[Statistical analysis of disability-adjusted life years for stomach and colorectal cancers in Changning District of Shanghai].

Objectives: To analyze the status and temporal changes of disability-adjusted life year (DALY) for stomach and colorectal cancers among registered permanent residents in Changning District of Shanghai Municipality, and provide scientific basis for the prevention and treatment of stomach and colorectal cancers in this district. Methods: Using the cancer registration data of stomach and colorectal cancers from 2002 to 2019, we estimated the indices such as the DALYs, the DALY crude rates, the age-standardized DALY rates, etc. Then we used the Joinpoint regression model to calculate the average annual percent change (AAPC) and annual percent change (APC) to explore the temporal variations in different periods. Results: The DALYs of stomach and colorectal cancers in Changning District from 2002 to 2019 were 55 931 person years and 65 252 person years, respectively. The crude rates of DALY were 512.16/105 and 597.51/105, respectively. We observed a higher disease burden in men than in women, and the peak rate of DALY in stomach cancer was in the 75-79 years age group, while in colorectal cancer the rate was in the 85-years-or-older age group. Joinpoint regression analysis showed that from 2002 to 2019, the age-standardized DALY rate of stomach cancer showed a downward trend (AAPC=-3.86%, P＜0.05), while the trend of colorectal cancer was not statistically significant(AAPC=-0.08%, P＞0.05). However, the trends in the age-standardized DALY rates of colorectal cancer were different between males and females, with males showing an upward trend (AAPC=1.24%, P＜0.05) and females showing a downward trend (AAPC=-1.67%, P＜0.05). Conclusions: The DALY of stomach and colorectal cancers in Changning District of Shanghai showed a decreasing trend. Males and the middle-aged and elderly populations are still the key targets for disease prevention and control in this district.

[Choice and application of time scale selection for Cox proportional hazards regression model in cohort studies].

Cox proportional hazards regression model (Cox model) is the most commonly used multivariate approach in time-to-event data analysis. A vital issue in fitting Cox model is choosing the appropriate time scale related to the occurrence of the outcome events. However, few domestic studies have focused on selecting and applying time scales for Cox model in the analysis of cohort study data. This study briefly introduced and compared several time scales in the reports from literature; and used data from the Shanghai Women's Health Study to illustrate the impact of different time scales on data analysis results, using the association between central obesity and the risk of liver cancer as an example. On this basis, several suggestions on selecting time scales in Cox model are proposed to provide a reference for the analysis of cohort study data.

Clinical efficacy of ticagrelor combined with aspirin in patients with coronary heart disease angina pectoris and its effects on NT-ProBNP and CK-MB levels.

OBJECTIVE: This study aims to explore the clinical efficacy of ticagrelor combined with aspirin in patients with coronary heart disease angina pectoris and the effects on N terminal pro B type natriuretic peptide (NT-ProBNP) and creatine kinase-MB (CK-MB) levels. PATIENTS AND METHODS: A total of 150 patients with coronary heart disease angina pectoris were prospectively analyzed in this study. These patients were admitted to Huaiyin Hospital of Huai'an City from February 2017 to February 2019. The patients were divided into control group and research group according to different treatment methods. The following indicators before and after treatment were observed: therapeutic efficacy, prevalence of adverse reactions, duration and frequency of angina attack, NT-ProBNP and CK-MB levels. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of NT-ProBNP and CK-MB for the curative effect of coronary heart disease angina pectoris. RESULTS: The total effective rate in the research group was higher than that in the control group (p<0.05). The prevalence of adverse reactions in the research group was lower than that in the control group (p<0.05). The duration and frequency of seizures of the two groups after treatment were lower than those before treatment. The duration and frequency of seizures in the research group were lower than those in the control group (p<0.05). The physiological function, physical pain, vital energy score and general health status in the research group were higher than those in the control group (p<0.05). The NT-ProBNP and CK-MB levels in both groups after treatment were decreased. CONCLUSION: Ticagrelor combined with aspirin has definite therapeutic effect on patients with coronary heart disease angina pectoris, with low prevalence of adverse reactions. It can significantly reduce the levels of NT-ProBNP and CK-MB, which is worthy of promotion.

Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma.

Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series of events leading to asthmatic symptoms is not clear. It is not certain whether, in asthma, there is a change in the intrinsic properties of ASM, a change in the structure and mechanical properties of the noncontractile components of the airway wall, or a change in the interdependence of the airway wall with the surrounding lung parenchyma. All these potential changes could result from acute or chronic airway inflammation and associated tissue repair and remodelling. Anti-inflammatory therapy, however, does not "cure" asthma, and airway hyperresponsiveness can persist in asthmatics, even in the absence of airway inflammation. This is perhaps because the therapy does not directly address a fundamental abnormality of asthma, that of exaggerated airway narrowing due to excessive shortening of ASM. In the present study, a central role for airway smooth muscle in the pathogenesis of airway hyperresponsiveness in asthma is explored.

Selected contribution: roles of focal adhesion kinase and paxillin in the mechanosensitive regulation of myosin phosphorylation in smooth muscle.

The increase in intracellular Ca(2+) and myosin light chain (MLC) phosphorylation in response to the contractile activation of tracheal smooth muscle is greater at longer muscle lengths (21). However, MLC phosphorylation can also be stimulated by Ca(2+)-insensitive signaling pathways (19). The cytoskeletal proteins paxillin and focal adhesion kinase (FAK) mediate a Ca(2+)-independent length-sensitive signaling pathway in tracheal smooth muscle (30). We used alpha-toxin-permeabilized tracheal smooth muscle strips to determine whether the length sensitivity of MLC phosphorylation can be regulated by a Ca(2+)-insensitive signaling pathway and whether the length sensitivity of active tension depends on the length sensitivity of myosin activation. Although active tension remained length sensitive, ACh-induced MLC phosphorylation was the same at optimal muscle length (L(o)) and 0.5 L(o) when intracellular Ca(2+) was maintained at pCa 7. MLC phosphorylation was also the same at L(o) and 0.5 L(o) in strips stimulated with 10 microM Ca(2+). In contrast, the Ca(2+)-insensitive tyrosine phosphorylation of FAK and paxillin stimulated by ACh was higher at L(o) than at 0.5 L(o). We conclude that the length-sensitivity of MLC phosphorylation depends on length-dependent changes in intracellular Ca(2+) but that length-dependent changes in MLC phosphorylation are not the primary mechanism for the length sensitivity of active tension.

Building a generic architecture for medical information exchange among healthcare providers.

Due to the inability to exchange clinical information among hospitals, continuity of care cannot be maintained and a tremendous amount of medical resource has been wasted. This paper describes an architecture that would facilitate exchange of clinical information among heterogeneous hospital information systems. It is dubbed 'Medical Information Exchange Center' or MIEC as part of a six-year Health Information Network Project hosted by the Department of Health. MIEC was designed so that it is innovative yet technically feasible today. It is convenient for authorized users yet secure enough so people can trust and has minimal impact to participated hospitals. Authorized users will be able to access information through two web-based interfaces directed to physician and non-physician users respectively. Hospitals are connected through a virtual private network to exchange patient information and users need to obtain a private key from the certificate authority in order to securely connect to MIEC. A pilot project was conducted to demonstrate the feasibility of this architecture and the problems encountered were discussed.

Depletion of focal adhesion kinase by antisense depresses contractile activation of smooth muscle.

Focal adhesion kinase (FAK) undergoes tyrosine phosphorylation in response to the contractile stimulation of tracheal smooth muscle. We hypothesized that FAK may play an important role in signaling pathways that regulate smooth muscle contraction. FAK antisense or FAK sense was introduced into muscle strips by reversible permeabilization, and strips were incubated with antisense or sense for 7 days. Antisense decreased FAK expression compared with that in untreated and sense-treated tissues, but it did not affect the expression of vinculin or myosin light chain kinase. Increases in force, intracellular free Ca2+ and myosin light chain phosphorylation in response to stimulation with ACh or KCl were depressed in FAK-depleted tissues, but FAK depletion did not affect the activation of permeabilized tracheal muscle strips with Ca2+. The tyrosine phosphorylation of paxillin, a substrate for FAK, was also significantly reduced in FAK-depleted strips. We conclude that FAK is a necessary component of the signaling pathways that regulate smooth muscle contraction and that FAK plays a role in regulating intracellular free Ca2+ and myosin light chain phosphorylation.

Tele-emergency medicine: the evaluation of Taipei Veterans General Hospital and Kinmen-Granite Hospital in Taiwan.

BACKGROUND: The purpose of the project was to establish computer networks between selected hospitals through high-speed communication and high power computer processing to electronically exchange medical information and to conduct clinical examination and consultation. Quality medical services can thus be provided to patients in the remote rural areas such as villages and small towns in the mountains, on the coasts and islets away from Taiwan. It also intended to facilitate continuing education for doctors in those areas. This study evaluates telemedicine between Taipei-Veterans General Hospital and Kinmen-Granite Hospital. METHODS: Patients were chosen from 1996-7 to 1997-6. The evaluation criteria included consulting quality, satisfaction of the doctors, benefits for the patients, and the charge being rendered. RESULTS: The results of evaluation for telemedicine between Taipei-Veterans General Hospital (VGHTPE) and Kinmen-Granite hospital (GH) are as follows: 93.0% doctors used telemedicine to seek a second opinion. After teleconsultation, the ratio of the patients showing cooperation was over 80%. Over 98% doctors thought telemedicine system helpful. The doctors in VGHTPE are more satisfied with the facility than local doctors in Kinmen. CONCLUSIONS: The clinical evaluation of the telemedicine showed positive results. It can be a useful tool to facilitate on-job training and education Tele-emergency medicine.

Role of Rho in Ca(2+)-insensitive contraction and paxillin tyrosine phosphorylation in smooth muscle.

We investigated whether Rho activation is required for Ca(2+)-insensitive paxillin phosphorylation, myosin light chain (MLC) phosphorylation, and contraction in tracheal muscle. Tyrosine-phosphorylated proteins have been implicated in the Ca(2+)-insensitive contractile activation of smooth muscle tissues. The contractile activation of tracheal smooth muscle increases tyrosine phosphorylation of the cytoskeletal proteins paxillin and focal adhesion kinase. Paxillin is implicated in integrin-mediated signal transduction pathways that regulate cytoskeletal organization and cell motility. In fibroblasts and other nonmuscle cells, paxillin tyrosine phosphorylation depends on the activation of Rho and is inhibited by cytochalasin, an inhibitor of actin polymerization. In permeabilized muscle strips, we found that ACh induced Ca(2+)-insensitive contraction, MLC phosphorylation, and paxillin tyrosine phosphorylation. Ca(2+)-insensitive contraction and MLC phosphorylation induced by ACh were inhibited by C3 transferase, an inhibitor of Rho activation; however, C3 transferase did not inhibit paxillin tyrosine phosphorylation. Ca(2+)-insensitive paxillin tyrosine phosphorylation was also not inhibited by the Rho kinase inhibitor Y-27632, by cytochalasin D, or by the inhibition of MLC phosphorylation. We conclude that, in tracheal smooth muscle, Rho mediates Ca(2+)-insensitive contraction and MLC phosphorylation but that Rho is not required for Ca(2+)-insensitive paxillin tyrosine phosphorylation. Paxillin phosphorylation also does not require actomyosin activation, nor is it inhibited by the actin filament capping agent cytochalasin D.

The contractile apparatus and mechanical properties of airway smooth muscle.

The functional properties of airway smooth muscle are fundamental to the properties of the airways in vivo. However, many of the distinctive characteristics of smooth muscle are not easily accounted for on the basis of molecular models developed to account for the properties of striated muscles. The specialized ultrastructural features and regulatory mechanisms present in smooth muscle are likely to form the basis for many of its characteristic properties. The molecular organization and structure of the contractile apparatus in smooth muscle is consistent with a model of force generation based on the relative sliding of adjacent actin and myosin filaments. In airway smooth muscle, actomyosin activation is initiated by the phosphorylation of the 20 kDa light chain of myosin; but there is conflicting evidence regarding the role of myosin light chain phosphorylation in tension maintenance. Tension generated by the contractile filaments is transmitted throughout the cell via a network of actin filaments anchored at dense plaques at the cell membrane, where force is transmitted to the extracellular matrix via transmembrane integrins. Proteins bound to actin and/or localized to actin filament anchorage sites may participate in regulating the shape of the smooth muscle cell and the organization of its contractile filament system. These proteins may also participate in signalling pathways that regulate the crossbridge activation and other functions of the actin cytoskeleton. The length-dependence of active force and the mechanical plasticity of airway smooth muscle may play an important role in determining airway responsiveness during lung volume changes in vivo. The molecular basis for the length-dependence of tension in smooth muscle differs from that in skeletal muscle, and may involve mechano-transduction mechanisms that modulate contractile filament activation and cytoskeletal organization in response to changes in muscle length. The reorganization of contractile filaments may also underlie the plasticity of the mechanical response of airway smooth muscle. Changes in the structural organization and signalling pathways of airway smooth muscle cells resulting form alterations in mechanical forces in the lung may be important factors in the development of pathophysiological conditions of chronic airway hyperresponsiveness.