[Transurethral bipolar plasmakinetic prostatectomy for benign prostatic hyperplasia in high-risk and senior patients in China: a systematic review and meta-analysis].

Objective: To evaluate the effectiveness and safety of transurethral bipolar plasmakinetic prostatectomy in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China. Methods: The PubMed, Cochrane Library, CBM, CNKI and WanFang databases were searched with computer for collecting relevant interventional case series from establishment dates to September 14, 2018. After quality evaluation and data extraction independently conducted by two authors, the Meta-analysis was performed using the Comprehensive Meta-analysis V2 software. Results: Eighteen studies involving 1 899 patients are included. Maximum flow rate increased to 12.28 ml/s (95%CI: 8.42-16.14), 12.88 ml/s (95%CI: 9.85-15.92) ,14.32 ml/s (95%CI: 10.47-18.18), 14.93 ml/s (95%CI: 10.19-19.67) and 20.00 ml/s (95%CI: 19.08-20.92) in 1, 3, 6, 12 and 24 months after surgery, respectively. International prostate symptom score decreased to -18.60 (95%CI: -23.20--14.00), -17.62 (95%CI: -20.21--15.03), -19.14 (95%CI: -20.70--17.59), -19.06 (95%CI: -21.53--16.60) and -22.90 (95%CI: -24.26--21.54), respectively. Quality of life decreased to -2.38 (95%CI: -4.26--0.50), -3.39 (95%CI: -4.57--2.21),-3.75 (95%CI: -4.14--3.36), -3.36(95%CI: -4.56--2.16), and -4.58(95%CI: -4.75--4.41). Post void residual decreased to -231.16 ml (95%CI: -288.30--174.01), -76.10 ml (95%CI: -116.71--35.50), -159.90 ml(95%CI: -207.21--112.59) and -87.70 ml (95%CI: -91.91--83.48). The event rate of postoperative adverse reactions all were not high. Conclusion: Transurethral bipolar plasmakinetic prostatectomy has better clinical efficacy and no obvious side effects in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China.

[Study on calculating the curative care expenditure of injury in Gansu Province based on "A System of Health Accounts 2011"].

Objective: To study the distribution and related factors of curative care expenditure (CCE) of injury in Gansu Province in 2017. Methods: Based on the "A System of Health Accounts 2011 (SHA 2011)", the curative care expenditure of injury in Gansu Province was calculated and analyzed. The five-stage stratified cluster sampling method was adopted to extract 149 medical and health institutions, 120 township hospitals (including community health service centers), 150 individual clinics and 600 village clinics (including community health service stations). The top-down allocation method was used to calculate the cost of injury treatment in Gansu Province, and the influencing factors were analyzed by multiple linear regression. Results: In 2017, the CCE of injury in Gansu province was 3.831 billion yuan, and the expense in general hospitals was 2.708 billion yuan. Among them, the cost of lower limb injury and head injury were 1.090 and 0.847 billion yuan. People aged 40 to 69 years old spent 1.901 billion yuan on injury treatment, and the CCE of injury treatment for men and women were 2.422 and 1.409 billion yuan respectively. The results of multiple linear regression showed that hospitalization expenditure was significantly associated with length of stay, operation, hospital grade, age, payment method and gender (P<0.001). Conclusion: The economic burden of injury in Gansu Province is relatively heavy, so it is necessary to focus on preventions for different groups and costly injury sites.

Clinical observation in edaravone treatment for acute cerebral infarction.

BACKGROUND: Acute cerebral infarction threats human health and life safety. The edaravone is a new antioxidant and hydroxyl radical scavenger, which is the novel scavenger for clinical use, mainly for nervous system diseases. OBJECTIVE: The purpose of this study is to observe the clinical treatment effects of edaravone on the degree of improvement of neurological impairment and functional movement impairment in patients with acute cerebral infarction. METHOD: A total of 130 patients admitted to our hospital because of acute cerebral infarction from December 2015 to May 2017 were selected for group analysis. These patients were divided into a control group (n = 65) and a treatment group (n = 65) with a random odd-even method. The control group accepted conventional treatment, while the treatment group received edaravone treatment on top of the conventional treatment of the control group. After treatment, the differences in functional movement, living ability score, neurological score, treatment effect, and adverse reaction of these two groups were tested and compared. RESULTS: The total treatment efficiency of conventional treatment in the control group was significantly lower than the combination treatment in the treatment group (P < 0.05). The inter-group differences in the National Institutes of Health Stroke Scale, activities of daily living, and Fugl-Meyer assessment scores after the treatment were significant between these two groups (P < 0.05). The posttreatment effect on the treatment group was superior to that on the control group (P < 0.05). The adverse reaction rate of the treatment group did not significantly vary from that of the control group (P > 0.05). CONCLUSION: Edaravone can significantly improve the degree of neurological impairment during acute cerebral infarction, functional movement, and living quality with a definite effect and high safety. Thus, this drug has a good prospect in clinical treatment.

[Technical guidelines for seasonal influenza vaccination in China (2018-2019)].

Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and complications from infection. Currently, China has licensed trivalent inactivated influenza vaccine (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. Except for a few major cities, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients must pay for it. To strengthen the technical guidance for prevention and control of influenza and operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC) Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" . The main updates in this version include: epidemiology, disease burden, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, IIV3 and IIV4 immune response, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The influenza vaccine TWG provided the recommendations for influenza vaccination for the 2018-2019 influenza season based on existing scientific evidence. The recommendations described in this report include the following: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-59 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to become pregnant during the influenza season. Children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in 2017-2018 influenza season or a prior season, 1 dose is recommended. People more than 8 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. For the people unable to be vaccinated before the end of October, influenza vaccination will continue to be offered for the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for use by staff members of the Centers for Disease Control and Prevention at all levels who work on influenza control and prevention, PoVs staff members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and staff members of maternity and child care institutions at all levels.

[Comparision for clinical efficiency of continuous adductor canal block and femoral nerve block in total knee arthroplasty].

OBJECTIVE: To compare the pain control efficiency of continuous adductor canal block (ACB) and femoral nerve block (FNB) in total knee arthroplasty. METHODS: From April to September 2016, patients with severe knee osteoarthritis undergoing primary unilateral total knee arthroplasty (TKA) were prospectively observed, and all the patients were randomized received ultrasound-guided continuous ACB or FNB after surgery. Numeric pain rating scales(NPRS)pain scores in rest and activity 2, 6, 12, 24 and 48 h after surgery were collected, and the preoperative and postoperative quadriceps strength at 24 and 48 h were analyzed. Opioids consumption and anesthesia related adverse effects were also recorded. RESULTS: In the study, 40 patients were enrolled, with 20 patients in each group, male:female=7:33, the age: (63.8±10.1) years, and the body mass index (BMI): (28.5±3.5) kg/m(2).The general conditions were comparable between the two groups. Though the rest pain 2 h after surgery [ACB=0.0(0,6), FNB=3.0(0,5), P=0.004] and activity pain 12 h post operation [ACB=3.0(3,0), FNB=5.5(0,10), P=0.004] were lower in ACB group compared with FNB group, there was no statistical difference in the other pain checking points between the two groups. The quadriceps strength 24 h and 48 h after surgery were(85.3±27.6) N and (80.0±30.1) N in ACB group, (69.0±29.4) N and (64.4±32.0) N in FNB group, both of them were declined by time. The exact data were higher in ACB group, however, there was no statistical difference between the two group by repeated measurements variance analysis(F=2.703, P=0.108).Four patients in ACB group and five in FNB acquired additional use of dolantin once (100 mg/per time) within 24 h. And among them, three patients acquired once dolantin in ACB, two in FNB, from 24 to 48 h postoperation. There were five patients who suffered nausea postoperation in ACB group, and one who reported xerostomia. Four patients in FNB had nausea with vomiting, and three experienced xerostomia. Deep vein thrombosis appeared in 2 patients in FNB group, but no one in ACB group. CONCLUSION: Continuous ACB is not superior in pain control after TKA compared with FNB, and the quadriceps strength could be reserved more by this method, which performed early benefits in fast rehabilitation.

[The effect of Ba Duan Jin on the balance of community-dwelling older adults: a cluster randomized control trial].

Objective: To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults. Methods: A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test. Results: A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95%CI: 2.23-3.88) points (P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95%CI: 4.03-5.37) points (P<0.001). Ba Duan Jin showed significant improvement (P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions: This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Late onset lupus nephritis in Chinese patients: classified by the 2003 International Society of Nephrology and Renal Pathology Society system.

AIM: The aim of this study was to assess clinicopathological characteristics and outcomes of a cohort of Chinese patients with late onset lupus nephritis. METHODS: Clinical, pathological and outcome data for patients with late onset lupus nephritis (onset at age ≥50 years) and early onset lupus nephritis (onset at age ≤40 years) were retrospectively analyzed and compared. RESULTS: Among 271 patients with renal biopsy-proven lupus nephritis, 30 were identified as having late onset lupus nephritis and 241 were identified as having early onset lupus nephritis. Lower female predominance was observed in the late onset patients (p = 0.06). The interval between presentation of lupus nephritis and diagnosis was significantly longer in the late onset group than in the early onset group (p = 0.003). In comparison with early onset group, patients in the late onset group had significantly lower scores for endocapillary hypercellularity (p = 0.041), subendothelial hyaline deposits (p = 0.022) and glomerular leukocyte infiltration (p = 0.032), but had significantly higher scores for tubular atrophy (p = 0.037) and interstitial fibrosis (p = 0.018). Regarding long-term survival and renal outcome, there was no significant difference between the two groups, although it seemed that the early onset group had a poorer renal outcome (p = 0.077, hazard ratio (HR) = 3.909, 95% CI: 0.862-17.726). CONCLUSIONS: Patients with late onset lupus nephritis were usually diagnosed later; they had milder active lesions and more severe chronic lesions in renal pathology. However, the renal outcome was similar between late and early onset patients.

[Management strategy for the resumption of regular diagnosis and treatment in gastrointestinal surgery department during the outbreak of coronavirus disease 2019 (COVID-19)].

Acute abdomen, abdominal trauma, gastrointestinal bleeding and gastrointestinal tumors are the main conditions that are routinely treated in gastrointestinal surgery department with high incidence and critical condition. These conditions need emergency or selective operations. During the outbreak of the coronavirus disease 2019 (COVID-19), it's a great challenge for us to meet the patients' requirement under the situation. As the COVID-19 was brought under control in China, the Department of General Surgery in Nanfang Hospital resumed regular medical services gradually. Based on our clinical practice, the four major measures of strengthening pre-hospital screening, perioperative prevention and control, medical staff protection, and ward management were adopted. These main measures include the strict implementation of the appointment system and triage system before admission; the conduction of epidemiological and preliminary screening of viral nucleic acids; the chest CT examination during the perioperative period to re-screen COVID-19; the reduction of the risk of droplets and aerosol transmission; the minimally invasive surgery combined with enhanced recovery program in order to reduce patient's susceptibility and shorten the length of postoperative hospital stay; the reinforcement of specific infection control training for medical staff; the strict implementation of hierarchical protection; the establishment of gastrointestinal surgery prevention and control system; the rehearsal of emergency exercise; the installation of quarantine wards; the screening and management of family care-givers; the strict disinfection of environment and materials. Our preliminary practice shows that following the work guidelines issued by the Guangdong Province COVID-19 Prevention and Control Office and adopting precise management strategies in combination with the specific clinical features of gastrointestinal surgery, it is possible to safely resume regular care for the patients and comply to epidemic control at the same time.

[Effect of skin soft tissue expansion on repair of large area of scars on extremities].

Objective: To investigate the effect of skin soft tissue expansion on repair of large area of scars on extremities. Methods: Twenty-five patients with large area of scars on extremities were admitted to our department from June 2007 to October 2014. There were 14 males and 11 females, aged 4 to 36 years. Operations were performed under local infiltration anesthesia or general anesthesia. In the first stage, 1 to 5 cylindrical expanders with capacities of 250 to 600 mL were placed at left or right sides or at upper or lower parts of the scars. In the second stage, scars of 21 patients were repaired with expanded transverse propulsive and lateral flaps, and scars of 4 patients were repaired with expanded perforator flaps whose pedicles were perforators of brachial artery, superior ulnar collateral artery, or posterior interosseous artery according to areas and shapes of the scars. The secondary wound areas ranged from 13 cm×7 cm to 34 cm×18 cm after dissolution or excision of scars. The areas of flaps ranged from 13 cm×7 cm to 20 cm×12 cm. The donor sites were sutured directly. The flaps after operation and follow-up of patients were observed and recorded. Results: All expanded flaps survived after operation. And the superficial distal part of flap whose pedicle was perforator of posterior interosseous artery in one patient was with necrosis, and other flaps survived well. During follow-up of 3 to 15 months after operation of the second stage, color and texture of flaps were similar to surrounding skin, while extremities of donor sites were thinner and auxiliary incisional scars formed after expansion. Conclusions: Expanded flap is a good way to repair large area of scar on extremities. Bilateral skin of scar is the first choice of donor site of expanded flap. If there isn't enough skin for expanding on bilateral sides, expanded perforator flap designed at upper or lower part of the scar is another choice to repair the scar.

[History of influenza pandemics in China during the past century].

Five influenza pandemics had occurred during the past century (1918 "Spanish flu" , 1957 "Asian flu" , 1968 "Hong Kong flu" , 1977 "Russian flu" and 2009 H1N1 Pandemic), accounting for hundreds of millions of people infected and tens of millions dead. China was influenced by all the five pandemics, and three of them (1957 "Asian flu" , 1968 "Hong Kong flu" and 1977 "Russian flu" ) were originated from China. The pandemics triggered the establishment of public health agencies and influenza surveillance capacities. In addition, more resources were allocated to influenza-related research, prevention and control. As a leader in the field of influenza, China should further strengthen its pandemic preparedness and response to contribute to global health.

Modulation of platinum-induced toxicities and therapeutic index: mechanistic insights and first- and second-generation protecting agents.

Platinum-type drugs have proven to be valuable in the treatment of a variety of solid tumors, beginning with the commercial approval of cisplatin 18 years ago. There are several clinically important toxicities commonly associated with the administration of these drugs. Despite the extensive use of cisplatin and carboplatin, the fundamental chemical transformations and mechanisms that underlie their antitumor and toxic effects have not been fully characterized. Several first-generation protective thiols have been clinically studied in an attempt to reduce the toxicity of platinum-type drugs; while some of these agents appear to protect against certain toxicities, nearly all platinum-protecting drugs have their own intrinsic toxicities, which can be additive to the toxicity of platinum-type drugs. Tumor protection by platinum-protecting drugs is an additional untoward effect that is associated with certain types of agents and must be addressed with care. Recent advances in theoretical and laboratory methods and the use of supercomputers have extended our understanding of the possible major mechanisms underlying platinum drug antitumor activity and toxicity; we present strong evidence that there are two classes of chemical species of platinum drug. One class appears to predominantly account for the antitumor activity, and the other class of chemical species produces many of the toxic effects of platinum drugs. We have discovered a new nontoxic, second-generation platinum-protecting agent, known as BNP7787, which appears to selectively inactivate and eliminate toxic platinum species. BNP7787 has recently entered phase I clinical testing in cancer patients.

[Prevention and factors inducing respiratory distress syndrome in prematures].

An analysis of 105 cases of prematures with respiratory distress syndrome, the idiopathic type were 9.5% (10/105). Fetal anoxia and ischemia, induced by pregnancy and during labour amounting to 87.6% (92/105), and of which 2.9% (3/105) was due to diabetes. It indicated that most cases of RDS are predominantly related with fetal anoxia and ischemia which results in pulmonary surfactant abnormality or impaired activity. It is important that in clinical diagnosis one should monitor cautiously the presence of premature birth with anoxia and ischemia, Thus, a preventive treatment must be given at least 24 hours prior to birth, and the earlier the least morbidity of RDS occurred.

[Study on schistosomiasis control strategy in Ertan reservoir].

OBJECTIVE: To explore means and strategies of preventing the spread of schistosomasis transmission due to the building of Ertan Dam. METHODS: To eliminate the infection sources and Oncomelania snails. To install concrete irrigation and piping system of water supply. To encourage the immigrants to build methane-generating tanks and improve sanitary facilities and conditions for families who live near the water-retaining line. RESULTS: 2,360 people and 152 cattle were treated for schistosome infection. Mollusciciding and environmental modification were made for eliminating snails at an area of 3,634,580 m2 and 67,105.5 m2 respectively. The length of concrete irrigation and piping system installed was 51.13 and 104.895 km respectively. Methane-generating tanks, water-heating instruments using solar energy and other sanitary facilities were established in 1,781 households. After three-year intervention, no infected snails were found and no infected human being, cattle and wild rats were detected. CONCLUSION: Schistosomiasis control was financially supported since the very beginning of the Ertan Dam project, which provided a condition for sustainable development. Continued surveillance of snails and infection sources should be carried out, which will provide scientific basis for schistosomiasis control in the Three Gorges region as well as other new projects of hydropower and water conservancy in endemic area.

[Effect of various cavity design, lining and restorative materials on the fracture resistance of teeth].

OBJECTIVE: To evaluate the influence of various cavity designs, lining and restorative materials on fracture resistance of teeth in vitro. METHODS: Factorial design with three factors and various levels was used. 36 extracted human maxillary premalors were prepared for occlusal cavity, MO cavity and MOD cavity. Various base material and restorations were used. All teeth were thermocycled and mounted for testing and then were loaded until fracture. The results were analyzed by a three-way ANOVA. Fracture patterns were observed at the same time. RESULTS: There was significant difference in fracture resistance among various cavity designs and restorations. The fracture patterns were different. CONCLUSIONS: The different classes of cavities and various restorations have significantly influence upon fracture resistance of teeth. There are interactions between cavities and restorations.

Evaluation of a nutrition education activity for medical students in China.

In China, where cancers and cardiovascular disease are the major causes of morbidity and mortality, an important role for preventive medicine has emerged. Therefore, preparing China's medical students to tackle contemporary health problems requires attention to nutrition and health promotion in the medical curriculum. To evaluate the effectiveness of a nutrition education activity for medical students, a two-group pre-test/post-test nutrition education program was conducted in a medical university in south-western China (n=300 per group). Students in another south-western Chinese medical university served as controls (n= 150 per group). Special features of the intervention were: (1) nutrition education materials developed from (a) the results of a pre-test survey of medical students and (b) discussions with medical students, faculty, and physicians; and (2) a multi-channel delivery, which included a classroom lecture-discussion; a nutrition knowledge competition; a handout providing a day's dietary allotment; campus radio and movie theatre announcements, and posters. Analysis of variance, chi-square, and t-tests showed a significant increase (P<0.05) in nutrition knowledge, but not in nutrition attitude score. The final nutrition knowledge and attitude scores were also found to be related to the students' increased exposure to the various channels (P<0.001). Also observed was an increase in the consumption of soybean and dairy products (P<0.05). It is concluded that the method is a useful and practical model for designing and developing student nutrition education activities in China, as well as demonstrating nutrition and health education methods among the medical university community.