Safety and efficacy of PD-1 inhibitors versus chemotherapy or ipilimumab in advanced melanoma:Meta-analysis / 中国免疫学杂志

Objective:To analyze the safety and efficacy of PD-1 inhibitors versus chemotherapy or ipilimumab in advanced melanoma.Methods:PubMed,CNKI,VIP and Wanfang databases were searched to collect randomised controlled trials of PD-1 inhibi-tors in treatment of advanced melanoma.The search time was from the establishment of the database to May 1,2022.Two reviewers independently screened the literature,extracted data,and assessed risk of bias of included studies.Meta-analysis was performed using RevMan5.4 and STATA16 software.Results:A total of 7 studies were included.Meta-analysis results show that:①Safety:Compared with chemotherapy,PD-1 inhibitor treatment had fewer adverse events,especially in the blood system;compared with ipilimumab alone,PD-1 inhibitor combined with ipilimumab had more adverse events,especially liver function indicators;there was no signifi-cant difference in the incidence of total adverse events between PD-1 inhibitor monotherapy and ipilimumab monotherapy.②Efficacy:The PFS,OS and ORR of PD-1 inhibitor versus chemotherapy or ipilimumab were HR=0.54,95%CI(0.45,0.62),P<0.05,HR= 0.69,95%CI(0.58,0.80),P=0.03 and OR=3.16,95%CI(2.59,3.86),P<0.05,respectively.Conclusion:PD-1 inhibitors have good efficacy in treatment of advanced melanoma,while different combination methods and different control treatments may have different efficacy.Limited by the quantity and quality of included studies,more research evidence is needed to support this.

Gene mutation analysis of glucose-6-phosphate dehydrogenase deficiency among infants in Kunming / 中华检验医学杂志

Objective:To analyze the genetic mutation characteristics of glucose-6-phosphate dehydrogenase (G6PD) deficiency among infants in Kunming.Methods:A total of 15 533 infants (7 994 males and 7 539 females) born in Kunming from January 1, 2018, to December 31, 2020, with an age range of 2 to 44 days, were selected. G6PD enzyme activity and gene mutation types were detected using fluorescence quantitative analysis, multicolor melting curve analysis (MMCA), and Sanger sequencing. Droplet digital PCR (ddPCR) was used for quantitative analysis of a newly identified variant family to determine the mutant allele proportion in family members. Meanwhile,the protein structure model and pathogenicity prediction of the novel variant were analyzed.Data analysis was conducted using SPSS 26.0. Specifically, chi-square tests were used for the detection rates of G6PD enzyme activity and gene mutations between different genders. One-way analysis of variance (ANOVA) was used for the comparison of enzyme activity among different mutation types.Results:Among 15 533 infants, 143 cases (129 males and 14 females) were tested positive for G6PD activity, with a detection rate of 0.92% (143/15 533). The difference in detection rates between males and females was statistically significant (χ 2=96.76, P<0.001). Out of 89 enzyme activity-positive cases (83 males and 6 females) underwent genetic testing, 77 (72 males and 5 females) were detected by MMCAand other 12 negative samples were underwent further Sanger sequencing, revealing mutations in 6 samples, all of which were males. Among the 83 individuals with gene mutations, 78 had heterozygous mutations, 1 had a homozygous mutation, and 4 had compound heterozygous mutations. A total of 12 mutation types were detected, with G6PD c.487G>A, c.1024C>T, c.1388G>A, and c.1376G>T being the most common, accounting for 74.70% (62/83) of all mutation types. The average G6PD enzyme activity of c.1376G>T was the lowest, and the differences were statistically significant compared to the average enzyme activity of the other three mutations ( P<0.05). One male infant with a newly identified G6PD c.242G>C mutation was detected, predicted to be pathogenic. ddPCR confirmed that the mother of the affected child was a c.242G>C mutant chimera, with a chimera proportion of 6.66%. Conclusions:In the Kunming region, the predominant G6PD deficiency gene mutation is c.487G>A, with the detection of a novel G6PD c.242G>C mutation. The application of ddPCR technology can assist in detecting the proportion of mutation chimeras.

Very-long chain acyl-coA dehydrogenase deficiency: report of a Chinese pedigree and a literature review / 中华医学遗传学杂志

OBJECTIVE@#To explore the correlation between clinical classification and genotype and prognosis among Chinese children with Very-long chain acyl-CoA dehydrogenase deficiency (VLCADD).@*METHODS@#A Chinese pedigree affected with VLCADD admitted at the First People's Hospital of Yunnan Province in February 2019 was selected as the study subject. The characteristics of disease onset, diagnosis and treatment and prognosis were retrospectively analyzed. Relevant literature was also systematically searched and reviewed.@*RESULTS@#The proband, a 1-year-old boy, had the clinical manifestations of frequently vomiting, hypoglycemia, abnormal liver function and myocardial enzymes. Tandem mass spectrometry screening showed significantly elevated C14, C14:1, C16:1, C16:2, C18 and C14/C8. Genetic testing revealed that he has harbored compound heterozygous variants of the ACADVL gene, namely c.664G>A (p.G222R) and c.1345G>A (p.E449K), which were respectively derived from his father and mother. The child was diagnosed with VLCADD cardiomyopathy type and deceased 2 weeks later. Literature review has identified 60 Chinese children with VLCADD. The clinical classifications were mainly cardiomyopathy type and liver disease type, which accounted for 73.3% (43/60). The combination of ACADVL gene variants were correlated with the clinical classifications of VLCAD. Children with one or two loss-of-function (LOF) mutations showed more severe clinical manifestation and a higher mortality. Cardiomyopathy type had the poorest prognosis, with a mortality rate of 76.9% (20/26). C14:1 may be used as an indicator for the diagnosis of VLCADD, but cannot be used for clinical subtyping and prognosis evaluation. The c.1349G>A (p.R450H) variant had the highest frequency among the Chinese patients, accounting for 10.8% (13/120).@*CONCLUSION@#The clinical classifications of VLCADD are strongly correlated with the prognosis, and LOF mutations are more common in those with severe clinical manifestations. c.1349G>A (p.R450H) may be the most common variant among the Chinese patients, and early screening and diagnosis can greatly improve the prognosis of patients.

Analysis of disease monitoring results in high incidence areas of brucellosis in Gansu Province from 2018 to 2020 / 中华地方病学杂志

Objective:To study the epidemiological characteristics of human brucellosis in high incidence areas of brucellosis in Gansu Province, and provide a guidance for precise prevention and control of brucellosis in the areas with high incidence of the disease.Methods:Using a retrospective research method, human brucellosis monitoring data from five high incidence counties of brucellosis in Gansu Province from 2018 to 2020, including Huan County (eastern), Guazhou County (western), Zhangjiachuan County (southern), Gaotai County (northern), and Jingtai County (central), were collected from monitoring database of the Central Transfer Payment Project. The epidemic characteristics of brucellosis in high incidence areas were described and analyzed.Results:From 2018 to 2020, there were a total of 787 laboratory confirmed cases of brucellosis in high incidence areas of brucellosis in Gansu Province, with a prevalence rate of 3.64%. The incidence rates for each year were 2.63% (205/7 780), 4.60% (327/7 111), and 3.78% (255/6 746), with statistically significant differences between different years (χ 2 = 41.44, P < 0.001). The prevalence rates of brucellosis in Huan County, Guazhou County, Zhangjiachuan County, Gaotai County, and Jingtai County were 0.02% (1/4 263), 3.67% (140/3 817), 4.32% (182/4 209), 4.89% (237/4 847), and 5.04% (227/4 501), respectively. There was a statistically significant difference in comparison between different regions (χ 2 = 211.59, P < 0.001). In 2018, the incidence rate was highest in Jingtai County in the central region, and scattered to Zhangjiachuan County in the south and Gaotai County in the north in 2019 and 2020. There were statistically significant differences in the prevalence rates among different genders, ages, ethnicities, educational levels, and occupational groups (χ 2 = 111.95, 212.76, 35.32, 89.59, 97.93, P < 0.001). From 2018 to 2020, the incidence of brucellosis in the < 20 (0.78%, 6.36%, 10.00%), 40 - 50 age groups (5.15%, 7.03%, 8.00%), students and young children (0.58%, 9.20%, 13.64%), and cadres (2.86%, 4.55%, 10.53%) showed an increasing trend year by year (χ 2trend = 21.55, 7.00, 30.63, 2.01, P < 0.001). Conclusions:The brucellosis in Gansu Province is still in a high level of growth stage, and the epidemic area is gradually dispersing; the cases are gradually becoming younger, and key occupational personnel are shifting from farmers and herdsmen to social workers. It is recommended to increase the scope of monitoring, increase publicity efforts, and enhance the self-protection and control awareness of key populations.

Establishment of prediction model for severe acute pancreatitis complicated with abdominal hypertension / 中华胰腺病杂志

Objective:To construct the prediction model of SAP complicated with intra-abdominal hypertension (IAH), and evaluate the prediction efficiency of the model.Methods:The clinical data of 322 SAP patients admitted to the emergency department of Cangzhou Hospital of Integrated Chinese and Western Medicine in Hebei Province from January 2017 to December 2021 were retrospectively analyzed. They were divided into IAH group ( n=153) and control group ( n=169) according to whether they had IAH complications or not. The clinical characteristics and laboratory test results of the two groups were compared. Multifactor logistic step-up regression was used to analyze the risk factors of SAP patients complicated with IAH. A nomogram model for predicting SAP complicated with IAH was established by using R software. The receiver operating characteristic curve (ROC) of the model was plotted, and the area under the curve (AUC) was calculated to evaluate its prediction efficiency. Calibration chart, Hosmer-Lemesshow test and decision curve analysis were used to evaluate the prediction accuracy and clinical application value of the model. The Bootstrap method was applied to verify the model internally. Results:In IAH group, cases with body mass index, CRP, procalcitonin (PCT), WBC, acute physiological and chronic health assessmentⅡ (APACHEⅡ) score, modified CT Severity Index score (MCTSI), incidence of complications (abdominal effusion, abdominal infection, gastrointestinal dysfunction, shock, multiple organ dysfunction syndrome), mechanical ventilation, the number of high-volume fluid reactivation (24 h≥4 L) were more than those in control group; serum albumin and serum calcium in IAH group were lower than those in control group, and the differences were statistically significant (all P value <0.05). Multivariate logistic regression analysis showed that serum albumin ( OR=0.815, 95% CI 0.710-0.937), CRP ( OR=1.005, 95% CI 1.002-1.008), MCTSI ( OR=2.043, 95% CI 1.695-2.463), complication of gastrointestinal dysfunction ( OR=4.179, 95% CI 2.170-8.049), and high-volume fluid resuscitation ( OR=4.265, 95% CI 2.269-8.015) were independent risk factors for IAH in SAP.The Nomogram prediction model was established using the five factors above as parameters, and the AUC value for predicting IAH complication was 0.886. The Hosmer-Lemesshow test showed a high consistency between the prediction results and the actual clinical observation results ( P=0.189). The results of decision curve analysis showed that the prediction probability of the model was between 10% and 85%, which could bring more benefits to patients. Conclusions:The early prediction model of SAP with concurrent IAH is successfully established, which can better predict the risk of SAP with concurrent IAH.

Spatial epidemic characteristics of human brucellosis in Gansu Province from 2016 to 2020 / 中华地方病学杂志

Objective:To learn about the epidemic dynamics and spatial epidemic characteristics of human brucellosis in Gansu Province.Methods:Data on human brucellosis in Gansu Province reported by China Disease Control and Prevention Information System from January 2016 to December 2020 were collected and analyzed by descriptive epidemiology and spatial clustering analysis.Results:A total of 10 025 cases of human brucellosis were reported in Gansu Province from 2016 to 2020, with a statistically significant difference in incidence rate between years (χ 2 = 242.86, P = 0.001). The incidence was the lowest in 2018 (6.03/100 000), and the highest in 2020 (11.39/100 000). The reported cases were concentrated in 45 - 55 years old, accounting for 34.52% (3 461/10 025); the male to female ratio was 2.91 ∶ 1.00 (7 458/2 567); farmers were the main occupation, accounting for 82.11% (8 232/10 025). Among the 86 counties (cities, districts) in Gansu Province, Yongchang County had the highest number of reported cases in 2020 (339 cases), and Sunan Yugur Autonomous County had the highest incidence in 2020 (190.89/100 000). Spatial autocorrelation analysis showed that there was significant spatial positive correlation between the incidence rate of human brucellosis in Gansu Province from 2016 to 2020 (global Moran's I > 0, Z > 1.96, P < 0.05), showing a spatial clustering distribution. The high-high clustering areas were concentrated in Yongchang County and Sunan Yugur Autonomous County. Conclusion:In Gansu Province, the main population of human brucellosis is middle-aged male farmers, and the incidence of brucellosis is spatially clustered.

Current Status and Progress of Diagnostic Techniques for Cancer of Unknown Primary / 肿瘤防治研究

Cancer of unknown primary (CUP) is a heterogeneous tumor type that has been diagnosed as a metastatic tumor by pathological examination, but the primary tumor cannot be identified through comprehensive clinical examination. The incidence of CUP accounts for approximately 1%–2% of all tumors. CUP progresses rapidly and has a short course. The treatment and prognosis of patients with CUP are closely linked to the primary site. In clinical settings, identifying the primary tumor remains challenging. Scholars have focused on improving the detection rate. Novel technologies, such as gene expression profiling, high-throughput sequencing, epigenetics, and liquid biopsy, have been successively applied to identify the primary tumor of CUP accurately, sensitively and specifically. With the guidance of molecular diagnosis, targeted therapy, immunotherapy, and combination therapy will usher in the era of precision treatment for CUP, which may become a typical example for individualized therapy.

Epidemiological characteristics and comparison of three diagnostic criteria on metabolic syndrome in adult residents of Zhejiang Province / 中华内分泌代谢杂志

Objective:To understand the epidemiological characteristics of metabolic syndrome(MetS) among adult residents in Zhejiang Province and compare three diagnostic criteria in adult residents.Methods:In this cross-sectisnal study participants were randomly chosen using multi-stage stratified cluster sampling method from 10 national chronic disease risk factor monitoring sites in Zhejiang Province of the 2018 China Chronic Disease and Risk Factors Surveillance Project. Demographics and information on chronic disease prevalence were obtained through questionnaire, physical measurements, and laboratory. After complex weighting of the data, an analysis and comparison of the prevalence of MetS under different diagnostic criteria among adult residents in Zhejiang Province was conducted.Results:A total of 5 369 adult residents were included, 2 411 males and 2 958 females. The prevalence of MetS using JIS, CDS and IDF diagnostic criteria was 33.62%, 25.32%, and 24.25%, respectively. The consistency rate between IDF and JIS was the highest(89.11%) and the Kappa value was 0.768( P<0.001). The consistency rate between IDF and CDS diagnostic criteria was 84.53%, and the Kappa value was 0.631( P<0.001). The consistency rate between JIS and CDS was the lowest(83.17%), and the Kappa value was 0.621( P<0.001). Under CDS diagnostic criteria, the prevalence of MetS was associated to gender, marital status, smoking and drinking. Conclusion:The prevalence of MetS is at a relatively high level among adult residents in Zhejiang province. The consistency between IDF and JIS diagnostic criteria is the highest. Screening for MetS should be strengthened to detect high-risk individuals early, reduce the risk of cardiovascular and cerebrovascular diseases and diabetes, and improve the quality of life of residents.

Adult linear scleroderma with ptosis: a case report and literature review / 中华神经科杂志

Objective:To discuss the clinical features, diagnosis and treatment of linear scleroderma (LS).Methods:A case of LS diagnosed in the Second Hospital of Shandong University in October 20, 2020, was reported and the clinical features and pathological documentation of the disease reported in the literature were reviewed.Results:A 24-year-old woman presented cicatricial alopecia on the left frontoparietal area and facial atrophy for about 10 years. Two years before, she began to suffer ptosis and neurological complaints. Clinical features of different stages of the disease are presented. All 15 patients reported in the literature were analyzed, with a median of 22 years and a male to female ratio of 9∶6. There were 4 cases of linear scleroderma with ipsilateral drooping eyelids and lateral contraction, 3 cases of linear scleroderma with demyelinating lesions, combined with lateral contraction, 3 cases of linear scleroderma combined with lateral atrophy, and 1 case of linear scleroderma with ipsilateral facial spasm. Two cases were with the chest sclerosing spot. Two cases of linear scleroderma were with epileptic seizure and white matter demyelination lesion. Six cases were treated with hormone, 2 cases were treated with methotrexate. One case was treated with both hormone and methotrexate. One case was treated with botulinum toxin. Three cases were treated with surgical correction of eyelid ptosis. One case was treated with ultraviolet A1 radiation phototherapy and 1 case was treated with vitamin therapy.Conclusions:Patients with scleroderma may have ipsilateral facial atrophy, blepharoptosis and facial spasm. Some patients involving the nervous system may have epilepsy and myelitis. And demyelinating lesions can be seen in magnetic resonance imaging. Localized scleroderma may develop into systemic scleroderma. Therefore, it is recommended to combine immunosuppressants as soon as possible to control the development of the disease if necessary.

Prevalence of brucellosis among humans and animals in Gansu Province from 2018 to 2020 / 中华地方病学杂志

Objective:To analyze the changes of spatial, seasonal, and age distribution of brucellosis among humans and animals in Gansu Province and to provide a reference for the next step in formulating prevention and control measures.Methods:Reported data of brucellosis of humans and animals in Gansu Province from 2018 to 2020 were collected. The human epidemic data were obtained from "China Disease Control and Prevention Information System", and the positive data of animals were obtained from the monthly report provided by Gansu Animal Disease Control Center. Human brucellosis was classified and analyzed according to year, month, age and region, and livestock brucellosis was classified according to year, month, population and region. ArcGIS 10.2 software was used to analyze the spatial epidemiological characteristics of the data. Measuring Geographic tool was used to calculate the shifting distance of the center of the disease incidence in humans and animals from 2018 to 2020.Results:From 2018 to 2020, a total of 6 375 cases of human brucellosis were reported in Gansu Province. The 40 - 59 age group accounted for 54.96% (3 504/6 375), 1 584 cases were reported in 2018, 1 787 cases were reported in 2019, and 3 004 cases were reported in 2020. The high incidence time of human brucellosis was July and November. A total of 48 180 brucellosis-positive animals (heads) were detected, of which 47 342 were positive sheep, accounting for 98.26% (47 342/48 180). The high incidence time of brucellosis among animals was October. Among the 14 cities (prefectures), the top cities of livestock brucellosis reported were Qingyang City, Zhangye City and Jiuquan City. The center of disease incidence among humans was located in Gulang County, Wuwei City. The center of disease incidence among animals was located in Wuwei City in 2018 and Qingyang City in 2020.Conclusions:The cases of brucellosis in humans and animals in Gansu Province are on the increase. In some areas, there are problems of separation of human and animal epidemics. It is necessary to actively strengthen monitoring and implement measures to prevent and control brucellosis in humans and animals in high-risk areas to curb the spread of the epidemic.

Association between sleep duration and hypertension among adults in Zhejiang Province / 预防医学

Objective@#To investigation the correlation between sleep duration and hypertension among adults in Zhejiang Province, and to provide scientific evidence for the prevention and control of hypertension.@*Methods@#Permanent residents at age of 18 years and older were enrolled from 10 surveillance sites for risk factors of chronic diseases included in the 2018 China Chronic Diseases and Risk Factors Surveillance Program. Subjects' demographic characteristics, smoking, alcohol consumption, sleep duration and development of hypertension were collected, and following complex weighting calculations, the association between sleep duration and hypertension were examined using a multivariable logistic regression model.@*Results@#Totally 5 770 adults were included, including 2 952 men (50.72%) and 3 178 women (49.28%), and the prevalence of hypertension was 29.39% (2 702 cases). There were 712 (8.37%), 1 077 (18.77%), 1 582 (28.68%), 1 717 (34.60%) and 682 adults (9.57%) with sleep duration of <6 h/d, 6 to 7 h/d, 7 to 8 h/d, 8 to 9 h/d and 9 h/d and longer, respectively. Taking the sleep duration of 7 to 8 h/d as a reference, multivariable logistic regression analysis identified a significant association between sleep duration of <6 h/d and the risk of hypertension (OR=1.709, 95%CI: 1.184-2.466), a significant association between sleep duration of 9 h/d and longer and the risk of hypertension (OR=1.369, 95%CI: 1.006-1.862) in men, significant associations between sleep duration of <6 h/d (OR=2.174, 95%CI: 1.528-3.093) and 6 to 7 h/d (OR=1.412, 95%CI: 1.078-1.850) and the risk of hypertension in women, and significant associations between sleep duration of <6 h/d (OR=3.095, 95%CI: 1.025-9.347) and 6 to 7 h/d (OR=2.046, 95%CI: 1.156-3.622) and the risk of hypertension in residents at ages of 18 to 44 years.@*Conclusions@#Short sleep duration may increase the risk of hypertension among adults at ages of 18 to 44 years in Zhejiang Province. Short sleep duration may increase the risk of hypertension in women and long sleep duration may increase the risk of hypertension in men.

Influenza-associated excess mortality in Zhejiang Province from 2016 to 2019 / 预防医学

Objective@#To estimate the influenza-associated excess mortality (IEM) in Zhejiang Province from 2016 to 2019, so as to provide insights into estimates of mortality burden due to influenza. @* Methods@#The data pertaining to all-cause death and influenza surveillance in Zhejiang Province from 2016 to 2019 were retrieved from Zhejiang Provincial Cause of Death Registration System and Influenza Surveillance System to create distributed lag non-linear models (DLNMs). The year-, influenza subtype- and age-specific IEM rates were estimated.@*Results@#The overall IEM was 18.67/105 (95%CI: 15.32/105-21.97/105) in Zhejiang Province from 2016 to 2019, with the lowest in 2016 (14.19/105, 95%CI: 12.00/105-16.37/105) and the highest in 2018 (22.92/105, 95%CI: 19.23/105-26.56/105). The IEM rates of influenza A (H1N1), influenza A (H3N2) and influenza B were 9.32/105 (95%CI: 7.65/105-10.98/105), 5.68/105 (95%CI: 4.24/105-7.11/105), and 3.66/105 (95%CI: 2.13/105-5.18/105). The greatest IEM was seen among residents at ages of 65 years and older (142.91/105, 95%CI: (115.99/105-169.55/105, followed by among individuals at ages of 15 to 64 years (2.74/105, 95%CI: 1.87/105-3.61/105), and the lowest was seen among individuals under 15 years of age (0.41/105, 95%CI: -0.33/105-1.14/105). @*Conclusions@#From 2016 to 2019, the highest IEM was seen in Zhejiang Province in 2018, and the elderly residents at ages of 65 years and above presented the greatest IEM, with influenza A (H1N1) as the predominant influenza subtype. Influenza surveillance and vaccination is recommended to be reinforced.

Glycosylated hemoglobin control and its influencing factors amongpatients with type 2 diabetes mellitus in rural communities of Zhejiang Province / 预防医学

Objective@#To investigate the degree and influencing factors of glycosylated hemoglobin ( HbA1c ) control among patients with type 2 diabetes ( T2DM ) living in rural communities of Zhejiang Province, so as to provide the reference for optimizing the management of diabetes patients in rural communities.@*Methods@#Permanent adult patients with T2DM that were registered and received standardized management in all communities of Jiashan County and Suichang County, and 6 communities of Yongkang City, Zhejiang Province in 2016 were recruited, and their demographic characteristics were captured from the health record system and chronic disease management system. The height, body weight, waist circumstance and blood pressure were measured, and HbA1c and blood lipid parameters were detected. The degree of HbA1c control ( <7% ) was analyzed, and its influencing factors were identified using a multivariable logistic regression model.@*Results@#A total of 10 339 patients with T2DM were enrolled, including 4 520 men ( 43.72% ) and 5 819 women ( 56.28% ), with a mean age of ( 63.54±9.78 ) years and the mean course of diabetes of ( 6.36±4.73 ) years. The rate of HbA1c control was 47.89%. Multivariable logistic regression analysis showed that males ( OR=1.123, 95%CI: 1.024-1.233 ), region ( Suichang, OR=2.413, 95%CI: 2.106-2.765; Yongkang, OR=2.460, 95%CI: 2.188-2.767 ), course of disease ( 5-9 years, OR=1.724, 95%CI: 1.504-1.977; 10 years and longer, OR=2.881, 95%CI: 2.477-3.351 ), use of hypoglycemic drugs ( OR=1.203, 95%CI: 1.089-1.329 ), development of chronic complications ( OR=1.190, 95%CI: 1.027-1.379 ), uncontrolled blood pressure ( OR=1.140, 95%CI: 1.030-1.261 ), uncontrolled blood lipid ( OR=1.258, 95%CI: 1.104-1.433 ), and smoking ( OR=1.318, 95%CI: 1.165-1.491 ) were statistically associated with HbA1c control among T2DM patients.@*Conclusion@#The rate of HbA1c control was 47.89% among T2DM patients in rural communities of Zhejiang Province. HbA1c control should be given a high priority among men living in low-economic-level regions with long course of disease, use of hypoglycemic drugs, chronic complications, smoking, uncontrolled blood pressure and lipid.

Trends in incidence and mortality of Alzheimer's disease in Zhejiang Province from 2003 to 2017 / 预防医学

Objective@#To analyze the trends in incidence and mortality of Alzheimer's disease (AD) in Zhejiang Province from 2003 to 2017, so as to provide the evidence for the development of AD prevention and control strategies. @* Methods@#The data pertaining to the incidence and mortality of AD in China from 2003 to 2017 were collected from the Global Burden Disease Study, and standardized to the data of the Sixth National Population Census in China in 2010. The trends in incidence and mortality of AD were analyzed using annual percent change (APC) and average annual percent change ( AAPC ) in Zhejiang Province from 2003 to 2017. @*Results@#The incidence of AD increased from 96.05/105 in 2003 to 140.96/105 in 2017 in Zhejiang Province, with AAPC of 2.776% ( P<0.05 ), and the greatest APC ( 3.419% ) was found during the period between 2003 and 2005 ( P<0.05 ). The standardized incidence of AD increased 102.06/105 in 2003 to 106.09/105 in 2017 in Zhejiang Province, with AAPC of 0.274% ( P<0.05 ), and the greatest APC ( 1.177% ) was measured during the period between 2003 and 2005 ( P<0.05). The mortality of AD increased from 24.60/105 in 2003 to 41.44/105 in 2017 in Zhejiang Province, with AAPC of 3.862% ( P<0.05 ), and the greatest APC (4.667%) was found during the period between 2005 and 2011 ( P<0.05 ). The standardized mortality of AD increased 26.83/105 in 2003 to 27.16/105 in 2017 in Zhejiang Province, with AAPC of 0.142% ( P>0.05 ), and the greatest APC ( 1.048% ) was measured during the period between 2005 and 2012 ( P<0.05 ).@*Conclusion@#Both the incidence and mortality of AD appeared a tendency towards a rise in Zhejiang Province from 2003 to 2017.

Development and Validation of the Humanistic Practice Ability of Nursing Scale

Purpose@#The purpose of this study was to develop a Humanistic Practice Ability of Nursing (HPAN) scale adapted to China and validate its psychometric properties. @*Methods@#The original HPAN scale was revised through a literature review. Sixteen experts who met the inclusion criteria were consulted 2 rounds by the Delphi method. According to their suggestions and opinions, the structure, content, and semantics of each item of HPAN were modified, and a HPAN scale was preliminarily developed. The HPAN scale was validated through item analysis, exploratory factor analysis, convergent validity, and reliability. The data came from 406 first-class hospital nurses. @*Results@#A 5-dimension, 29-item HPAN scale demonstrated satisfactory fit with significant factor loadings. The split-half reliability coefficient of the scale was .98, the split-half reliability coefficient of each dimension was .86–.99, Cronbach's α coefficient was .96, and the Cronbach's α coefficient of each dimension was .87–.98. The model fit of the scale was good, and the items of the scale showed convergent and discriminant validity. @*Conclusion@#The HPAN scale indicated that the reliability and validity were good. It is easy to imply factors of HPAN. This scale can be used to assess the HPAN.

Development and Validation of the Humanistic Practice Ability of Nursing Scale

Purpose@#The purpose of this study was to develop a Humanistic Practice Ability of Nursing (HPAN) scale adapted to China and validate its psychometric properties. @*Methods@#The original HPAN scale was revised through a literature review. Sixteen experts who met the inclusion criteria were consulted 2 rounds by the Delphi method. According to their suggestions and opinions, the structure, content, and semantics of each item of HPAN were modified, and a HPAN scale was preliminarily developed. The HPAN scale was validated through item analysis, exploratory factor analysis, convergent validity, and reliability. The data came from 406 first-class hospital nurses. @*Results@#A 5-dimension, 29-item HPAN scale demonstrated satisfactory fit with significant factor loadings. The split-half reliability coefficient of the scale was .98, the split-half reliability coefficient of each dimension was .86–.99, Cronbach's α coefficient was .96, and the Cronbach's α coefficient of each dimension was .87–.98. The model fit of the scale was good, and the items of the scale showed convergent and discriminant validity. @*Conclusion@#The HPAN scale indicated that the reliability and validity were good. It is easy to imply factors of HPAN. This scale can be used to assess the HPAN.

The effect and mechanism of dihydroartemisinin on triple-negative breast cancer MDA-MB-231 cells / 西安交通大学学报(医学版)

【Objective】 To study the inhibitory effect of dihydroartemisinin （DHA） on triple negative breast cancer MDA-MB-231 cells and its mechanisms. 【Methods】 CCK-8 method was used to detect the inhibitory effects of DHA， artemisinin derivative， on the proliferation of triple negative breast cancer MDA-MB-231 cells. qRT-PCR and Western blot were used to test the expressions of CIZ1， Snail and TGF-β1 at mRNA and protein levels. After the exogenous application of TGF-β1 cytokines or TGF-β1 pathway inhibitor SD-208， Wound healing， Transwell invasion assay and Western blotting were performed to detect the effects of activation/inhibition of TGFβ1-smads pathway on the anti-metastatic effects of DHA and its mechanisms. 【Results】 DHA could significantly inhibit the proliferation of human breast cancer MDA-MB-231 cell lines in a dose-dependent manner. It could significantly suppress CIZ1， Snail， and TGF-β1 expressions at mRNA and protein levels in MDA-MB-231 cells. TGF-β1 cytokines treatment could enhance the migration and invasion ability of breast cancer cell， where TGF-β1 treatment also enhanced CIZ1， snail protein expression and smad2/3 protein phosphorylation level. DHA could reverse the above TGFβ1-induced effects. Furthermore， after the application of the TGF-β1 pathway inhibitor SD-208， the anticancer activity of DHA was enhanced， and the expressions of CIZ1， snail and phos-smad2/3 proteins were significantly inhibited. 【Conclusion】 DHA could significantly inhibit the proliferation and metastasis of breast cancer cells through suppressing the TGF-β1/Smad and CIZ1 signaling.

Application of innovative PBL in pathophysiology teaching / 中华医学教育探索杂志

Pathophysiology is a comprehensive subject, which is very important to cultivate the clinical comprehensive thinking of medical students. Pathophysiology involves a wide range of subjects and contents, and is one of the major and difficult courses in basic medicine. Based on many years of research and practice, we have developed main-line-problem-based learning (ML-PBL). ML-PBL is a diversified teaching mode, including the main line teaching method, clinical case discussion method, and the main line synopsis explaining method. The analysis of application results shows that ML-PBL teaching improves the student performance. Furthermore, ML-PBL is more conducive to cultivating the comprehensive clinical thinking ability, improving the independent learning ability, and fully mobilizing the learning initiative.

Regulation of capsaicin receptor TRPV1 on depressive behavior and neuronal autophagy in cerebral ischemia-reperfusion mice / 中华行为医学与脑科学杂志

Objective:To explore the effect and molecular mechanism of capsaicin receptor(TRPV1) on neuronal autophagy and depression-like behavior in mice.Methods:Using the method of random number table, 87 C57 male mice were divided into Sham operation group (Sham group), cerebral ischemia/reperfusion group (I/R group) and capsazepine(CPZ) preconditioning cerebral ischemia/reperfusion group (I/R+ CPZ group), with 28 mice in each group due to 3 incompatible.Mice in the I/R group were subjected to right middle cerebral artery occlusion (MCAO) to establish a cerebral ischemia-reperfusion model.Mice in the I/R+ CPZ group were injected with CPZ in the lateral ventricle prior to moulding.Mice in the Sham group had only wire plugs inserted and no arterial embolization was performed.The mNSS score was used to evaluate the degree of neurological deficits.The depression-like behaviour of mice was detected by the tail suspension test and forced swimming test.The infarct volume was observed by TTC staining.The pathological changes in the amygdala were observed by HE staining, and the expression of Beclin-1, LC3, p62 and p-PI3K, p-AKT and p-mTOR proteins were detected by Western blot.Statistical analysis was performed using SPSS 23.0 software.The t-test was used for comparison between two groups and one-way ANOVA was used for comparison of multiple group. Results:The neurological deficit score in I/R+ CPZ group (9.77±2.32) was significantly lower than that in I/R group (12.85±2.73) ( t=3.10, P<0.01). Compared with I/R group, the tail suspension immobility time of I/R+ CPZ Group ((93.28±50.69)s, (143.80±35.61) s; t=2.94, P<0.01) and the forced swimming immobility time ((139.50±13.33)s, (175.30±19.78)s; t=2.94, P<0.01) were significantly reduced.The results of TTC staining showed that the cerebral infarct volume in I/R+ CPZ group was significantly lower than that in I/R group ((19.30±5.19)%, (33.60±3.90)%; t=5.40, P<0.01). HE staining showed that the number of cells in the amygdala region of mice in the I/R+ CPZ group increased compared with that in the I/R group, with tighter arrangement and reduced deep staining of nuclear fixation.Western blot showed that compared with I/R group, the expression levels of autophagy related proteins Beclin-1( t=2.94, P<0.05) and LC3 ( t=3.16, P<0.05) in amygdala of I/R+ CPZ group were down-regulated, while the expression levels of p62( t=3.60, P<0.05), p-PI3K ( t=7.79, P<0.01), p-AKT ( t=4.15, P<0.01) and p-mTOR ( t=6.15, P<0.01) were up-regulated. Conclusion:Cerebral ischemia/reperfusion activates neuronal autophagy, and CPZ may regulate the PI3K-AKT-mTOR pathway, thus inhibits excessive activation of autophagy, thereby acting as a neuroprotective agent and improving post-stroke depression-like behaviour.

Initial research on the brain functional magnetic resonance imaging induced by olfactory stimulations in multiple sclerosis / 中华神经科杂志

Objective To observe the characteristics of brain activation of multiple sclerosis (MS) patients and healthy controls at functional magnetic resonance imaging (fMRI) with olfactory stimulation,determine the locations of activation in areas of olfactory center and explore the MS olfactory related network.Methods Eighteen MS patients from the Affiliated Hospital of North Sichuan Medical College from February 2017 to March 2018 were enrolled as MS group,and 20 matched healthy adults during the same period served as controls.The Visual Analogue Scale was used to evaluate olfactory function in all subjects,the rest structure MRI was performed first,and volatile gases of lavender and rose solution were used to alternately stimulate olfactory during fMRI scanning.The brain activation was obtained by using matlab2013a and SPM8 softwares.The distribution and quantity of demyelination lesions were counted on T2 weighted image,and Spearman correlation analysis was done with SPSS 17.0 software package.Results The activated brain areas in the healthy control group included bilateral middle frontal gyrus,bilateral insula,bilateral supramarginal gyrus,bilateral orbitofrontal gyrus,right thalamus,right central anterior gyrus,bilateral cingulated gyrus,bilateral hippocampus,bilateral amygdala and bilateral superior frontal gyrus (t =2.11,P＜0.05).The activated brain areas in the MS group included right cerebellum,left insula,left superior temporal gyrus,right inferior frontal gyrus (t=2.19,P＜0.05).Compared with the control group,the MS group showed statistically significant decrease in activated values in right insula,right amygdala,right inferior frontal gyrus,right frontal middle gyrus,and the left supramarginal gyrus (t=2.04,P＜0.05).The distribution and number of demyelination lesions and major activation of brain regions with olfactory in the MS group demonstrated no significant correlation (r=-0.524,P=0.054).Conclusions Multiple brain areas involved in the olfactory processing and olfactory-related brain network existed.The activation of olfactory center had dominance in the right brain.The activation of the brain area in the MS group was significantly reduced,and the activation voxel and activation intensity were weakened.The olfactory-related brain network changed in MS patients.The distribution and number of demyelination lesions had no significant effect on the major activation of brain regions with olfactory stimulation.