Alcohol and mortality in Russia: prospective observational study of 151,000 adults.

BACKGROUND: Russian adults have extraordinarily high rates of premature death. Retrospective enquiries to the families of about 50,000 deceased Russians had found excess vodka use among those dying from external causes (accident, suicide, violence) and eight particular disease groupings. We now seek prospective evidence of these associations. METHODS: In three Russian cities (Barnaul, Byisk, and Tomsk), we interviewed 200,000 adults during 1999-2008 (with 12,000 re-interviewed some years later) and followed them until 2010 for cause-specific mortality. In 151,000 with no previous disease and some follow-up at ages 35-74 years, Poisson regression (adjusted for age at risk, amount smoked, education, and city) was used to calculate the relative risks associating vodka consumption with mortality. We have combined these relative risks with age-specific death rates to get 20-year absolute risks. FINDINGS: Among 57,361 male smokers with no previous disease, the estimated 20-year risks of death at ages 35-54 years were 16% (95% CI 15-17) for those who reported consuming less than a bottle of vodka per week at baseline, 20% (18-22) for those consuming 1-2·9 bottles per week, and 35% (31-39) for those consuming three or more bottles per week; trend p<0·0001. The corresponding risks of death at ages 55-74 years were 50% (48-52) for those who reported consuming less than a bottle of vodka per week at baseline, 54% (51-57) for those consuming 1-2·9 bottles per week, and 64% (59-69) for those consuming three or more bottles per week; trend p<0·0001. In both age ranges most of the excess mortality in heavier drinkers was from external causes or the eight disease groupings strongly associated with alcohol in the retrospective enquiries. Self-reported drinking fluctuated; of the men who reported drinking three or more bottles of vodka per week who were reinterviewed a few years later, about half (185 of 321) then reported drinking less than one bottle per week. Such fluctuations must have substantially attenuated the apparent hazards of heavy drinking in this study, yet self-reported vodka use at baseline still strongly predicted risk. Among male non-smokers and among females, self-reported heavy drinking was uncommon, but seemed to involve similar absolute excess risks. INTERPRETATION: This large prospective study strongly reinforces other evidence that vodka is a major cause of the high risk of premature death in Russian adults. FUNDING: UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union, WHO International Agency for Research on Cancer.

[Analysis of reoperation for infertility women with tubal pregnancy after conservative surgery].

OBJECTIVE: To evaluate the cause of infertility and tubal abnormality in women of tubal pregnancy after conservative treatment with laparotomy or laparoscopy through a combination of laparoscopy, hysteroscopic tubal catheterization and hydrotubation. METHODS: Laparoscopy was performed to observe pelvic adhesions, tube shape, fimbriated extremity of fallopian and other factors related with infertility for 37 inpatients with infertility after tubal pregnancy and undergoing conservative surgery during December 2008 and October 2010. Meanwhile, hysteroscopic tubal catheterization and hydrotubation were performed with laparoscopy to examine tube patency. RESULTS: Among them, 97.3% had tube infertility caused by tube abnormality and adhesions, or tube obstruction alone or concurrently. For all tubes, tube obstruction accounted for 79.7% (59/74) , fimbrial occlusion of fallopian tube 54.1% (40/74) and tube abnormality 52.7% (39/74) . Pelvic adhesion occurred at a rate of 89.2% and there were I degree (21.6%), II degree (32.4%), III degree (35.1%) and IV degree (0). For tubes with pregnancy history, 48.6% showed tube abnormality, 45.9% fimbrial occlusion of fallopian tube and 75.7% (28/37) tube obstruction. Comparatively, for the tubes without pregnancy history, 56.8%showed tube abnormality, 62.2%fimbrial occlusion of fallopian tube and 86.5%tube obstruction. No significant difference existed in tube shape, umbrella end and tube obstruction between the tubes with pregnancy history and those without pregnancy history. Neither statistically significant difference was found in adhesion degree, tube shape, umbrella end and tube obstruction of diseased and normal tubes between laparotomy and laparoscopy groups. CONCLUSION: Infertility of women after tubal pregnancy and conservative surgery is mainly caused by abnormal tube including pelvic adhesion, tube morphological abnormality and tube obstruction. No marked inter-group difference exists in fertility damage after conservative surgery with laparotomy or laparoscopy.

[Related factors associated with pelvic adhesion and its influence on fallopian tube recanalization in infertile patients].

OBJECTIVE: To investigate factors with pelvic adhesions and the effect of different degrees pelvic adhesions on fallopian tube recanalization in infertile patients. METHODS: Total of 527 infertile patients undergoing hysteroscopy and laparoscopic surgery in Affiliated Hospital of Chinese People's Armed Police Forces Logistics College were studied retrospectively. According to the extent of pelvic adhesions, tubal umbrella adhesions and atresia, 377 cases were classified into adhesion groups, including 73 cases in grade I, 221 cases in grade II, 75 cases in grade III and 8 cases in grade IV based on adhesion score. The 150 cases with no obvious pelvic adhesion were matched as control group. Among 8 cases with grade IV ahesion were exluded from ahesion group the relationship between pelvic adhesions and related history, abdominal lesions, tubal patency and the prognosis were studied. RESULTS: (1) Related factors: the frequency of pelvic adhesion and more than 7 years of infertility of 23.9% (88/369) in adhesion group were significantly higher than 12.0% (18/150) in control groups. (2) HISTORY: compared with the control group (12.7%, 19/150; 28.7%, 43/150; 11.3%, 17/150; 12.0%, 18/150; 17.3%, 26/150), patients with pelvic adhesions present more incidence abortion (23.6%, 87/369), uterine cavity operation (38.2%, 141/369), ectopic pregnancy (20.9%, 77/369), pelvic inflammatory disease (25.5%, 94/369) and abdominopelvic surgery (31.4%, 116/369). (3) Endoscopy exploration: the incidence of hydrosalpinx (24.7%, 91/369), tube distorted (15.7%, 58/369) and salpingostomy (72.9%, 269/369) in adhesion group were higher than those in control group (2.0%, 3/150; 4.0%, 6/150; 12.0%, 18/150), but relatively lower incidence of pelvic endometriosis lesions (5.7%, 21/369) and mesosalpinx cysts (16.3%, 60/369) than those in control group (16.0%, 24/150; 30.0%, 45/150). The rate of proximal tubal recanalization (59.5%, 91/153) in adhesion group was lower than 75.4% (52/69) in control group. However, the rate of distant tubal recanalization of 84.4%, (281/333) in adhesion group and; 13/15 in control group didn't show statistical difference. (4) PROGNOSIS: the rate of ectopic pregnancy of 9.7% (29/299) in adhesion group was significantly higher than 3.1% (4/128) in control group. Among cases with grade III adhesion exhibited the highest rate of ectopic pregnancy (13.0%, 7/54; OR = 4.62, 95%CI: 1.29 - 16.50). (5) Multivariate analysis: it was found that more than two drug abortions (OR = 3.29, 95%CI: 1.34 - 8.07), pelvic and(or) abdominal surgery history (OR = 2.20, 95%CI: 1.35 - 3.57) and pelvic inflammatory disease history (OR = 1.54, 95%CI: 1.21 - 1.97) were risk factors with pelvic adhesions. CONCLUSION: More than or equal to two drug abortion history, pelvic inflammatory disease and pelvic and abdominal surgery damage were important factors for pelvic adhesions of infertility patients, which may decrease the possibility of proximal tubal recanalization and increase ectopic pregnancy risk.

Preparation and inhibitory effect of salicin dimethyl ether in Laryngeal cancer cells through the apoptosis activation.

Laryngeal cancer is detected commonly worldwide, and it ranks second highest in incidence among the respiratory tract neoplasms following only head and neck squamous cell cancer. In the present study salicin dimethyl ether was synthesized and evaluated against laryngeal cancers cells for anticancer property. MTT assay was used for the measurement of changes in TU686 and Tu212 cell proliferation while as induced apoptosis was detected by flow cytometry. Protein expression was determined by western blotting and expression of mRNA by RT-PCR assay. In the present study salicin dimethyl ether was synthesized by the reaction of salicin with methyl iodide using sodium hydride as base. Salicin dimethyl ether treatment led to a significant decrease in TU686 and Tu212 cell proliferation in a dose-dependent manner. In TU686 and Tu212 cells salicin dimethyl ether treatment caused a significant increase in cell apoptosis and elevated caspase-3 activity. Treatment with salicin dimethyl ether led to a prominent reduction in Bcl-2 protein expression in TU686 and Tu212 cells at 72 h. Salicin dimethyl ether treatment led to a prominent decrease in p-PI3K and p-Akt protein expression in TU686 and Tu212 cells, compared to the untreated cells. A significant increase in miR­15a expression in TU686 and Tu212 cells was observed on treatment with salicin dimethyl ether at 72 h. In summary, the current study demonstrates that salicin dimethyl ether, a synthetic derivative of salicin, suppresses proliferation of TU686 and Tu212 cells. The underlying mechanism involves induction of apoptosis, inhibition of PI3K/Akt pathway and promotion of miR-15a expression. Therefore, salicin dimethyl ether may be used for inhibition of laryngeal cancer growth, however, in vivo studies need to be conducted to confirm the effect.

10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial.

BACKGROUND: If carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the long-term effects of successful CEA. METHODS: Between 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0·3-2·5) or to indefinite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6-11). The primary outcomes were perioperative mortality and morbidity (death or stroke within 30 days) and non-perioperative stroke. Kaplan-Meier percentages and logrank p values are from intention-to-treat analyses. This study is registered, number ISRCTN26156392. FINDINGS: 1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89·7% versus 4·8% at 1 year (and 92·1%vs 16·5% at 5 years). Perioperative risk of stroke or death within 30 days was 3·0% (95% CI 2·4-3·9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4·1% versus 10·0% at 5 years (gain 5·9%, 95% CI 4·0-7·8) and 10·8% versus 16·9% at 10 years (gain 6·1%, 2·7-9·4); ratio of stroke incidence rates 0·54, 95% CI 0·43-0·68, p<0·0001. 62 versus 104 had a disabling or fatal stroke, and 37 versus 84 others had a non-disabling stroke. Combining perioperative events and strokes, net risks were 6·9% versus 10·9% at 5 years (gain 4·1%, 2·0-6·2) and 13·4% versus 17·9% at 10 years (gain 4·6%, 1·2-7·9). Medication was similar in both groups; throughout the study, most were on antithrombotic and antihypertensive therapy. Net benefits were significant both for those on lipid-lowering therapy and for those not, and both for men and for women up to 75 years of age at entry (although not for older patients). INTERPRETATION: Successful CEA for asymptomatic patients younger than 75 years of age reduces 10-year stroke risks. Half this reduction is in disabling or fatal strokes. Net benefit in future patients will depend on their risks from unoperated carotid lesions (which will be reduced by medication), on future surgical risks (which might differ from those in trials), and on whether life expectancy exceeds 10 years. FUNDING: UK Medical Research Council, BUPA Foundation, Stroke Association.

[Clinical efficacy of pishen bingbu recipe in patients with sympathetic cervical spondylosis and its impact on heart rate variability].

OBJECTIVE: To investigate the clinical effect of Pishen Bingbu Recipe (PBR) in treating patients with sympathetic cervical spondylosis (SCS) of qi-blood deficient syndrome type and its impact on heart rate variability (HRV). METHODS: Fifty patients were randomized into the control group and the treatment group equally. Both were treated with mecobalamin, vitamin B1, neurotropin, and occipital - jaw band traction in the sitting posture, but to patients in the treatment group, PBR was given additionally. The course of treatment was 60 days. Therapeutic effect and changes of HRV indexes were observed. RESULTS: After treatment, in the treatment group, 5 patients (20%) were clinically cured, treatment was markedly effective in 12 patients (48%), effective in 7 (28%) and ineffective in 1 (4%), while the corresponding data in the control group were 2 (8%), 4 (16%), 18 (72%) and 1 (4%) respectively, demonstrating the efficacy in the treatment group was superior to that in the control group (P <0.05). Before treatment, the HRV indexes in the two groups were insignificantly different respectively (P >0.05). But after treatment, difference between groups was observed in terms of either time domain or frequency domain. Those of time domain were: standard deviation of NN intervals (SDNN, ms) 133.41 +/- 8.61 vs 115.61 +/- 13.49, average standard deviation of 5 min NN intervals (SDANN, ms) 126.90 +/- 9.99 vs 106.20 +/- 8.84, HRV trigonometric index (HRVTI) 35.10 +/- 4.48 vs 25.51 +/- 2.24; and those of frequency domain: low frequency (LF, ms2) 379.90 +/- 159.07 vs 477.70 +/- 396.91 high frequency (HF, ms2) 157.10 +/- 28.18 vs 122.10 +/- 101.90, and LF/HF ratio 2.37 +/- 0.52 vs 4.27 +/- 2.84. All were superior in the treatment group (P < 0.05). CONCLUSION: PBR shows evidently clinical efficacy on SCS, it can significantly improve the functional activities of sympathetic nerve in patients.

Infertility evaluation via laparoscopy and hysteroscopy after conservative treatment for tubal pregnancy.

OBJECTIVE: Evaluate the cause of infertility and impairment of tubal reproductive functions in infertility patients, who suffered tubal pregnancy after conservative treatment, using laparoscopy, hysteroscopic tubal catheterization, and hydrotubation. METHODS: Seventy-five infertility patients treated for tubal pregnancies were divided into two groups based on past treatment methods of their tubal pregnancies, conservative-medical group and conservative-surgical group. The severity of pelvic adhesions, tubal morphology, tubal fimbria, and other infertility factors were observed via laparoscopy. Additionally, hysteroscopic tubal catheterization and hydrotubation was used to diagnose tubal patency and evaluate the intrauterine cavity. RESULTS: There were one or more factors associated with infertility in the 75 patients, among which abnormal tubal was an absolutely important factor. In conservative-medical group, 92.11% (35/38) of the patients were with bilateral or unilateral oviduct exceptions, such as adhesion around or distorted tubal, closure or adhesion in umbrella end, lumen block. In conservative-surgical group, all of the patients were with bilateral or unilateral fallopian tube lesions. As two fallopian tubes per patient, 80.26% (61/76) of the tubes in conservative-medical group was damaged, 95.95% (71/74) in conservative-surgical group. The differences between the two groups was significant (P < 0.05). However, differences between these two groups in morphology of damaged tubes, anomaly of umbrella end and occlusion of lumen were not significant (P > 0.05). Incidence of pelvic adhesions in conservative-medical group was 76.32% (29/38), which was lower than 100% (37/37) of conservative-surgical group. The difference was significant (P < 0.05), which suggested that conservative-medical treatment was more effective than surgical treatment in preventing pelvic adhesion. CONCLUSION: Factors associated with tubal infertility affect patients who accepted conservative treatment for tubal pregnancy. In patients with a history of a tubal pregnancy, it may be less likely to compromise future reproductive function for conservative-medical treated patients than that for conservative-surgery treated patients.