Falls incidence and its influencing factors among the rural community elderly aged 65 years and above in Chongqing City / 公共卫生与预防医学

Objective To investigate the current situation and risk factors of falls in the rural community elderly aged 65 years and above in Chongqing City, and to provide references for developing preventive measures. Methods The multistage cluster random sampling method was used to select several rural communities in Chongqing City from September to December, 2019, and then the elderly aged 65 years and above who lived in the communities for one year were chosen to serve as the surveyed subjects. A self designed questionnaire (sociodemographic factors, exercise status, illness and medication status and fall to related information) was used to collect the data regarding falls occurring in the last year. The chi-square test and multi factor multi-variant logistic regression analysis were utilized to analyze the data, the used software was SPSS 25.0. Results A total of 801 rural community elderly people in Chongqing City were surveyed．The average age was (71.64±5.85) years old. 7.12% of elderly need cane or walker. 6.87% of them self-reported their health was poor. 42.57% of elderly seldom have the habit of exercise. The prevalence of heart disease, diabetes, osteoporosis, arthritis, cataract, deafness self-reported was 8.99%、8.11%、17.48%、25.97%、13.73% and 6.24% respectively. Totally 104 elderly people experienced 128 falls in the past 12 months, and the incidence rates of falls and falling times were 12.84% and 15.98% respectively．The multi-variant logistic regression analysis showed that poor heath status self-reported（OR=4.04，95% , CI：1.71-9.52）, diabetes （OR=2.68，95% CI： 1.41-5.12）, osteoporosis （OR=1.91 , 95% CI：1.16-3.15）, arthritis （OR=2.60 , 95% CI：1.65-4.11） and non self-care（OR=2.44，95% CI：1.16-5.16） were the risk factors for falls in the rural community elderly. Conclusions The incidence rate of falls in the rural community elderly aged 65 years and above in Chongqing City was low．It is necessary to formulate comprehensive intervention measures for the risk factors of fall so as to reduce the incidence rate of falls in the elderly.

Implication practice of “Internet Plus” new technology in chronic diseases management in community / 公共卫生与预防医学

Objective  To introduce and evaluate the practice of “Internet Plus” new technology for health management of chronic diseases in community in Yichang, and to provide reference for chronic disease patients' health management in community. Methods  Data of hypertensive patients were collected from the national basic public health service system, the big data intelligent sorting system for chronic disease patients in Yichang City, and the basic public health service system in urban areas in Yichang from 2016 to 2020. Data on the discovery, sorting and filing, standardized management rate and blood pressure control of urban hypertension patients were analyzed. The application effect of “Internet Plus” new technology in chronic disease community health management was evaluated. Results  From 2016 to 2020, 15 934 patients with hypertension were found and their health records were established through big and intelligent data in Yichang City, accounting for 93.54% (15 934 / 17 035) of the total. The rate of standardized management in each district increased year by year, with an increase of 8.71% in 2020 compared with 2016, and the difference was statistically significant (χ2=1273.30, P2=867.14, P<0.001). Conclusion  Data exchange and sharing among medical institutions at all levels can strengthen the health management of chronic diseases in the community. The “Internet Plus” new technology, integrating the Internet, big data, cloud computing and intelligent terminal technology, can effectively improve the detection, management and treatment rate of chronic diseases, and provide a new direction for the health management of chronic diseases.

A study on the application of Hay and IPE in the position evaluation of functional departments directors at public hospitals / 中华医院管理杂志

Objective:To conduct a position evaluation of functional departments directors by means of Hay guide-chart profile (Hay) and international position evaluation (IPE) for heads of public hospital departments, and a comparative analysis of the results, for reference in reforming the performance-related pay system of the functional departments.Methods:From July to August of 2021, positions of ten functional department directors of a public tertiary general hospital were selected, and expert groups within and out of the hospital were invited for a position evaluation using both Hay and IPE. Cronbach α and intraclass correlation coefficient were used in the reliability and consistency evaluation. Technique for order preference by similarity to ideal solution (TOPSIS) was conducted to compare the differences between results of both methods, with the position value ranked by quartiles. Results:22 position evaluation forms were issued and 20 were recovered (12 for in-hospital experts and 8 for extramural experts). In Hay evaluation, the scores of medical affairs department and hospital head office were higher, averaging 757.30 and 727.21 respectively, and those of logistics management department were the lowest, being 279.94. In-hospital experts scored lower than those extramural experts on the posts of directors of scientific research management department, Party committee office and medical insurance department, while the scores of the directors of the hospital head office were higher than those extramural experts. In IPE evaluation, the position values of hospital head office and medical affairs department were the highest, averaging 680.25 and 621.00 respectively, and the score of the logistics management department was the lowest, being 365.05. In-hospital experts scored lower than those extramural experts on the posts of directors of Party committee office, scientific research management department and logistics management department, while the scores of the directors of the hospital head office were higher than those of extramural experts. The Cronbach α coefficients of position value scoring of functional department heads evaluated by two evaluation methods were 0.943 (Hay) and 0.800 (IPE) respectively. The hospital head office and medical affairs department ranked the first quartile, the Party committee office and nursing department ranked the second, while the medical insurance department and logistics department ranked the third and fourth respectively. In addition, the ranking differences of the information technology department, human resource department, financial department and scientific research management department were within one quartile. Conclusions:The position evaluation results of Hay and IPE are consistent, but the former is more sensitive. Ranking of position values by quartiles via TOPSIS can support the reform of performance-related pay system of functional departments of public hospitals.

Literature Analysis and Textual Research on Huaihuasan / 中国实验方剂学杂志

Huaihuasan， first recorded in Puji Benshifang by XU Shu-wei from the Southern Song dynasty， consists of four herbs， namely Sophorae Flos （fried）， Platycladi Cacumen （smashed with pestle and baked）， Schizonepetae Spica， and Aurantii Fructus （cut into pieces after the removal of pulp and then fried yellow with wheat bran）. At present， Huaihuasan and its modified formulas vary in clinical usages and dosages， and the resulting outcomes have been investigated. However， there are few reviews uncovering its historical evolution. On this basis， this review systematically combed and verified the historical evolution， dose conversion between ancient and modern times， efficacy， and indications of Huaihuasan， as well as the origin and processing of the contained herbs. The findings have demonstrated that Huaihuasan is composed of four herbs， with the original plants and medicinal parts basically the same as those recorded in the 2020 edition of Chinese Pharmacopoeia. Sophorae Flos refers to the dried flower and bud of Sophora japonica in family Leguminosae， Platycladi Cacumen the dried branch and leaf of Platycladus orientalis in family Cupressaceae， Schizonepetae Spica the dried flower spike of Schizonepeta tenuifolia in family Labiatae， and Aurantii Fructus the dried immature fruit of Citrus aurantium in family Rutaceae or its cultivated varieties. On account of the efficacy in clearing intestine， stopping bleeding， dispersing wind， and moving Qi， Huaihuasan has been mainly used to treat intestinal diseases such as bloody defecation and perianal abscess. In modern clinical practice， it is mainly applicable to patients with hematochezia and bleeding due to internal hemorrhoid， ulcerative colitis， or anal fissure. It was suggested that the raw medicinal materials should be decocted and processed according to the methods described in the 2020 edition of Chinese Pharmacopoeia. Following the conversion formula of one Qian=4 g， this paper determined the dosages of Sophorae Flos （fried）， Platycladi Cacumen （smashed with pestle and baked）， Schizonepetae Spica， and Aurantii Fructus （cut into pieces after the removal of pulp and then fried yellow with wheat bran） all to be 2 g， with the total dosage being 8 g. Such comprehensive analysis based on ancient books and modern literature has provided a more scientific reference for the clinical application， research， and development of this classical formula.

Research on the commonalities and characteristics of provincial-level performance appraisal plan for tertiary public hospitals / 中华医院管理杂志

Objective:To understand the commonalities and characteristics of provincial-level performance appraisal plan of tertiary public hospitals, and to provide reference for improving and promoting their performances.Methods:The provincial plans introduced from January 31, 2019 to March 31, 2020 matched with the performance appraisal of the national tertiary public hospitals were retrieved through portal websites of the provincial people′s government and health commission, and 19 programs supplemented with local indicators on the basis of the National assessment index were selected as the research objects. The key information such as release time, issuing authority, evaluation object, implementation subject and index system of the plans were extracted, and content analysis method was used to analyze the characteristics and commonalities.Results:Ten out of 19 plans were released during June to July of 2019, and 12 plans were issued by the general office of the provincial people′s government, and the main body of assessment was the provincial-level health commission. Two first-level indicators of Party building and social benefits were added. The supplement of second-level indicators mainly focused on mandatory tasks, quality and safety, primary-level organization construction, service process and moral culture construction. A total of 241 third-level indicators were added, of which qualitative indicators accounted for 65.15%(157 indicators). The top five provinces with the most supplementary indicators were Guizhou, Jilin, Heilongjiang, Liaoning and Zhejiang. Seven provincial-level regions of Shanghai, Ningxia, Guangxi, Qinghai, Guizhou, Anhui and Yunnan clarified the grading standards and methods for performance appraisal results.Conclusions:The supplementary indicators of provincial-level performance appraisal plans for tertiary public hospitals focus on social benefits, Party building, and quality of medical care. The proportion of qualitative indicators is high, the classification of assessment objects is not clear enough, the characteristics of localized supplementary indicators are obvious, and the grading and result of performance appraisal index need to be optimized.

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients / 中华医学杂志(英文版)

BACKGROUND@#A patient's infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence.@*METHODS@#The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients' oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed.@*RESULTS@#In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0-62.0) years were analyzed. After in-hospital treatment, patients' inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0-11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients' stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0-16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0-4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients' urine specimens after throat swabs were negative. Using a multiple linear regression model (F = 2.669, P = 0.044, and adjusted R = 0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients' stools (t = -2.699, P = 0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs. 8.0 days, respectively; t = 2.550, P = 0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs. 11 days, respectively; t = 4.631, P  0.05).@*CONCLUSIONS@#In brief, as the clearance of viral RNA in patients' stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.

Effect of intervention on osteoporosis related knowledge and behavior in city residents / 上海预防医学

Objective To evaluate the impact of comprehensive intervention mode on osteoporosis related knowledge and behavior among city residents aged over 40-year-old and to provide reference for osteoporosis prevention and treatment. Methods Health education including self-management of osteoporosis was conducted among Chongqing city residents aged over 40-year-old for 4 consecutive months.All the subjects were asked to fill out the questionnaire during face-to-face interview before and after the intervention.The changes in knowledge and daily life style were tested by Chi-square test. Results The residents surveyed were 2 028 before the intervention and 1 986 after the intervention.After the intervention, the proportion of awareness was significantly higher (P < 0.01) than that before the intervention in the following: features of osteoporosis(33.23% vs 18.49%), sensitive population of osteoporosis(10.52% vs 3.75%), balanced diet to prevent osteoporosis (23.82% vs 11.09%), bone health supplements (51.06% vs 32.84%), recommended daily calcium intake for postmenopausal women and older people (34.89% vs 13.91%).After the intervention, the proportions of residents who never drink milk and its products, and never eat beans and their products were decreased significantly (13.49% vs 23.09%, and 4.94% vs 7.00%, P < 0.01).The proportion of residents who take average more than 30 minutes daily outdoor activity under sunlight was increased significantly after the intervention (64.25% vs 59.27%, P < 0.01).The proportion of residents preferring salty food was decreased significantly after the intervention (8.26% vs 14.89%, P < 0.01). Conclusion The comprehensive intervention mode of health education in combination with traditional and new media as well as health self-management is a cost-effective prevention measure for osteoporosis, which can improve the osteoporosis cognitive level of middle-aged and senile people and the development of good behavior.

Analysis of medical service efficiency of clinical departments based on data envelopment analysis-BCC model / 中华医院管理杂志

Objective:To analyze the output efficiency of medical services in clinical departments, so as to provide a breakthrough point for rational allocation of resources and improvement of service efficiency.Methods:The classic BCC model of data envelopment analysis(DEA) was used to evaluate the medical service efficiency of 44 clinical departments in a hospital, and the comprehensive efficiency, pure technical efficiency, scale efficiency and scale benefits were analyzed. The input indicators were the number of medical staff, medical costs and the number of beds at the end of the period. The output indicators were diagnosis-related group(DRG) indicators, including the number of DRG groups, total weight, case mix index, cost consumption index, time consumption index and mortality rate of low-risk group.Results:The average values of comprehensive efficiency, pure technical efficiency and scale efficiency of the whole hospital in 2018 were 0.897, 0.920 and 0.975 respectively. DEA was relatively effective in 16 departments(36%), weakly effective in 7 departments(16%), and ineffective in 21 departments(48%). In the case of constant output, the redundancy rates of the actual beds, medical staff and medical business expenditure of non DEA effective departments were 17.3%, 20.3% and 17.1% respectively; under the same input, the output of non DEA effective departments was insufficient.Conclusions:The comprehensive efficiency of medical services in this hospital is ideal, but the proportion of non DEA effective departments is relatively high. It is suggested to improve the efficiency of medical services by optimizing resource input, strengthening discipline construction, and strengthening cost control.

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients / 中华医学杂志(英文版)

Background@#A patient’s infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence.@*Methods@#The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients’ oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed.@*Results@#In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0–62.0) years were analyzed. After in-hospital treatment, patients’ inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0–11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients’ stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0–16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0–4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients’ urine specimens after throat swabs were negative. Using a multiple linear regression model (F=2.669, P=0.044, and adjusted R2=0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients’ stools (t=-2.699, P=0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs 8.0 days, respectively; t=2.550, P=0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs 11 days, respectively; t=4.631, P <0.001). There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results (P >0.05).@*Conclusions@#In brief, as the clearance of viral RNA in patients’ stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.

Early clinical efficacy of unicompartmental knee arthroplasty and total knee arthroplasty for elderly patients with medial compartmental knee osteoarthritis / 局解手术学杂志

Objective To compare the early clinical efficacy of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) for elderly patients with medial compartmental knee osteoarthritis.Methods A total of 35 elderly patients with medial compartmental knee osteoarthritis were selected from September 2014 to March 2018 in our hospital, of whom 16 cases treated by UKA were observation group and 19 cases treated by TKA were control group.ResultsThe operation time, intraoperative blood loss, the rate of perioperative blood transfusion, postoperative drainage volume and hospitalization stays of observation group were less than those of control group, the difference were significant (P＜0.05).Before the treatment, there was no significant differences in the KSS score between two groups (P＞0.05).After the treatment, KSS scores of two groups had been improved to some extent, and the observation group was better than the control group, the difference was significant (P＜0.05).No revision or infection happened in 1 year post-operative follow-up of either group.The observation group (0) were less than the control group (26.32％) in thrombosis rate, the difference was significantly (P＜0.05).ConclusionBoth UKA and TKA have certain early clinical efficacy, but UKA had advantages such as shorter operation time, shorter hospitalization, less pain, lower incidence of adverse reaction, which can promote the postoperative function recovery, the early clinical efficacy is more significant.

Outcomes of splenectomy in relapsed/refractory autoimmune hemolytic anemia / 中华血液学杂志

Objective@#To evaluate the outcomes of splenectomy in the treatment of relapsed/refractory autoimmune hemolytic anemia (AIHA).@*Methods@#Retrospective analysis was performed in 30 cases with relapsed/refractory AIHA who were treated with splenectomy in our hospital. The pre- and post-operative blood routine indexes and responses were followed up.@*Results@#Among the 30 relapsed/refractory AIHA patients, 20 were pure AIHA (including 13 patients with warm antibody AIHA, 2 with warm-cold double antibody AIHA and 5 with Coombs negative AIHA) and 10 were Evans syndrome. The short-term response was evaluated 10-14 days after operation, and the overall response rate (ORR) of short-term response was 90% [12 cases in complete response (CR), 6 cases in partial response (PR)] in 20 therapeutic evaluable cases. Among 13 patients with long-term follow-up data, except 3 patients with Evans syndrome died (2 cases were refractory to splenectomy, 1 case relapsed after surgery), the ORR of 10 patients with relapsed/refractory pure AIHA at 6 months and 12 months were 90% (9/10) and 70% (7/10), respectively, with a median follow-up of 14 (4-156) months. At the end of follow-up, 3 cases had maintained CR for more than 3 years.@*Conclusion@#The short-term response of splenectomy as a second-line treatment for relapsed/refractory AIHA is satisfactory, and long-term outcome of splenectomy is up to 70% at 1 year. Approximately one-third of patients could maintain sustained remission.

Efficacy of Lactated Ringer's versus Normal Saline in Treating Patients with Septic Shock / 中国医学科学院学报

Objective To compare the clinical efficacy of lactated Ringer's (LR) and normal saline (NS) in treating patients with septic shock. Methods The clinical data of 198 patients with septic shock who received fluid resuscitation in the Intensive Care Unit of Quzhou People's Hospital from January 2014 to January 2016 were retrospectively analyzed. These patients were divided into NS group (n=100) and LR group (n=98) according to fluids used. The amounts of trial fluid,other liquids,and blood products and the average total fluid volume were recorded. The oxygenation index (PO/FiO),mean artery pressure (MAP),central venous pressure (CVP),and B-type natriuretic peptide (BNP) before and after treatment as well as the early goal-directed therapy (EGDT) 8 h (EGDT8),EGDT 24 h recovery rate,EGDT recovery time,28-day mortality rate were compared. Other secondary outcomes including bleeding,allergic reaction,acute kidney injury (AKI),venous blood filtration (RRT) rate,hyperkalemia,and ICU stay were also recorded. The 28-day survival rate was calculated using the Kaplan-Maier method,and the difference in survival rate was compared by log-rank test. Results The two groups showed no significant difference in gender,age,body weight,source of admission to ICU,procalcitonin level,source of sepsis,Acute Physiology and Chronic Health Evaluation Ⅱ score,number of AKI patients,amount of white blood cells,and C-reactive protein level (all P>0.05). The amount of blood products on the first day [(782±357)ml vs.(606±273)ml;t=2.044,P=0.046] and the average total amount of liquid on the first three days [(5470±1078)ml vs.(5092±929) ml;t=2.640,P=0.009] were significantly higher in NS group than in LR group. The amount of trial fluid and the volumes of other fluids were not significantly different (both P>0.05). The PO/FiO,MAP,CVP,and BNP levels significantly increased after treatment in both groups (all P<0.05);however,they were not significantly different between LR group and NS group at different time points before and after treatment (all P>0.05). The incidences of hyperlactacidemia (86.0% vs.71.4%,OR:2.457,95%CI:1.202-5.023,P=0.012) and hyperchloremia (25.0% vs.13.2%,OR:2.179,95%CI:1.041-4.562,P=0.036) were significantly higher in NS group than in LR group. These two groups showed no significant difference in EGDT8,24 h recovery rate,EGDT recovery time,28-day mortality rate,AKI,RRT rate,hyperkalemia,and ICU stay (all P>0.05). Kaplan-Meier survival analysis showed that the 28-day survival rate was not significantly different (χ log-rank=0.012,P=0.911). Conclusion When liquid resuscitation is applied in patients with septic shock,the use of LR can lower blood transfusion requirement on the first day and total liquid dosage on the first three days (compared with NR), along with lower incidences of hyperlactacidemia and hyperchloremia,although there was no significant difference in the 28-day mortality rate.

Effects of ferritin heavy chain of Clonorchis sinensis on human hepatic stellate cell line LX-2 / 中华地方病学杂志

Objective To observe the effects of recombinant protein ferritin heavy chain of Clonorchis sinensis (CsFHC) on human hepatic stellate cell line LX-2. Methods LX-2 cells were cultured in vitro by the cell culture method . Cell proliferation/toxicity detection kit (CCK-8) was used to detect the cell proliferation activity of LX-2 cells stimulated with CsFHC recombinant protein [0 (control), 1, 2, 5, 10, 20 nmol/L] at 48 h and 72 h, respectively, and the effect of CsFHC recombinant protein on cell cycle was analyzed by flow cytometry; a semi quantitative RT-PCR was used to detect the mRNA expression of type I collagen (Collagen Ⅰ), type Ⅲ collagen (Collagen Ⅲ) and α smooth muscle actin (Αsma). Results The effects of CsFHC on proliferation of LX-2 cells (48 h: 0.987 ± 0.042, 1.315 ± 0.105, 1.298 ± 0.078, 1.432 ± 0.089, 1.781 ± 0.040, 1.581 ± 0.056; 72 h:1.050 ± 0.030, 1.503 ± 0.111, 1.671 ± 0.102, 1.769 ± 0.123, 1.927 ± 0.067, 1.492 ± 0.081) between groups were significantly different statistically (F = 1892.133, 534.136, P<0.05). The quiescent stage/DNA synthesis (G0/G1 ) cells in 1, 2, 5, 10, and 20 nmol/L CsFHC recombinant protein groups (74.93 ± 4.05, 75.87 ± 4.16, 76.73 ± 5.03, 78.57 ± 5.51, 74.90 ± 3.61) were significantly higher than that of control group (54.90 ± 3.61, P<0.05);the synthesis phase (S) + DNA synthesis late/mitotic (G2/M) cells (22.24 ± 3.06, 24.13 ± 2.00, 18.54 ± 1.53, 18.71 ± 1.53 and 21.17 ± 3.06) were lower than that of control group (33.26 ± 2.65,P < 0.05). In control and 1, 2, 5, 10, 20 nmol/L CsFHC recombinant protein groups, the differences of Mrna expression levels of Collagen Ⅰ, Collagen Ⅲ and α SMA were statistically significant (48 h:F=81.419, 14.417, 70.456;72 h:F=79.224, 50.461, 41.872, P<0.05). Conclusion The CsFHC recombinant protein can stimulate the proliferation and activation of LX-2 cells in vitro, the CsFHC involved in the process of hepatic fibrosis induced by Clonorchis sinensis.

Comparison of double titanium plate and clavicular hook plate for the treatment of Neer II distal clavicular fracture / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical efficacy of double titanium plate and clavicular hook plate for the treatment of Neer II distal clavicular fracture.</p><p><b>METHODS</b>From April 2013 to June 2015, 42 patients with Neer II distal clavicle fractures were non-randomly selected, including 25 males and 17 females. All patients were fresh closed fractures. Twenty patients were treated with double titanium plate with tight rope(group A), including 11 males and 9 females aged from 16 to 49 years old with an average age of(33.8±10.7) years;the time from injury to operation ranged from 2 to 5 days with an average of (3.5±1.8) days. Twenty-two patients were treated with clavicle hook plate(group B), including 14 males and 8 females aged from 27 to 53 years old with an average age of (37.7±9.9) years;the time from injury to operation ranged from 2 to 5 days with an average of (3.1±2.0) days. Operative time, blood loss, hospital stays and postoperative complications were observed and compared; fracture healing were compared among preoperative, postoperative at 1, 3 and 6 months; VAS and ASES scoring were used to evaluate shoulder function.</p><p><b>RESULTS</b>All patients were followed up from 6 to 12 months with an average of 7.2 months. All incisions were healed at stage I. Blood loss in group A were less than that of group B(<0.05); while there were no significant difference in hospital stays and operative time between two groups. No shoulder pain occurred in group A, 4 cases occurred shoulder pain in group B, and had significant difference. Fracture healing time ranged from 3 to 6 months with an average of 4.3 months. VAS score and ASES score in group A were higher than that of group B in pain, function and total score.</p><p><b>CONCLUSIONS</b>Compared with clavicle hook plate, double titanium plate has advantages of shorter incision wound, less bleeding and simply operation, less complications, and could avoid pain for removing internal fixation. Over reduction of acromioclavicular joint during operation does not affect its superior curative effect. It is better choice for the treatment of Neer II distal clavicle fracture.</p>

Dynamics of Rodent and Rodent-borne Disease during Construction of the Three Gorges Reservoir from 1997 to 2012 / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the impact of impoundment and active public health interventions on rodent populations and rodent-borne diseases in the Three Gorges reservoir region from 1997 to 2012.</p><p><b>METHODS</b>Surveillance data from 1997 to 2012 were extracted from the Public Health Surveillance System of The Three Gorges established in 1997. Temporal changes in the incidences of hemorrhagic fever with renal syndrome (HFRS) and leptospirosis, rodent density, pathogen-carrying rates, and their correlations were analyzed.</p><p><b>RESULTS</b>The average indoor and outdoor rodent densities decreased overall from 1997 to 2012. The average densities decreased by 47.72% (from 4.38% to 2.29%) and 39.68% (from 4.41% to 2.66%), respectively, after impoundment (2003-2012) compared with before impoundment (1997-2002). The average annual incidence rates of HFRS and leptospirosis were 0.29/100,000 and 0.52/100,000, respectively, and decreased by 85.74% (from 0.68/100,000 to 0.10/100,000) and 95.73% (from 1.47/100,000 to 0.065/100,000), respectively, after impoundment compared with before impoundment. Incidences of HFRS and leptospirosis appear to be positively correlated with rodent density in the reservoir area.</p><p><b>CONCLUSION</b>This study demonstrated that rodent density and incidences of rodent-borne diseases decreased and were maintained at low levels during construction of the Three Gorges dam. Measures that reduce rodent population densities could be effective in controlling rodent-borne diseases during large-scale hydraulic engineering construction.</p>

Vitamin C Attenuates Hemorrhagic Shock-induced Dendritic Cell-specific Intercellular Adhesion Molecule 3-grabbing Nonintegrin Expression in Tubular Epithelial Cells and Renal Injury in Rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The expression of dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin (DC-SIGN) in renal tubular epithelial cells has been thought to be highly correlated with the occurrence of several kidney diseases, but whether it takes place in renal tissues during hemorrhagic shock (HS) is unknown. The present study aimed to investigate this phenomenon and the inhibitory effect of Vitamin C (VitC).</p><p><b>METHODS</b>A Sprague-Dawley rat HS model was established in vivo in this study. The expression level and location of DC-SIGN were observed in kidneys. Also, the degree of histological damage, the concentrations of tumor necrosis factor-μ and interleukin-6 in the renal tissues, and the serum concentration of blood urea nitrogen and creatinine at different times (2-24 h) after HS (six rats in each group), with or without VitC treatment before resuscitation, were evaluated.</p><p><b>RESULTS</b>HS induced DC-SIGN expression in rat tubular epithelial cells. The proinflammatory cytokine concentration, histological damage scores, and functional injury of kidneys had increased. All these phenomena induced by HS were relieved when the rats were treated with VitC before resuscitation.</p><p><b>CONCLUSIONS</b>The results of the present study illustrated that HS could induce tubular epithelial cells expressing DC-SIGN, and the levels of proinflammatory cytokines in the kidney tissues improved correspondingly. The results also indicated that VitC could suppress the DC-SIGN expression in the tubular epithelial cells induced by HS and alleviate the inflammation and functional injury in the kidney.</p>

Progress on osteochondritis dissecans / 中国骨伤

Along with the popularity of youth movement, the incidence of osteochondritis dissecans (OCD) showed a trend of increase, but its pathogenesis is not yet clear. Previous studies suggested that trauma is the main potential cause, but with the emergence of vast family cases, hereditary factor is also gradually taken seriously. Arthroscopy is the "gold standard" for diagnosing OCD, but for the patient with early incomplete joint surface lesions, the diagnositic value of MRI is better than the arthroscopy. For the patients with stable form OCD, nonoperative management should be used such as adjusting activity, fixator and drugs; for the patient with unstable form OCD or failing after conservative treatment, surgery should be generally used such as joint clearing, drilling, microfracture method, fixation and transplantation. With the progress of research, stem cell technology and platelet-rich plasma gradually applied in cartilage repair, which will improve the curative effect of OCD, but still further clinical and experimental research, and also a long-term effective follow-up are needed.

Different biological characteristics between nucleus pulposus and annulus fibrosus cells in rabbits / 中国骨伤

<p><b>OBJECTIVE</b>To compare biological characteristics between nucleus pulposus and annulus fibrosus cells in vitro model.</p><p><b>METHODS</b>Five New Zealand white rabbits (2 to 3 kg, either gender) were isolated nucleus pulposus and annulus fibrosus under sterilized condition, then cultured in nutrient solution with 15% FBS and DMEM/F12 (1:1) by enzyme digestion combined with tissue block method. When 90% cells fused, subcultring were performed. Cell morphology were observed by inverted phase contrast microscope, cell viability were detected by trypan blue staining, histological were observed by a toluidine blue and HE staining, cell proliferation were tested by MTT method, then the cell morphology, viability, proliferation between nucleus pulposus and annulus fibrosus were compared.</p><p><b>RESULTS</b>There were no obviously differences between nucleus pulposus and annulus fibrosus in original and the first strain. Physalides were appeared in annulus fibrosus on the second generation. The strapping time was later, and activity was lower in nucleus pulposus than annulus fibrosus. The growth of cell proliferation in nucleus pulposus was lower than annulus fibrosus from the ninth day.</p><p><b>CONCLUSION</b>The cell activity in annulus fibrosus is higher than nucleus pulposus. Digenerative disc disease may caused by recession of nucleus pulposus,local biomechnical changes, furether caused structure change and function loss of annulus fibrosus.</p>

Effect of comprehensive control and prevention for chronic disease in demonstration plot of Chongqing / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of comprehensive control and prevention for chronic diseases in demonstration plot of Chongqing.</p><p><b>METHODS</b>Residents were enrolled through multi-stage stratified random sampling method from 17 districts or counties which had successfully established demonstration plots and 21 districts or counties which had not established demonstration plots (non-demonstration plot for short) yet on May, 2012. Questionnaire was designed to survey awareness of health knowledge, health behaviors and utilization of health supportive tools. The results were analyzed by SPSS 15.0 software.</p><p><b>RESULTS</b>We investigated 15 108 residents, 6156 of which were in demonstration plot and others (8951) were not. The findings revealed the percentage of the people who were aware the national action of health lifestyle in demonstration plot and in non-demonstration plot were 44.4% (2734/6157) and 40.2% (3598/8951), respectively, and the awareness of the hypertension risk of too much sodium were 72.4% (4458/6156) and 67.5% (6042/8951), respectively, and the awareness of the cardinal vascular disease (CVD) risk of obesity and overweight were 77.2% (4753/6157) and 69.6% (6230/8951), respectively. About the residents' health behaviors in demonstration plot and in non-demonstration plot, the utilization rates of salt restriction scoop or pot were 23.5% (1447/6157) and 17.9% (1602/8951), and the utilization rates of oil restriction pot were 16.7% (1028/6157) and 11.8% (1064/8951), respectively. Totally, 33 of the 37 indexes were shown higher in demonstration plot than that in non-demonstration plot (P < 0.05).</p><p><b>CONCLUSION</b>The chronic diseases comprehensive control and prevention in demonstration plot was more effective, and the remarkable improvement of health knowledge and behaviors level had been achieved in demonstration plot.</p>

Diagnosis and surgical treatment of 52 patients with pancreatic body and tail carcinoma / 中国肿瘤临床

Objective:The present study discussed the clinical diagnosis and treatment of pancreatic body and tail carcinoma. Methods:The data of 52 patients with pancreatic body and tail carcinoma treated in Tianjin Medical University Cancer Institute and Hospital from January 2008 to December 2012 were reviewed retrospectively. The data included historical materials of perioperative examination and therapy. The data of 49 cases were reviewed retrospectively, and the median survival was calculated by the Kaplan-Meier method. The effects of the clinicopathologic parameters on the prognosis of patients with pancreatic body and tail carcinoma were examined by the log rank test. Results:Thirty-eight patients underwent exploratory surgery among which 24 had surgical resection, and the standard procedure was distal pancreatectomy plus splenectomy. The tumor staging was stage I in five patients (13.16%), stage II in nineteen patients (50%), stage III in five patients (13.16%), and stage IV in nine patients (23.67%). The median survival time was 18.0 ± 1.23 months for patients who received radical resection and 10.0 ± 2.71 months for patients who underwent nonspecific treatment or palliative therapy. The radical resection was associated with a longer survival period than the nonspecific treatment or palliative therapy (P<0.01). Conclusion:Early diagnosis is the key to achieving long-term survival. The radical resection plays an important role in improving the surgical treatment.