perforators). The mean deviation was 1.34 cm, which is acceptable for clinical application. The mean vertical distance between perforator B and perforators A and C in clinical study (4.81 cm) corresponded to the finding of the Doppler study (4.2 cm), whereas the mean distance between perforators and the A-P line (1.57 cm) was more than the Doppler finding (0.48 cm). CONCLUSION: The A-P line is still a reliable guiding line for Doppler detection and flap design. The ABC system is suitable for the Chinese population but must be adjusted: perforator B is marked first at the midpoint and 0.5 cm lateral to the A-P line and perforators A and C are marked 4 cm distal and proximal to perforator B, respectively. In designing the flap, the region 3 cm around point B and the region between the two horizontal planes at point B and 4 cm lower should both be contained into the flap, no matter what the finding of Doppler detection is.

Effectiveness of Orthotic Treatment on Clinical Outcomes of the Patients with Adolescent Idiopathic Scoliosis Under Different Wearing Compliance Levels: A Systematic Review.

BACKGROUND: Wearing spinal orthosis for 16 to 23 hours a day during the teenage years could be challenging and stressful for patients with adolescent idiopathic scoliosis (AIS). The investigation of clinical outcomes under various orthosis-wearing compliances can provide helpful insight into orthotic treatment dosage. This systematic review aims to investigate actual orthosis-wearing compliance and evaluate the effectiveness of orthotic treatment in controlling scoliotic curvature and preventing surgery for patients with AIS under various levels of orthosis-wearing compliance. METHODS: A literature search of 7 electronic databases, namely PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL Complete, Web of Science, and Embase, was conducted on May 19, 2023. Participant characteristics, orthotic treatment protocols, compliance information, outcome measures, and key findings were extracted. The Newcastle-Ottawa Scales were used to evaluate the quality of included cohort and case-control studies. RESULTS: This study systematically reviewed 17 of 1,799 identified studies, including 1,981 subjects. The actual compliance was inconsistent and ranged from 7.0 to 18.8 hours daily. The proportion of compliant subjects in each study varied from 16.0% to 78.6% due to the heterogeneity of calculation period, measurement methods, and orthosis prescription time. Thirteen studies were investigated to determine the effectiveness of orthotic treatment in controlling curve deformity under different compliance groups, and 2 studies compared the compliance under different treatment outcomes. The rate of curve progression, defined as surpassing the measurement error threshold of 5° or 6° after orthotic treatment, varied from 1.8% to 91.7% across the studies. Ten studies defined the treatment failure, surgery, or surgery indication as Cobb angle progressing to a certain degree (e.g., 40°, 45°, or 50°) and reported failure/surgery/surgery indication rates ranging from 0.0% to 91.7% among different compliance level groups. CONCLUSION: This review found that the actual compliance with orthotic treatment was generally lower than the prescribed wearing time and exhibited wide variation among different studies. The electronic compliance monitors show promise in regular orthotic treatment practice. More importantly, the group with higher and consistent compliance has significantly less curve progression and lower surgery or failure rate than the group with lower and inconsistent compliance. Further studies are proposed to investigate the minimal orthosis-wearing compliance in patients with AIS treated with different types of orthoses. LEVEL OF EVIDENCE: Level III, Systematic Review. See Instructions for Authors for a complete description of levels of evidence.

The effects of a physical exercise program in Chinese kidney transplant recipients: a prospective randomised controlled trial.

Background: Kidney transplant has become the preferred therapy for end-stage renal disease. However, kidney transplant recipients (KTRs) still face several challenges, such as physical inactivity. The purpose of this study was to explore the effects of a nurse-led physical exercise program in Chinese KTRs. Methods: A total of 106 participants were enrolled from the Third Xiangya Hospital of Central South University between July 2021 and June 2022 and randomly assigned to the control or intervention groups. Participants in the control group were provided with routine nursing care and participants in the intervention group received a nurse-led rigorous physical exercise program that was divided into two stages: the pre-discharge stage and the post-discharge stage. The pre-discharge stage included the non-ambulatory and ambulatory stages. The Chinese traditional exercise Baduanjin was incorporated into the physical exercise during the ambulatory stage. The post-discharge stage continued the same exercise as the ambulatory stage at home. After 3 months of intervention, both groups received the same follow-up for 3 months. The primary and secondary outcomes of all participants were collected. The data were analysed with repeated measures analysis of variance to examine the effectiveness of the intervention. Results: Compared with the control group, the intervention group had less fatigue and more motivation to be active in primary outcomes. Moreover, patients in the intervention group had a higher phase angle, a longer 6-minute walk distance, more 30-second chair stand times and decreased anxiety and depression levels in secondary outcomes. No adverse events were observed during the intervention. There were no significant differences in all dimensions of the quality-of-life questionnaire between the intervention and the control group. Conclusion: Chinese KTRs could benefit from the nurse-led physical exercise program post-operatively. Trial registration: ChiCTR2100048755.

[Ultrasound-guided assistant infusion technique for percutaneous radiofrequency ablation of liver cancer].

OBJECTIVE: To assess the value of an infusion-based separation technique to assist in ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) of liver cancers abutting the liver edge. METHODS: Twenty-four cases of malignant liver tumors abutting the hepatic edge were treated with US-guided puncture accompanied by the assistant infusion technique. The US-guided puncture was made with a 22-G needle through the hepatic tissue and into the abdominal cavity near the target tumor. Infusion of a saline solution was used to separate the liver from any surrounding structures so that percutaneous RFA could be safely performed. Complications, including gastrointestinal injury, hemorrhage and death, were recorded. Technical efficacy and safety were evaluated. RESULTS: Among the 24 patients, the target tumors were adjacent to the right kidney (n=6), colon (n=6), stomach (n=5), pericardium (n=4), and gall bladder (n=3). Twenty-three patients received a successful radical percutaneous RFA with assistant infusion. The assistant infusion volumes ranged from 80-390 ml and created spaces ranging from 0.8-2.5 cm between the liver and surrounding structures. Five of the cases with tumors adjacent to the stomach or colon received the largest volume infusions. The infusion failed to create a separation space in only one case, due to the presence of an adhesion; as a result, this patient was treated with palliative RFA. The mean hospital stay for all 24 patients was four days after surgery. No severe complications or deaths occurred. At 1-month follow-up, computed tomography images showed that 22 cases had complete ablation, yielding a technical success rate of 95.7% (22/23). No needle track implantation was observed. CONCLUSION: Assistant infusion for percutaneous radiofrequency ablation creates a protective space between the liver and surrounding structures in patients with liver tumors abutting the liver edge. This safe and effective assistant technique broadens the range of patients available for percutaneous RFA treatment.

Emergency department utilization after the implementation of Massachusetts health reform.

STUDY OBJECTIVE: Health care reform in Massachusetts improved access to health insurance, but the extent to which reform affected utilization of the emergency department (ED) for conditions potentially amenable to primary care is unclear. Our objective is to determine the relationship between health reform and ED use for low-severity conditions. METHODS: We studied ED visits, using a convenience sample of 11 Massachusetts hospitals for identical 9-month periods before and after health care reform legislation was implemented in 2006. Individuals most affected by the health reform law (the uninsured and low-income populations covered by the publicly subsidized insurance products) were compared with individuals unlikely to be affected by the legislation (those with Medicare or private insurance). Our main outcome measure was the rate of overall and low-severity ED visits for the study population and the comparison population during the period before and after health reform implementation. RESULTS: Total visits increased from 424,878 in 2006 to 442,102 in 2008. Low-severity visits among publicly subsidized or uninsured patients decreased from 43.8% to 41.2% of total visits for that group (difference=2.6%; 95% confidence interval [CI] 2.25% to 2.85%), whereas low-severity visits for privately insured and Medicare patients decreased from 35.7% to 34.9% of total visits for that group (difference=0.8%; 95% CI 0.62% to 0.98%), for a difference in differences of 1.8% (95% CI 1.7% to 1.9%). CONCLUSION: Although overall ED volume continues to increase, Massachusetts health reform was associated with a small but statistically significant decrease in the rate of low-severity visits for those populations most affected by health reform compared with a comparison population of individuals less likely to be affected by the reform. Our findings suggest that access to health insurance is only one of a multitude of factors affecting utilization of the ED.

[Clinical study of combination of Chinese medicine and western medicine in treatment of 500 patients with hemophilia hemorrhage].

OBJECTIVE: To study the effect and safety of haemostatic apozem combined with haemostatic mixture on hemophilia hemorrhage. METHODS: Five hundred hemophilia patients were randomly recruited from Shaanxi Yida Hematology Institute from February 2005 to July 2010. Under the condition of using no blood products such as platelet cofactors VIII and IX, oral administration of haemostatic apozem combined with intravenous dripping of haemostatic mixture were given to 332 hemorrhagic patients and 451 patients in need of surgery for hemorrhagic prevention. The treatment was lasted for three successive weeks. The hemostatic time, hemorrhage absorption (recovery) time, and their safety were observed. RESULTS: The hemostatic time for open bleeding and closed bleeding was (0.85 +/- 0.83) h and (2.69 +/- 0.65) h respectively. The average hemostatic time was (2.00 +/- 0.69) h. The recovery time for different portions was as follows respectively: intra-cranial hemorrhage (14.13 +/- 6.01) days; muscular hemorrhage (18.18 +/- 7.34) days; hematuria (8.25 +/- 4.69) days; arthrorrhagia(3.27 +/- 1.31) days; ecchymoma (7.16 +/- 2.32) days; bleeding of oral and nasal cavities (4.26 +/- 1.35) days; intramedullary hemorrhage (19.15 +/- 1.36) days; hematoma ulceration (50.01 +/- 20.91) days. The hemorrhage recovery ratio was 99.10% (329/332). The success rate of preventing from surgery hemorrhage was 100% (451/451). No severe adverse reaction occurred during the therapeutic course. CONCLUSIONS: Haemostatic apozem combined with haemostatic mixture was effective and fast in preventing and treating hemophilia hemorrhage, with no complications or adverse reactions. It could be taken as the first choice for prevention and treatment of hemophilia hemorrhage.

Lessons Learned From Emergency Department Fall Assessment and Prevention Programs.

Objectives This research describes the experiences of emergency departments (EDs) with geriatric fall programs and qualitatively synthesizes lessons learned to inform other EDs planning new fall program implementation. Methods By using grounded theory, we conducted semi-structured, open-ended telephone/skype interviews of emergency physicians and geriatric providers recruited from a purposeful sampling technique. The interviews were transcribed and reviewed by two investigators. The codes were generated and listed, and common concepts emerged. Lastly, the final codes were organized into concepts and themes with the aim to create a strong coding structure. Result The main lessons learned are: (1) understand the hospital's existing local environment and resources, (2) utilize champions and interdisciplinary teams, (3) acknowledge that specific fall assessment tools and interventions vary widely between institutions, (4) engage in routine plan-do-study-act (PDSA) cycles to improve the quality of fall initiatives, and (5) operate under the principle that falls are a syndrome, which must be incorporated within the multifactorial medical needs of geriatric fall patients. Conclusion Based on the lessons learned from our ED fall implementation pioneers, implementing an effective geriatric fall protocol in an ED setting is complicated. Understanding a hospital's resources, assigning champions, working as an interdisciplinary team, choosing proper fall assessment tools/interventions, and completing regular PDSA cycles are important lessons for ED programs planning to implement their own ED fall programs.

Minimally invasive versus open radical resection surgery for hilar cholangiocarcinoma: Comparable outcomes associated with advantages of minimal invasiveness.

BACKGROUND: Minimally invasive surgery (MIS) provides a new approach for patients with hilar cholangiocarcinoma (HCCA). However, whether it can achieve similar outcomes to traditional open surgery (OS) remains controversial. METHODS: To assess the safety and feasibility of MIS for HCCA, a systematic review and meta-analysis was performed to compare the outcomes of MIS with OS. Seventeen outcomes were assessed. RESULTS: Nine studies involving 382 patients were included. MIS was comparable in blood transfusion rate, R0 resection rate, lymph nodes received, overall morbidity, severe morbidity (Clavien-Dindo classification > = 3), bile leakage rate, wound infection rate, intra-abdominal infection rate, days until oral feeding, 1-year overall survival, 2-year overall survival and postoperative mortality with OS. Although operation time was longer (mean difference (MD) = 93.51, 95% confidence interval (CI) = 64.10 to 122.91, P < 0.00001) and hospital cost (MD = 0.68, 95% CI = 0.03 to 1.33, P = 0.04) was higher in MIS, MIS was associated with advantages of minimal invasiveness, that was less blood loss (MD = -81.85, 95% CI = -92.09 to -71.62, P < 0.00001), less postoperative pain (MD = -1.21, 95% CI = -1.63 to -0.79, P < 0.00001), and shorter hospital stay (MD = -4.22, 95% CI = -5.65 to -2.80, P < 0.00001). CONCLUSIONS: The safety and feasibility of MIS for HCCA is acceptable in selected patients. MIS is a remarkable alternative to OS for providing comparable outcomes associated with a benefit of minimal invasiveness and its application should be considered more.

[Rolling needle pricking-cupping therapy and traditional pricking-cupping therapy for cervical spondylosis of neck type: a randomized controlled trial].

OBJECTIVE: To compare the clinical efficacy between rolling needle pricking-cupping (RNP-C) and traditional pricking-cupping (TP-C) for cervical spondylosis of neck type. METHODS: A total of 96 patients with cervical spondylosis of neck type were randomly divided into an RNP-C group, a TP-C group and an electroacupuncture (EA) group, 32 cases in each group. Each group was treated with EA at Jingbailao (EX-HN 15), Fengchi (GB 20), Dazhui (GV 14), Jianjing (GB 21) and ashi points with continuous wave and 2 Hz of frequency; each EA treatment lasted for 20 min, once every 3 to 5 days, totaling 6 treatments. On the basis of EA treatment, the patients in the TP-C group were treated with bloodletting by seven-star needle, followed by fire cupping; the patients in the RNP-C group were treated with bloodletting by rolling needle, followed by fire cupping. The treatment was given once a week for 4 weeks. The follow-up was 1 month. Before treatment, 2 and 4 weeks into treatment and follow-up, the Northwick Park neck-pain questionnaire (NPQ) and visual analogue scale (VAS) scores were evaluated. The acupuncture pain degree was recorded at the first treatment and 2 and 4 weeks into treatment. The efficacy was evaluated after 4 weeks of treatment. RESULTS: Compared before treatment, the scores of NPQ and VAS in each group were all reduced at 2 and 4 weeks into treatment and follow-up (P<0.05). The scores of NPQ in the TP-C group and the RNP-C group were lower than those in the EA group at 2 and 4 weeks into treatment (P<0.05). The scores of VAS in the TP-C group and the RNP-C group were lower than those in the EA group at 2 and 4 weeks into treatment and follow-up (P<0.05). The differences of NPQ and VAS scores between the TP-C group and the RNP-C group at each time point after treatment were not significant (P>0.05). The acupuncture pain degree in the RNP-C group was lower than that in the TP-C group (P<0.05). The total effective rates were 79.3% (23/29) in the TP-C group and 75.0% (24/32) in the RNP-C group, which was superior to 63.3% (19/30) in the EA group (P<0.05), but there was no statistical significance between the TP-C group and the RNP-C group (P>0.05). CONCLUSION: TP-C and RNP-C could both improve the cervical pain symptoms in patients with cervical spondylosis of neck type, and improve the overall function of the cervical spine, and the curative effect is similar.

[Clinical Efficacy of Low-Dose Decitabine alone for Treatment of Myelodysplastic Syndrome].

OBJECTIVE: To investigate the clinical efficacy and safety of low-dose decitabine (DAC) alone for treatment of myelodysplastic syndrome (MDS) Methods: Fifty-one patients with meddle- and high-risk MDS were selected, and were randomly divided into A, B and C groups according to the drug regimens: the therapeutic regimen in A group consisted of low dose DAC 10 mg/(m2·d)×7 d; the therapeutic regimen in B group: normal dose DAC 20 mg/(m2·d) ×5 d; the therapeutic regimen in C group: low dose DAC+CAG DAC 10 mg/(m2·d) d 1-5，cytarabine 10 mg/(m2·d) q12h d 1-7, aclaromycin 10 mg/d d 1-4，G-CSF 200 µg/(m2·d), d 1-7. All patients in 3 groups were treated for 4 circles. The efficacy and response were compared among 3 groups. RESULTS: The complete remission rates (CR%) in A, B and C groups were 18.75%, 22.22% and 23.53% respectively, and the overall response rate (ORR%) in A, B and C groups were 56.25%, 61.11% and 58.82% respectively, without statistical difference among 3 groups (P＞0.05)．After 1 year of follow-up, the survival rate was not significantly different among 3 groups, the blood cell accounts were higher than the basic value. After 1 course of treatment, the inhibition rate of III-IV grade myelosuppression was statistically significantly different among the 3 groups (P＜0.05), and the infection rate among 3 groups also was statistically different, The incidence of myelosuppression and infection in A group was significantly lower than that in B and C groups. The per capita blood transfusion during the four-month treatment was not statistically different among 3 groups. however, that in the A group was lesser than B and C groups. CONCLUSION: The therapeutic efficacy of low dose decitabine alone for treatment of MDS is equal to routine dose decitabine and decitabine plus CAG, but the low dose group shows less myelosuppressive and more safe effects.

Cascade Analysis: An Adaptable Implementation Strategy Across HIV and Non-HIV Delivery Platforms.

BACKGROUND: Cascades have been used to characterize sequential steps within a complex health system and are used in diverse disease areas and across prevention, testing, and treatment. Routine data have great potential to inform prioritization within a system, but are often inaccessible to frontline health care workers (HCWs) who may have the greatest opportunity to innovate health system improvement. METHODS: The cascade analysis tool (CAT) is an Excel-based, simple simulation model with an optimization function. It identifies the step within a cascade that could most improve the system. The original CAT was developed for HIV treatment and the prevention of mother-to-child transmission of HIV. RESULTS: CAT has been adapted 7 times: to a mobile application for prevention of mother-to-child transmission; for hypertension screening and management and for mental health outpatient services in Mozambique; for pediatric and adolescent HIV testing and treatment, HIV testing in family planning, and cervical cancer screening and treatment in Kenya; and for naloxone distribution and opioid overdose reversal in the United States. The main domains of adaptation have been technical-estimating denominators and structuring steps to be binary sequential steps-as well as logistical-identifying acceptable approaches for data abstraction and aggregation, and not overburdening HCW. DISCUSSION: CAT allows for prompt feedback to HCWs, increases HCW autonomy, and allows managers to allocate resources and time in an equitable manner. CAT is an effective, feasible, and acceptable implementation strategy to prioritize areas most requiring improvement within complex health systems, although adaptations are being currently evaluated.

[The effects of 10-week core strength training on the body balance in the middle-aged men].

OBJECTIVE: To observe the effects of core strength training on the body balance of middle-aged men, which could provide evidence for improving the body balance and reducing the risk of falls in the middle-aged men. METHODS: Sixteen 50~60 years old men were randomly divided into experimental group (core strength training, n=8) and control group(n=8). Intermittent core strength trainings were used for dynamic and static training, push-pull training and unarmed lower limb strength training by suspension ropes and yoga mat. The time for training was 50~60 min/day, 4~5 times/week for a total of 10 weeks. The men in control group remained their original living habits. We measured the ability of body static balance and dynamic balance before and after the core strength training. RESULTS: ① Compared with before exercise training, both closed single foot standing time and the body dynamic balance were increased significantly in the experimental group after exercise training(P<0.01)(10.63±1.69 s vs 9.00±2.27 s; 77.38±10.94 vs 89.50±5.53). ② Compared with before exercise training, star excursion balance test(SEBT) values were significantly increased in the left leg(the right leg support) in eight directions and the right leg(the left leg support)in six directions (P<0.01). CONCLUSIONS: Ten-week core strength training can significantly increase the body static and dynamic balance in the middle-aged men.

Motivations for Deceased Organ Donation Among Volunteers in China: A Qualitative Research Study.

BACKGROUND To align with guiding principles on human organ and tissue transplantation published by the World Health Organization (WHO), the Red Cross Society of China (RCSC) launched a new nationwide organ donation program in 2010 to recruit organ donation volunteers. Despite severe shortage of donated organs, there is a very low rate of volunteering for organ donation among the Chinese population (only 0.03 donors per million population) in the national program. Motivating organ donation is the key to the success of organ transplantation in China. MATERIAL AND METHODS Semi-structured 45- to 60-min interviews were conducted among 34 volunteers. Data analysis was performed with Nvivo 8.0 software. RESULTS Six motivations for organ donation were identified: helping others/altruism, fulfilling long-cherished wishes, reducing the burdens, making the best use of everything, giving back to society, and life extension. Factors affecting the motivation of organ donation among volunteers in China included traditional values, personal experiences, role model effect, family support, and problems in the donation system. Possible strategies to improve organ donation included fostering a scientific concept of the body and death, focusing donation promotion efforts on certain groups, and simplifying the process of organ donation. CONCLUSIONS There are multiple reasons for Chinese people to register for organ donation, with helping others as the central motivation.

Music therapy to relieve anxiety in pregnant women on bedrest: a randomized, controlled trial.

PURPOSE: To explore the effect of music therapy on anxiety alleviation for antepartal women on bedrest in China. DESIGN AND METHODS: One hundred and twenty patients recruited from one tertiary hospital in Changsha city, China were enrolled in a randomized controlled trial. Women in the experimental group received music therapy for 30 minutes on 3 consecutive days. Usual care participants had a 30-minute rest on 3 consecutive days. Variables included anxiety (State-Trait Anxiety Inventory), and physiological responses (vital signs, fetal heart rate). Descriptive statistics, t tests, chi tests, Wilcoxon rank sum tests, and Pearson correlation analyses were used to analyze the data. RESULTS: Anxiety levels decreased and physiological responses improved significantly in the intervention group, which was provided with music therapy while on bedrest. CLINICAL IMPLICATIONS: Carefully selected music that incorporates a patient's own preferences may offer an inexpensive and effective method to reduce anxiety for antepartal women with high risk pregnancies who are on bedrest.