Influencing factors of phenobarbital treatment effect in rural epilepsy patients in Hubei Province / 公共卫生与预防医学

Objective To analyze the main factors influencing the management effect of rural epilepsy prevention and control projects in Hubei Province, and to provide reference for further improving the management effect. Methods According to the phenobarbital treatment and management plan of the rural epilepsy project, the target population was screened and reviewed, and patients who met the inclusion criteria were enrolled into the project management. Regular follow-up visits, free drug treatment, health education and other measures were carried out, and all relevant information was collected and integrated into the survey data. After the data was reviewed level by level, SPSS20.0 software was used for statistical analysis. Results From January 1, 2015 to December 31, 2020, among patients treated and managed with phenobarbital in 6 project counties, 1430 patients were treated and managed for more than 1 year, of whom 1119 (78.25%) had no seizures or had more than 75% reduction in the number of seizures during the observation period. Compared with other age groups, the age group of 65 years and above had the highest markedly effective/effective ratio (95.77%). From the point of follow-up, the markedly effective/effective ratio of 5 years and above was the highest (91.51%). Compared with those who received no treatment prior to enrollment and those who received regular treatment, the patients receiving informal treatment had the lowest markedly effective/effective ratio (82.43%). 1213 cases (84.83%) had good compliance during the observation period, of whom 1062 cases (87.55%) had a reduction in the number of seizures by more than 50% compared with that before treatment. Univariate analysis showed that the age of patients, the length of follow-up, the treatment status before enrollment, the average daily dose of phenobarbital and the compliance of patients all had an impact on the management effect, and the difference was statistically significant (P<0.05). Multivariate analysis showed that the markedly effective/effective rate of patients in the age group of 65 years and above was 6.749 times that of the younger age group. Receiving informal treatment prior to enrollment was a risk factor for difficult-to-control epilepsy. The markedly effective/effective rate of patients receiving informal treatment was 0.29 times that of patients never receiving treatment. Good compliance was a protective factor for epilepsy control, and the markedly effective/effective rate of patients with good compliance was 2.058 times that of patients with poor compliance. Conclusion The epilepsy prevention and management project in rural areas has a significant effect on seizure control. Early treatment, standardized treatment, and improvement of treatment compliance are effective ways to improve the management effect of epilepsy patients.

A qualitative study of family caregivers'experiences of caring for adolescents with first-episode depression / 中国心理卫生杂志

Objective:To explore the care experience of caregivers of adolescents with first-episode depres-sion.Methods:Nine family caregivers of adolescent with first-episode depression were enrolled.A qualitative re-search was carried out,and semi-structured interviews were performed to investigate the caregivers'opinion of de-pressive disorder,emotional state,caring experiences and dilemma,coping strategy,and support requirements.The data were analyzed,summarized and distilled by using the Colaizzi phenomenological 7-step analysis.Results:Four kinds of first order themes of caring experiences(complex caring experience,heavy burden of care,yearn for sup-port,achieved post-traumatic growth)were extracted,including 10 kinds of second order themes,namely shock and disbelief,pessimism and helplessness,guilt and stigma,inefficient coping strategy,impaired physical and mental health,heavy economic burden,family relationship tension,changed personal role,lack of medical support,dying to be admitted by society.Conclusion:Family caregivers of adolescent with first-episode depression may have obvious negative emotions,which faced with caring dilemma such as impaired health status or heavy economic burden,and urgently need professional resources and social support.

Association between sleep and obesity in adults / 预防医学

Objective@#To examine the associations of sleep with overweight/obesity and central obesity in adults, so as to provide insights into improving sleep quality and preventing obesity in adults.@*Methods@#Demographics, height, body weight, waist circumstance and sleep status were collected from the Hubei Provincial Surveillance Program for Adult Chronic Diseases and Their Risk Factors in 2020. Subjects' sleep condiction, overweight/obesity and central obesity were descriptively analyzed. The associations of sleep with overweight/obesity and central obesity were examined using a multivariable logistic regression model.@*Results@#A total of 17 789 participants were recruited, with an average age of (56.21±13.05) years, 61.50% women, and mean duration of (7.18±1.56) h/d. There were 7 019 participants with snoring/asphyxia/suffocation (39.46%), 6 108 participants with sleep difficulty (34.34%), 8 064 participants with night waking at least twice (45.33%), 268 participants taking hypnotics (1.51%), and 6 267 participants with early morning awakening and difficulty in sleep again (35.23%), and there were 8 960 participants with overweight/obesity (50.37%) and 6 148 participants with central obesity (34.56%). Multivariable logistic regression analysis showed that sleep duration of <7 h/d (OR=1.081, 95%CI: 1.007-1.159), snoring/asphyxia/suffocation (OR=2.367, 95%CI: 2.222-2.521), and night waking at least twice (OR=1.106, 95%CI: 1.028-1.191) significantly correlated with overweight/obesity, and sleep duration of >8 h/d (OR=0.834, 95%CI: 0.761-0.913), snoring/asphyxia/suffocation (OR=2.153, 95%CI: 2.019-2.297), and night waking at least twice (OR=1.193, 95%CI: 1.105-1.288) were statistically associated with central obesity.@*Conclusion@#Sleep duration, snoring/asphyxia/suffocation and night waking are associated with overweight/obesity and central obesity.

Application of neural network model and logistic regression in the prediction of chronic obstructive pulmonary disease / 公共卫生与预防医学

Objective To establish a mathematical prediction model for chronic obstructive pulmonary disease (COPD) by applying an artificial neural network (ANN) and logistic regression analysis method. Methods A cross-sectional survey was conducted in 2015 to collect epidemiological data of COPD of 2 400 residents from Hubei Province. Subjects were randomized into training group and test group at a ratio of 7:3. The prediction models of COPD were established using ANN and logistic multiple regression. The predictive performance of the two models was compared. Results Information from a total of 1 569 subjects was valid and analyzed, including 1,099 cases in the training group and 470 cases in the test group. The area under curve (AUC) of ANN for training group and test group was 0.80 and 0.78, respectively. The AUC of logistic regression for training group and test group was 0.75 and 0.74, respectively. Conclusion It is feasible to apply ANN and logistic regression models to predict COPD, which can provide scientific evidence for COPD prevention and treatment.

Glibenclamide protects neurovascular units in rats with cerebral ischemia/reperfusion injury by regulating inflammatory signaling pathway HSP70/p-Akt/MMP-9/COX-2 / 中华神经医学杂志

Objective To investigate the protective effect of glibenclamide on neurovascular units (NVUs) and its possible mechanism in cerebral ischemia/reperfusion injury models.Methods One hundred and twenty healthy male SD rats were randomly divided into sham-operated group, model group, and glibenclamide (GBC) treatment group (n=40). Two h reperfusion models of acute focal middle cerebral artery occlusion were prepared by thread occlusion in rats of the latter two groups; rats in the model group were treated with 0.05％ DMSO saline solution two h after ischemia, and rats in the GBC treatment group were given intraperitoneal injection of 10μg/kg GBC with single dose. Immunofluorescence and Western blotting were used to detect the protein levels of sulfonylurea receptor 1 (SUR1) and transient receptor potential cation channel subfamily M member 4 (TRPM4) 8 h after reperfusion, and ELISA was used to detect the plasma level of matrix metalloproteinase 9 (MMP-9). At 24 h after reperfusion, Zea Longa scale was used to determine the neurological deficits; water content in the brain tissues was detected by dry and wet weight method, and blood-brain barrier (BBB) permeability was detected by Evans blue (EB) staining; Nissl staining was employed to detect the survival neurons; ionized calcium bindingadaptor molecule-1 (Iba-1) and cyclooxygenase-2 (COX-2) positive cells and IgG seepage quantity were detected by immumohistochemical staining to assess the neuro-vascular inflammation; the expressions of heat shock protein 70 (HSP70), phosphorylated protein kinase B (p-Akt), phosphorylated c-jun amino-terminal kinase (p-JNK), and phosphatidylinositol-3 kinase (PI3K) were detected by Western blotting.Results (1) At 8 h after reperfusion, the protein expressions of SUR1 and TRPM4 in the brain tissues of the model group were significantly increased as compared with those of the sham-operated group (P<0.05), and the two proteins were co-located; as compared with those in the model group, the protein expressions of SUR1 and TRPM4 in GBC treatment group was decreased, but the differences were not statistically significant (P>0.05). As compared with the sham-operated group, the model group had significantly higher MMP-9 level (P<0.05); as compared with the model group, the GBC treatment group had significantly lower MMP-9 level (P<0.05). (2) At 24 h after reperfusion, as compared with the sham-operated group, the model group had significantly increased Zea Longa scale scores, statistically increased brain water content, significantly increased EB permeability, significantly increased IgG seepage quantity, significantly smaller number of Nissl's staining-positive neurons, significantly larger number of Iba-1, COX-2 positive cells, and significantly decreased protein expressions of HSP70 and p-Akt (P<0.05); as compared with the model group, the GBC treatment group had significantly decreased Zea Longa scores, statistically decreased brain water content, significantly decreased EB permeability, significantly decreased IgG seepage quantity, significantly larger number of Nissl's staining-positive neurons, significantly smaller number of Iba-1, COX-2 positive cells, and significantly increased protein expressions of HSP70 and p-Akt (P<0.05).Conclusion SUR1-TRPM4 expression is increased after cerebral ischemia/reperfusion injury, and inhibition of SUR1-TRPM4 with GBC shows a protective role in NVUs after cerebral ischemia/reperfusion injury, possibly by regulating HSP70/p-Akt/MMP-9/COX-2 inflammatory signal pathway.

Analysis of geographic distribution of arsenic in drinking water of residents in Hubei Province / 中华地方病学杂志

Objective To make clear the arsenic distribution in drinking water sources in Hubei Province, make provincial distribution map of high-arsenic water and provide scientific basis for formulating refined measures to prevent and control arsenic poisoning of drinking water type in Hubei Province. Methods In 103 counties of Hubei Province, residents were sampled according to different water supplies (centralized water supply, small centralized water supply in rural areas and decentralized water supply). One water sample was collected from source water and tap water in centralized water supply system and at least 3 samples were collected from decentralized water supply system in a village. Water iodine content was tested using atomic fluorescence spectrometry and a distribution map of high-arsenic water at county level was drawn using ArcGIS 10.2. Results Totally 38 292 water samples were collected. The water-arsenic-concentration median was less than 1.00 μg/L. The high-arsenic water detection rate in urban centralized water supply was 3.7%(80/2 176);which were all 0.1%(4/4 304,30/31 812) in small centralized water supply in rural areas and decentralized water supply. The high-arsenic water sources from centralized water supplies were distributed centrally in the south, the central and the east of Hubei Province and those from dispersed water supplies were distributed dispersedly in the south, the central and the east of Hubei Province.Conclusions There are still some dispersed water supplies with very high arsenic concentration in Hubei Province, which should be included to change the water area as soon as possible. Moreover, high arsenic water samples are found from centralized water supplies, which means the water treatment process should be upgraded or water resources should be changed.

Distribution of fluorine content in drinking water of residents in Hubei Province / 中华地方病学杂志

Objective To make clear the fluorine content distribution in drinking water of residents in Hubei Province,draw a provincial distribution map of high-fluorine water and provide scientific basis for formulating refined prevention and control measures of drinking water type fluorosis in Hubei Province.Methods In 116 counties of Hubei Province,including development zones,scenic zones and farmlands,drinking water of residents was sampled according to different water supplies (centralized water supply,small centralized water supply in rual areas and decentralized water supply) from 2013 to 2015.For a centralized water supply,one sample was collected from the source water and the tap water each and at least 3 samples were collected for decentralized water supply in a village.Selective electrode method was used to detect the water fluorine content and ArcGIS 10.2 was used to draw distribution map of high-fluorine water at county level.Results A total of 38 284 water samples were collected,the median of fluorine content was 0.21 mg/L.The highest detective rate of all types of water supply with high fluorine content was pressure water well (64/100,64.0％) and high-fluorine water sample was not found in the reservoir.The high-fluorine water sources from centralized water supplies were distributed dispersedly in the north-west and the east of Hubei Province and those from decentralized water supplies were distributed dispersedly in the middle-north and the east of Hubei Province.Conclusions Fluorine concentration in drinking water is generally low.However,there are still some high-fluorine water supplies which should be reported to Hubei Provincial Water Resources Department as soon as possible.Moreover,there is a phenomenon of fluorine rebounce in the water reduction project,and managements of those projects should be strengthened.

Geography distribution of iodine in drinking water in Hubei Province / 中华地方病学杂志

Objective To make clear the geography distribution of iodine in drinking water in Hubei Province,and make a provincial distribution map and provide scientific basis for formulating refined prevention and control measures to iodine deficiency disorders in Hubei Province.Methods In 116 counties of Hubei Province,including development zones,scenic zones and farmlands,drinking water samples were collected according to different water supplies (centralized water supply and decentralized water supply).One source water and a tap water sample were collected for a centralized water supply and at least 3 samples for decentralized water supply in a village were collected.Water iodine quantitative detection kit was used to detect the water iodine content and ArcGIS 10.2 to draw the distribution map of water iodine at county level.Results Totally 38 275 water samples were collected,and 83.47％ (31 950/38 275) of them were came from decentralized water supply.The water-iodine-concentration median was 4.89 μg/L and 66.28％ (25 368/38 275) of them were lower than 10 μg/L.Samples with water-iodine-concentration higher than 150 μg/L were 0.15％ (56/38 275),which were distributed in the southern,northern and centre Hubei Province and a few in the east.Conclusions Iodine concentration in drinking water is generally low in Hubei Province.As an important and main measure to prevent iodine deficiency disorders,universal salt iodization (USI) should be carried out as a long-term measure.Districts of iodine content higher than 150 μg/L should be reported to Hubei Provincial Water Resources Department as soon as possible.

A dental fluorosis trend analysis of children aged 8 to 12 in drinking-water-type endemic fluorosis areas of Hubei Province from 2010 to 2014 / 中华地方病学杂志

Objective Through the dynamical monitoring of the water improvement projects operation,we intend to understand the prevalent trends of endemic fluorosis of children aged 8 to 12 in Hubei,to evaluate the effect of control measures and to provide the basis for making preventive measures.Methods In Hubei,ten surveillance counties were selected,and three epidemic villages were selected as fixed monitoring villages in each county from 2010 to 2014.In those villages,the operation situation of water improvement projects and the fluoride content in drinking water were detected,and the dental fluorosis of children aged 8 to 12 was diagnosed.Results From 2010 to 2014,the normal operation rate of water improvement projects was 75.61％-100.00％,the average of water fluorine content did not change,the differences were not statistically significant (F =2.00,P ＞ 0.05).The numbers of water improvement projects with water fluorine content in excessive amount was increased in the past five years which was only one project in 2010-2012 and was increased to two projects in 2013 and 2014.In 2010-2014,the dental fluorosis prevalence rate of whole children was 9.45％ (525/5 557),the dental fluorosis prevalence rate of exceeding-standard villages of water fluoride content was 42.40％ (92/217),the dental fluorosis prevalence rate of qualified villages was 8.11％ (433/5 340).The children's dental fluorosis prevalence rate of exceeding-standard villages of water fluoride content was higher than that in qualified villages;the differences were statistically significant (x2 =282.60,P ＜ 0.05).Conclusions The operation rate of water-improving projects is mostly higher than 90％,and so is the qualification rate of fluoride content in drinking water.The operation condition and water quality of the water-improving projects in Hubei need to be improved.The prevalence of children dental fluorosis of affected villages has dropped significantly after low fluoride water is provided continuously.

Inhibitory effect of Aristolochia fruit on Cytochrome P450 isozymes in vitro and in vivo

The mature fruits of Aristolochia debilis, known in China by the name, "Madouling" has been popularly prescribed in Asia, particularly in China, to treat a range of conditions including gynaecological problems, arthritis and wound healing. This study was aimed to evaluate the potential effect of Madouling on the cytochrome P450 [CYP] isozymes in vitro in microsomal fractions and in vivo in rats. The influence of Madouling on CYPs activity was first explored by an in vitro method of estimating levels of four respective metabolites in rat liver microsomes. The results were re-examined in vivo in rats by using a cocktail approach involving the probe drugs theophylline, tolbutamide, chlorzoxazone and dapsone. Pharmacokinetics of the four substrates was used to analyze the activities of the targeting isozymes. In vitro study revealed that Madouling decreased the activity of CYP1A2, 3A1 and 2E1. However, no significant influence on CYP2C6 was found. These results coincided with those of in vivo study to a great degree except that in vivo estimation the herb didn't inhibit CYP1A2 significantly. From the data obtained, Madouling is suggested as a c and idate for clinically significant CYP interactions. Drug co-administrated with Madouling may need dose adjustment.

Analysis of testing and acceptance results in controlling and eliminating coal-burning-borne endemic fluorosis in Hubei Province / 中华地方病学杂志

Objective To investigate and analyze the examination and acceptance results for coalburning-borne endemic fluorosis control and elimination in Hubei Province.Methods A county-level selfinspection and a provincial-level spot-check were conducted to investigate the status of improved-stove usage,the situation of correctly drying corn and chili,and the dental fluorosis prevalence among children aged 8 to 12 in 501 historic coal-burning-borne endemic fluorosis villages of 6 counties (cities) in Hubei Province from 2012 to 2014.The endemic areas were selected according to the Control Standards of Endemic Fluorosis in Endemic Areas (GB 17017-2010) and Eliminating Standards of Coal-burning Type Endemic Fluorosis.Results The results of county-level inspection showed that the qualified rates of improved stoves,the correct-usage rates of qualified stoves,and the correctly drying rates of corn and chili were all higher than 98％ in targeted villages,and the prevalence rate of dental fluorosis of children was 7.73％ (2 319/30 003).The results of provincial-level recheck were more than 99％ and 8.25％ (353/4 277),respectively.The results of county-level inspection were of good consistency with those of provincial-level recheck (88.89％,48/54).Five counties (cities) but one had met the standard of fluorosis control or elimination.Conclusion Coal-burning-borne endemic fluorosis scope in Hubei Province is narrowed greatly and the prevalence rates are decreased significantly.

Changes of cerebrovascular reserve of obstructive sleep apnea hypopnea syndrome patients evaluated by transcranial cerebral Doppler and its relationship with stroke / 中华神经医学杂志

Objective To evaluate the changes ofcerebrovascular reserve (CVR) of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) by transcranial cerebral doppler (TCD) and to study its relation with stroke.Methods One hundred and twenty-six patients with OSAHS,admitted to our hospitals from July 2012 to January 2013 and diagnosed as having OSAHS,were chosen in our study;they were divided into mild OSAHS group (n=49),moderate OSAHS group (n=44) and severe OSAHS group (n=33) according to test results of polysomnography (PSG).Another 40 healthy controls were collected.The CVR of all subjects were evaluated by TCD merging with CO2 experiment and compared among different groups.All the subjects were accepted continued two-year follow-up and recorded the accidents of stroke.The morbidities of stroke were compared between different groups.Results As compared with those in the control group and mild OSAHS group,all of the contractile reserve,dilatation reserve and overall reserve descended in moderate OSAHS group and severe OSAHS group with statistically significant differences (P＜0.05).As compared with those in the moderate OSAHS group,all of the contractile reserve,dilatation reserve and overall reserve descended in severe OSAHS group,and the differences were statistically significant (P＜0.05).In the two years of follow-up,the incidence of stroke in the severe OSAHS group (12.12％) was significantly higher than that in the control group (0％),mild OSAHS group (0％) and moderate OSAHS group (4.55％,P＜0.05).Conclusion The heavier the condition of OSAHS,the more obviously descended the CVR;the stroke morbidity of severe OSAHS patients is increased significantly.

Effect of raw Radix Rehmanniae on the pharmacokinetics of pioglitazone in rats

Raw Radix Rehmanniae [RRR] is a frequently used traditional Chinese medicine in the treatment of diabetes mellitus according to the statistics on all of the anti-diabetic formulas recorded in New National Traditional Chinese Medicine. Pioglitazone and RRR may be co-administrated for presumably enhanced therapeutic effects because of the common indications. Therefore, the aim of the study was to evaluate the effect of RRR on the pharmacokinetics of pioglitazone in healthy rats and type 2 diabetic rats. The pharmacokinetic effect of RRR on pioglitazone was studied in healthy rats and type 2 diabetic rats. A validated UPLC-MS/MS method was used to analyze the concentration of pioglitazone in blood samples. The pharmacokinetic parameters were calculated using non-compartmental analyses by Winnonlin 5.0.1. In healthy group, the pre-treatment of RRR significantly [P<0.05] reduced the C[max] but enhanced the V/F of pioglitazone; whereas in T2DM group, significant increase of C[max] and decrease of V/F and T[1/2] were found after the rats were pre-treated with RRR. However, AUC[0-t] and CL/F remained unchanged in both healthy group and T2DM group. In conclusion, co-administration with RRR could alter the pharmacokinetic profiles of pioglitazone to statistically significant levels.

Evaluation of depression status following basal ganglia infarction by diffusion tensor magnetic resonance imaging / 中华神经科杂志

ObjectiveTo study the anatomical abnormalities of basal ganglia and research their influence on depression status in patients with post stroke depression (PSD)by diffusion tensor imaging (DTI) of MRI.MethodsPatients with basal ganglia infarction were recruited,and divided into groups of PSD and non depression control group by Hamilton Depression Rating Scale (HAMD) assessment. All the patients were evaluated with National Institute of Health Stroke Scale ( NIHSS). And the patients were checked by DTI sequence.Fractional anisotropy (FA),average diffusion coefficient (ADC) values and the number of nerve fiber were measured in bilateral caudatum,pallidum,putamen and thalamus.ResultsThe score of NIHSS (6.29 ± 3.45 ) was significantly higher in PSD group than that in non-depression group (3.95 ± 1.90 ;t =2.219,P =0.036). No significant difference was found between the two groups for the DTI data of the basal ganglia nuclei ( t =0.056-1.618,all P ＞ 0.05 ). Compared with contralateral construction (0.40 ± 0.02 ),the FA value decreased in the left putamen ( 0.37 ± 0.03 ) in the PSD group ( t =2.243,P =0.045 ).By Spearman correlations analysis,the HAMD score was positively correlated with NIHSS score ( r =0.464,P =0.017 ),and negatively correlated with the FA values of left pallidum (r=-0.563,P=0.005),right pallidum (r=-0.416,P=0.035) and left putamen (r =-0.428,P =0.029).Conclusions The occurrence of PSD was associated with neurological functional deficit following basal ganglia infarction.The depression level was correlated with the increasing of NIHSS score,the reductions in bilateral pallidum and left putamen FA values.This research contributes to evaluation of the PSD status in patients with basal ganglia infarction.