A nomogram for predicting rectovaginal fistula after low anterior resection for rectal cancer.

PURPOSE: Rectovaginal fistula (RVF) is a complicated and troublesome complication of low anterior resection (LAR) for rectal cancer. We aimed to investigate the risk factors for post-LAR RVF and develop a predictive nomogram. METHODS: We performed a retrospective analysis of 821 female patients with rectal cancer who underwent LAR between October 2010 and October 2018. Logistic regression was performed to identify risk factors. A nomogram was developed to predict RVF. RESULTS: The incidence of post-LAR RVF was 3.4% (28/821). A multivariate analysis showed that the preoperative serum hemoglobin level (OR 2.449, 95% CI 1.144-5.239), the distance between the tumor and anal verge (OR 4.158, 95% CI 1.392-12.418), surgical procedure (OR 2.369, 95% CI 1.117-5.027), hysterectomy (OR 2.996, 95% CI 1.106-8.833), and bilateral oophorectomy (OR 5.823, 95% CI 1.639-20.689) were significantly associated with the development of RVF. A nomogram was developed, which showed a C-index of 0.824 (95% CI 0.730-0.918) and an adjusted C-index of 0.790. CONCLUSION: This study identified the preoperative serum hemoglobin level, the distance between the tumor and the anal verge, the type of surgical procedure, hysterectomy, and bilateral oophorectomy as predictors of post-LAR RVF. A nomogram was successfully developed. It could aid in the prediction of RVF in patients undergoing LAR.

The development and validation of Huaxi emotional-distress index (HEI): A Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings.

BACKGROUND: Depression and anxiety among general hospital patients are common and under-recognized in China. This study aimed toward developing a short questionnaire for screening depression and anxiety in non-psychiatric clinical settings, and to test its reliability and validity. METHODS: The item pool which included 35 questions about emotional distress was drafted through a comprehensive literature review. An expert panel review and the first clinical test with 288 general hospital patients were conducted for the primary item selection. The second clinical test was performed to select the final item in 637 non-psychiatric patients. The reliability and validity of the final questionnaire were tested in 763 non-psychiatric patients, in which 211 subjects were interviewed by psychiatrists using Mini International Neuropsychiatric Interview (MINI). Multiple data analysis methods including principal components analysis (PCA), item response theory (IRT), and receiver operating characteristic (ROC) curve were used to select items and validate the final questionnaire. RESULTS: The series selection of items resulted in a 9-item questionnaire, namely Huaxi Emotional-distress Index (HEI). The Cronbach's α coefficient of HEI was 0.90. The PCA results showed a unidimensional construct. The area under the ROC curve (AUC) was 0.88 when compared with MINI interview. Using the optimal cut-off score of HEI (≥11), the sensitivity and specificity were 0.880 and 0.766, respectively. CONCLUSIONS: The HEI is considered as a reliable and valid instrument for screening depression and anxiety, which may have substantial clinical value to detect patients' emotional disturbances especially in the busy non-psychiatric clinical settings in China.

Impacts of semi-transparent window on reflectance from metallic gratings at oblique incidence.

This work both numerically and experimentally investigates the reflectance from the smooth side of a semi-transparent 508-µm-thick window with metallic gratings attached on the other side. The incident light is oblique and linearly polarized, and its wavelength ranges from 2.5 to 25 µm. Three gratings with various levels of profile complexity and periods are investigated. Influences from the intrinsic material absorption, light refraction, total internal reflection, interference, and diffraction on both the specular and hemispherical reflectance are studied. Moreover, the applicability of effective medium theory to our samples is verified.

[Content of mineral elements of Gastrodia elata by principal components analysis].

OBJECTIVE: To study the content of mineral elements and the principal components in Gastrodia elata. METHOD: Mineral elements were determined by ICP and the data was analyzed by SPSS. RESULT: K element has the highest content-and the average content was 15.31 g x kg(-1). The average content of N element was 8.99 g x kg(-1), followed by K element. The coefficient of variation of K and N was small, but the Mn was the biggest with 51.39%. The highly significant positive correlation was found among N, P and K . Three principal components were selected by principal components analysis to evaluate the quality of G. elata. P, B, N, K, Cu, Mn, Fe and Mg were the characteristic elements of G. elata. CONCLUSION: The content of K and N elements was higher and relatively stable. The variation of Mn content was biggest. The quality of G. elata in Guizhou and Yunnan was better from the perspective of mineral elements.

[Study on sustainable development of industy of ethnic medicine in minority area].

Ethnic medicine industry is facing many problems such as narrow market, exhaustion of resource, decline of ethnic medicine and no qualified successors. Sustainable development theory was utilized to analyse the elements and problems of ethnic medicine industry, and the counter measures were put forward to get rid of the predicament and to realize the sustainable development which depends on the ethnic medicine resources, national medicine, industrial policy, personnel training and modern technology. The development issues of ethnic medicine industry can be solved by the coordination of enterprise, government and public. Finally the ethnic medicine can provide better services for society.

[Research on life history and phenological period of wild-stimulated cultivated Gastrodia elata f. elata in Guizhou].

In order to get to know the imitation of wild Gastrodia elata in life history and phenology period, by G. elata f. elata forest wild simulated cultivation in Dafang county, Guizhou province, observing and recording its morphological characteristics of each growth and development stage. This experiment summarized the law of its life history over 24 months, amplified the characteristics of each 5 phenology periods over the sexual and asexual reproduction of wild simulated cultivated G. elata f. elata in Guizhou. Which the results could clear the process of wild simulated cultivated G. elata f. elata in Guizhou, and provide a theoretical support for the standard technical of the simulated wild G. elata.

[Study on germination characteristics of Disporum cantoniense].

OBJECTIVE: To study the seed germination characteristic and optimal germination condition of wild Disporum cantoniense. METHODS: Used wild Disporum cantoniense seed as the test materials, the rate of water absorption of the seed was determined. The germination rates under different conditions, along a temperature gradient (15, 20, 25 and 30 degres C), in light or dark, on top or between wet filter papers, and keeping or removing the seed coat, were determined respectively using petri dish method. At the same time germination trends were observed. RESULTS: The thousand seed weight was 33.24 g, and the seed water-absorbing reached saturation pot after soaking for 30 h. Higher germination rates were respectively recorded at 25 degrees C, between filter papers, and in dark after 24 h soaking in the pretreatment solution. CONCLUSION: The optimal condition for the germination of the seed of wild Disporum cantoniense is as follow: keeping testa, seed soaking for 24 h in seed germination agent and being incubated between wet filter papers in dark at 25 degrees C.

Stereochemical insights into neuroprotective alkaloids from the aerial parts of Emilia sonchifolia.

A new alkaloid featured with a dibenz[c,e]azepin-5-one scaffold, namely emililactam A (3), together with a known pyrrolidine alkaloid (emilisonchine, 1) and a known flavonoid alkaloid [8-(2″-pyrrolidinone-5″-yl)-quercetin, 2] were isolated from the aerial parts of Emilia sonchifolia. Compounds 1 and 2 were isolated as racemic forms which were further separated, for the first time, to their corresponding enantiomers [(+)-1/(-)-1 and (+)-2/(-)-2], respectively, by using chiral-phase HPLC. The structure of new compound 3 was elucidated by extensive spectroscopic analysis. In addition, the absolute configurations of optically pure (+)-1/(-)-1 and (+)-2/(-)-2 were determined by the time-dependent density functional theory electronic circular dichroism (TDDFT-ECD) calculations. In an in vitro bioassay, compounds (+)-1, (-)-1, (±)-1, and 3 exhibited moderate neuroprotective effects against corticosterone-induced injuries of PC12 cells.

[Microstructural abnormalities of basal ganglia and thalamus in children with first-episode Tourette's syndrome: a diffusion tensor imaging study].

OBJECTIVE: To investigate the microstructural integrity of basal ganglia and thalamus in children with first episode drug-naive Tourette's syndrome (TS) by diffusion tensor imaging (DTI). METHODS: Ten right handed patients with TS (mean age = 8.1 +/- 2.7 years old, 7 males and 3 females) and 10 age and gender-matched healthy control subjects (mean age = 9.5 +/- 1.6 years old, 9 males and 1 female) were recruited. All of the participants had normal findings on conventional MRI. DTI was performed using a 3.0T MR scanner by employing a spin echo single-shot EPI sequence with 15 diffusion encoding directions. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were generated from each participant's DTI images using DTIStudio software. Bilateral regions of interest (ROI) for the caudate nucleus, putamen,globus pallidus and thalamus were manually traced through ROIEditor software on averaged DWI maps. The differences on DT-MRI variables (ADC, FA) between the two groups were compared using the SPSS13.0 software. Significance level was set at 0.05. RESULTS: Significant decrease in FA values in left globus pallidus and bilateral thalamus, and increase in ADC values in the bilateral caudate nucleus, bilateral putamen and bilateral thalamus were found in the children with TS compared with the normal controls. CONCLUSION: The results support the hypothesis of abnormalities in basal ganglia and thalamus in the pathophysiology of TS.

Why is the recognition rate of psychological distress under-estimated in general hospitals? A cross-sectional observational study in China.

This study aimed to investigate the recognition rate of psychological distress in general hospitals in China and to examine the main associated factors.Using a cross-sectional study design, the questionnaires were administered to a total of 1329 inpatients from a tertiary hospital. The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire (PHQ-15) and the Whiteley-7 (WI-7) were used to assess patients' mental health status. Two subjective questions were used to identify the awareness of psychological distress in patients and doctors.The frequency of psychological distress measured by the questionnaires was high in our sample (53.4%). However, the recognition rates of both patients (34.9%) and by doctors (39.1%) was low. The concordance rate between patients and doctors of whether the patient had psychological distress or not was extremely poor (Kappa = 0.089, P = .001). Factors associated with the poor concordance rate included patients' annual household income and clinically significant self-reported symptoms of anxiety and hypochondriasis.The recognition rate of psychological distress was underestimated and this may be related to a lack of awareness of mental disturbances and patients' low annual household income.

Patient-doctor concordance of perceived mental health service needs in Chinese hospitalized patients: a cross-sectional study.

BACKGROUND: To assess the subjective concordance on mental health service needs in hospitalized patients between patients and doctors in China. METHODS: A cross-sectional study was performed in one day. All hospitalized inpatients from selected departments of West China Hospital were recruited as potential participants. A questionnaire set including demographic variables and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7) questionnaires were completed by the included patients. They and their doctors in-charge were asked if they perceived that the patients needed mental health services. RESULTS: The overall response rate in patients was 84.25% and the final sample consisted of 1,273 patients. Among those, 605 patients (47.53%) themselves believed that they needed mental health services, whereas only 345 patients (27.10%) were deemed to be in need of mental health services only by their doctors. Kappa statistics showed that the concordance rate between patients and doctors was low in the total patient group (kappa =0.055) and in the group of patients with significant depression or anxiety (kappa =0.080). A logistic regression analysis showed that the ward where the patients were treated was related to a consistent recognition of mental health needs (OR =1.667). CONCLUSIONS: The concordance between Chinese inpatient perception and doctor evaluation of mental health service needs for these patients was low. Therefore, it seems necessary to develop effective strategies to improve the detection rate, such as the use of screening-instruments and the training of health professionals in the detection of psycho-social distress.

Prevalence and strong association of high somatic symptom severity with depression and anxiety in a Chinese inpatient population.

BACKGROUND: The prevalence of the high somatic symptom severity (HSSS) and its associations with sociodemographic factors, depression, and anxiety has not been surveyed in inpatient populations at general hospitals. METHODS: A sample including 1329 inpatients in a Chinese general hospital was surveyed using Chinese version of 15-item patient health questionnaire (PHQ-15), 9-item patient health questionnaire, and generalized anxiety disorder 7-item scale. RESULTS: A total of 27.8% (n = 369) of the participants had HSSS (PHQ-15 ≥ 10). The multivariate regression showed that HSSS was significantly associated with depression (adjusted odds ratio [aOR], 5.219), anxiety (aOR, 5.810), or depression or anxiety (aOR, 5.338) but neither with sex, age, marital status, education status, household income, nor 7 kinds of physical disease systems. DISCUSSION: The symptom profile and high prevalence of HSSS, and its association with clinically significant depression and anxiety in this inpatient population were mostly consistent to that documented by studies in other populations.

[Epidemiological investigation on major depressive disorder in the most heavily damaged areas from Wenchuan earthquake in 2008].

OBJECTIVE: To assess the prevalence, demographic characteristics, risk factors and protective factors on major depression disorder (MDD) among the affected people in the epicenter, 7 months after the 2008-earthquake in Wenchuan, China. METHODS: Stratified multistage cluster randomization was conducted to choose 14 503 subjects aged 15 years or over in the city of Dujiangyan, Beichuan county and Qingchuan county, Sichuan province. We used the general health questionnaire (GHQ-12) as the screening instrument, and the structured clinical interview for DSM-IV-TR axis I disorder-patient edition (SCID-I/P) as the tool for diagnosis. RESULTS: There were 180 persons diagnosed as MDD with other 13 asymptomatic ones. The point prevalence of MDD was 1.27% and the lifetime prevalence was 1.36%. Risk factors were including:being female (OR = 1.56, 95%CI: 1.136 ∼ 2.143, P < 0.05), co-morbidity with somatic diseases (OR = 4.02, 95%CI: 2.75 - 5.90, P < 0.05), wounded in the earthquake (OR = 3.29, 95%CI: 1.92 - 5.65, P < 0.05), property loss up to 10 000 - 20 000 Yuan (OR = 2.09, 95%CI: 1.18 - 3.69, P < 0.05), property loss up to > 20 000 Yuan (OR = 2.54, 95% CI: 1.38 - 4.68, P < 0.05), death or missing of family members (OR = 3.79, 95%CI: 2.08 - 6.89, P < 0.05) and in middle-age (OR = 2.31, 95%CI: 1.38 - 3.86, P < 0.05) etc. Having had a job seemed to be a protective factor (OR = 0.60, 95%CI: 0.43 - 0.83, P < 0.05). CONCLUSION: Major depressive disorder appeared to be a common psychiatric disease in these quake-stricken areas, that causing serious problems. Sustained follow-up and care provided to the affected people in these areas were of extreme importance.