In 2016, a national one million general population cohort project was set up in China for the first time in "Precision Medicine Research" Key Project, National Key Research and Development Program of China, which consists of general population cohorts in seven areas in China. As one of the seven major areas in China, northeastern China has unique climate and specific dietary patterns, and population aging is serious in this area. And the burden of chronic and non-communicable diseases ranks tops in China. Therefore, it is of great significance to establish a large general population cohort in northeastern China to explore the area specific exposure factors related to pathogenesis and prognosis of chronic and non-communicable diseases, develop new prevention strategies to reduce the burden of the diseases and improve the population health in northeastern China. In July 2018, the general population cohort study in northeastern China was launched, the study includes questionnaire survey, health examination and blood, urine and stool sample collection and detection in recruited participants. By now, the cohort has covered all age groups, and the baseline data of 115 414 persons have been collected. This paper summarizes the design and practice of the general population cohort study in northeastern China to provide reference for related research in China.

Objective:To study the patterns of tocilizumab (TCZ) use, its efficacy and safety in patients with rheumatoid arthritis (RA) in routine clinical practice.Methods:A total of 407 patients with RA were enrolled from 23 centers and treated with TCZ within 8 weeks prior to the enrollment visit, and were followed for 6-month. The patterns of TCZ treatment at 6 months, the effectiveness and safety outcomes were recorded. Statistical analysis was performed using SAS version 9.4.Results:A total of 396 patients were included for analysis, in which 330 (83.3%) patients received TCZ combined with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and 16.7%(66/396) received TCZ monotherapy. At baseline, TCZ was initiated in 56.6%(224/396) and 9.6%(38/396) of patients after failure of DMARDs and other biological agents (bDMARDs) respectively. During the 6-month follow-up period, the mean frequency of TCZ administration was (3.7±1.6), the mean TCZ dosage was (7.4±1.2) mg/kg, and the mean interval between doses was (40±13) days. 120(25.8%) patients were on TCZ treatment at the end of the study. Improvements in disease activity, systemic symptoms and patient report outcomes were observed at the end of the study. 22.7%(90/396) patients experienced at least one treatment related adverse event, and 8 patients experienced at least one serious adverse event.Conclusion:This study demonstrates that TCZ treatment is effective in patients with RA when being treated for 6 months with an acceptable safety profile. The duration of TCZ treatment needs to be extended.

Objective:To explore the outcomes of urethra around corpora cavernosus anastomotic urethroplasty for the treatment of complex posterior urethral strictures.Methods:Between June 2008 and June 2020, 35 patients with complex posterior urethral strictures were treated using urethra rerouted under one corpora cavernosus anastomotic urethroplasty. The patients’ age was 3-54 years(mean 23.2 years), the urethral stricture or loss length was 4-7 cm(mean 5.2 cm), and 6 patients associated with urethrorectal fistula. The technique involved: ①The anterior urethra is dissected long more than 5 cm, separation of the proximal corporeal bodies, inferior pubectomy and the dissected proximal urethra.②A channel around the left crus of the penis through the inferior pubectomy is separated and urethra rerouted under left corpora cavernosus to allow a tension-free anastomosis to the proximal urethra.Results:Two patients lost follow-up; the remainder 33 patients were followed-up for 3 to 144 months(mean 37 months). Thirty-two patients could void normally(97%), The examination of maximal urinary flow rates(Q max) were taken in 21 patients, of whom Q max was 13.6-35.5 ml/s (mean 17.5 ml/s) in 7 children and 16.3-77.6 ml/s(mean 27.9 ml/s) in 14 adult patients. All 6 patients associated with urethrorectal fistula successful repaired, of these patients 1 had died of hemorrhage of brain 6 years postop. One patient developed urethral stenosis postoperatively. Continence was achieved in 29 patients, the remaining 3 patients had incontinence from mild to moderate. Conclusions:Urethra rerouted under left corpora cavernosus anastomotic urethroplasty is not only an effective surgical salvage option, with low recurrent rate for patients with complex posterior urethral strictures, but also do not cause curve and affect growth of corpora cavernosus.

Objective To explore how to effectively prevent and detect cancer early postoperative intestinal obstruction and treatment methods and means.Methods This retrospective analysis of 13 years occurred in 57 patients with rectal cancer diagnosis and treatment of cases of early postoperative intestinal obstruction process, including fasting,gastrointestinal decompression,fluid therapy,liquid paraffin,diatrizoate and surgical treatment of oral contrast.Results In 57 cases,paralytic intestinal obstruction in 7 cases,conservative treatment was relieved,the success rate was 100.0%;early inflammatory intestinal obstruction in 37 cases after conservative treatment of 36 cases of remission,the success rate was 97.3%;mechanical intestinal obstruction in 13 cases after conservative treatment could not be alleviated,conservative success rate was 0.0% and was cured by reoperation.The first two groups of patients compared with mechanical intestinal obstruction patients,conservative success rate had statistical differences (χ2 =40.08,11.08,all P<0.01).Conclusion Cancer treatment lies in early postoperative intestinal obstruction effective prevention,early detection,close observation and timely and effective treatment,a good grasp of timing of surgery and surgical indications.

Objective To explore the influence of oral administration of glucose before surgery on insulin resistance and oxidative stress in castric cancer patients undergoing surgery.Methods 63 cases of castric cancer patients undergoing surgery were divided into observation group (n=32) and the control group (n=31) according to random number table method.Patients were given fasting after ten o'clock the day before surgery.Patients in the observation group were dealed with 500 ml 100 g/L glucose solution orally,while patients in the control group were dealed with the same amount of distilled water 3 hours before surgery.The general information and operation indicators were recorded.Blood glucose (GLU),insulin,malondialdehyde (MDA) and superoxide dismutase (SOD) levels were detected before surgery and 4 hours after surgery.Insulin resistance index(HOMAIR) was recorded also.Results The general data between the two groups before the test started had no statistically significant difference (P＞0.05).All patients completed test successfully,and the complications such as choking cough,aspiration did not happen during the treatment.The operation time,Intraoperative fluid infusion,intraoperative blood loss and postoperative pathological stage between the two groups had no statistical difference (P＞0.05).GLU,insulin and HOMA-IR in the two groups after surgery increased significantly than those before surgery,and the difference had statistical significance (P＜0.05).GLU,insulin and HOMA-IR were significantly lower in the observation group than in the control group,and the difference had statistical significance (P＜0.05).SOD and MDA in the two groups after surgery increased significantly than those before surgery,and the difference had statistical significance (P＜0.05).SOD in the observation group was significantly higher,while MDA was significantly lower than those in the control group,and the difference had statistically significance(P＜0.05).Conclusion Oral administration of glucose before surgery in castric cancer patients undergoing surgery can reduce insulin resistance and oxidative stress,and it is safe.

Objective To investigate the reason for hidden hemorrhage of hip fracture in elder.Methods All of 94 elder patients,who were diagnosed with intertrochanteric fracture or femoral neck fracture and received treatment in our department from October,2013 to September,2015,were included in this study.The time between injuries to admission was less than 4 hours of the two groups of patients.And the patients whose hemoglobin was less than 100 g/L were removed when admission,in order to avoid the interference of primary anemia.All information,including height,weight,and the value of hemoglobin (Hb) and hematocrit (Hct),were collected.Blood tests were performed immediately after admission,at daily morning preoperatively,and at the morning of the day of surgery.Preoperative blood loss (hidden hemorrhage) was recorded.With respect to blood loss of hidden hemorrhage,statistical analysis was performed at different times (immediate time after admission,and day 1,2,and 3 postoperatively)in the group of intertrochanteric fracture or in the group of femoral neck fracture,and subsequently performed between the two groups.Results The blood loss in the group of intertrochanteric fracture was 196.3 ml,310.1 ml and 418.3 ml in the 1st day,the 2nd day and the third day after admission.There was a significant difference among different time with respect to blood loss.The blood loss was 39.8 ml,65.7 ml and 82.9 ml in the 1st day,the 2nd day and the third day after admission in the group of femoral neck fracture.There was also a significant difference among different time with respect to blood loss.In experimental group,mean blood loss was 418.3 ml and mean Hb decreased by 23.7 g/L at day 3 postoperatively.In control group,mean blood loss was 82.9 ml and mean Hb decreased by 6.7 g/L at day 3 postoperatively.A significant difference was observed between the two groups.The blood loss in patients with intertrochanteric fracture was higher than that in patients with femoral neck fracture.Conclusion The blood loss was gradually increased in elder patients with intertrochanteric fracture over time.There was a significant difference in different time with respect to blood loss.Moreover,a significant difference was found in blood loss of hidden hemorrhage between intertrochanteric fracture and femoral neck fracture.

Objective To analyze the influence of different digestive tract reconstruction methods on blood sugar in T2DM patients after subtotal gastrectomy,and to explore the possible mechanism.Methods The clinical data of 64 cases of T2DM patients undergoing subtotal gastrectomy because of gastric ulcer or cancer were retrospectively analyzed.They were divided into Roux-en-Y group (34 cases) and Billroth Ⅱ group (30 cases) according to the different reconstruction methods of digestive tract,and they were treated by Roux-en-Y anasto-mosis and Billroth Ⅱ anastomosis respectively after subtotal gastrectomy.They were followed up for 6 months.BMI,fasting blood sugar,2 h postprandial blood glucose,glycosylated hemoglobin,fasting insulin,insulin resistance index (HOMA-IR),glucagon peptide 1 (GLP-1),gastric inhibitory peptides (GIP),and GIP/GLP-1 before surgery and one week,one month,3 months,and 6 months after surgery were compared between the two groups.Results BMI of the two groups 3 months,and 6 months after surgery was significantly lower than those before surgery (P＜0.05),and it had no statistical significance between the two groups at the same time point (P＞0.05).Compared with preoperative,the fasting blood sugar,2 h postprandial blood glucose,glycosylated hemoglobin,fasting insulin,HOMA-IR one week,one month,3 months,and 6 months after surgery in the two groups were significantly lower than those before surgery (P＜0.05).The fasting blood sugar,and 2 h postprandial blood glucose were lower in Roux-en-Y group than in Billroth Ⅱ group (P＜0.05).The glycosylated hemoglobin in Roux-en-Y group was lower than those in Billroth Ⅱ group at 3 months,and 6 months after surgery (P＜0.05).Compared with those before surgery,GIP and GIP/GLP-1 in the two groups at one week,one month,3 months,and 6 months were significantly decreased after operation (P＜0.05).Also,they were significantly lower in Roux-en-Y group compared with Billroth Ⅱ group at the same time point.Conclusion Roux-en-Y anastomosis after subtotal gastrectomy may be more beneficial?for reducing blood glucose in T2DM patients,which may be more beneficial for keeping the balance of entero-insular axis.

Objective To explore the causes of persistent abnormal muscle response (AMR) after microvascular decompression (MVD) for hemifacial spasm (HFS) and the clinical outcomes of these patients.Methods MVD was performed under intraoperative electrophysiological monitoring of AMR in 372 HFS patients in 2014.Before MVD,the characteristic AMR of HFS was recorded in 326 patients.The patients were divided into two groups based on whether AMR disappeared or persisted following MVD;21 patients showed persistent AMR after successful MVD while AMR disappeared after decompression in the other 305 patients.The clinical features,treatment efficacy and postoperative complications were compared between these two groups.Results Gender,side of depression and mean age between the two groups showed no significant differences (P＞0.05).The immediate postoperative cure rate of the AMR disappeared group (88.9％) was significantly higher than that in the AMR persisted group (28.6％,P＜0.05).The follow-up cure rate showed no significant difference between the two groups (P＞0.05),and the postoperative and follow-up complications showed no significant differences (P＞0.05).Conclusion The long duration of HFS patients may be responsible for persistent AMR after successful decompression,and it is more likely for these patients to get delayed cured;their long-term outcomes showed no difference as compared with those in patients with disappeared AMR after MVD.

Objective To investigate the correlation between the biomarkers related to radio-sensitivity and preoperative radiotherapy in rectal cancer patients, and to establish a logistic regression model to predict the effect of the preoperative radiotherapy through detecting the expression levels of the molecular markers. Methods 33 patients with rectal cancer who received preoperative radiotherapy from January 2010 to January 2015 were retrospectively analyzed. Patients' information was also collected including the serum level of carcino-embryonic antigen (CEA), the immune-histochemical expression levels of vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), thymidylate synthase (TS) and Ki-67, and image data (CT or magnetic resonance imaging) before radiotherapy, preoperative clinical staging and the postoperative pathologic staging. According to the postoperative pathological remission, the treatment effects of preoperative radiotherapy included effective (CR+PR) and ineffective (PD+SD) were evaluated. The relationship between these molecular markers and the curative effect of preoperative radiotherapy was analyzed by logistic regression analysis using SPSS v17.0 software, and a logistic curative effect prediction model was established. Results As a result of single factor and multiple factors logistic binary regression analysis, CEA, VEGF and Ki-67 were recognized as the interested factors for the radio-sensitivity predicting in patients with rectal cancer who received preoperative radiotherapy. A molecular markers predictive model for radio-sensitivity in preoperative radiotherapy in rectal cancer is as follow: log P=1.700-0.276×CEA-0.238×VEGF-0.135 ×EGFR+1.377 ×TS+0.080 ×Ki-67. Serum CEA level and the expression of VEGF might associate with radio-resistant, and the expression of Ki-67 might associate with better reaction to preoperative radiotherapy. Conclusion The levels of serum CEA, VEGF and Ki-67 may be the predictors of radio-sensitivity in rectal cancer patients who received preoperative radiotherapy.

Objective:To explore the traits of gray matter volume in general anxiety disorder (GAD)and ob-sessive compulsive disorder (OCD)by using magnetic resonance imaging (MRI)technique.Methods:Twenty-eight GAD,25 OCD and 39 normal controls were recruited.All patients were met the Diagnostic and Statistical Mannal of Mental Disorders,Fourth Edition,Text Revision (DSM-IV-TR)or the International Statistical Classifica-tion of Disease and Related Health Problems Tenth Revision (ICD-10)diagnostic criteria for GAD or OCD.All subjects underwent structural MRI scan.The severity of anxiety and OCD symptoms were rated in all patients with the Hamilton Anxiety Rating Scale (HAMA)and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).The gray matter volume (GMV)was compared between all groups by using the voxel-based morphometry (VBM)a- nalysis.The correlation analysis between GMV and total scores of HAMA and Y-BOCS was performed in GAD and OCD.Results:The GMV was increased in regions including left anterior cingulate cortex in GAD (P =0.016,small volume correction),while only decreased GMV was observed in OCD in bilateral orbitofrontal cortex (OFC)(P <0.001,uncorrected).GAD had larger GMV than OCD in several regions including bilateral OFC (P <0.001,un-corrected).The higher total score of HAMA was associated with increased GMV of right temporal cortex in GAD, and with the GMV of OFC in OCD (P <0.001,uncorrected).Conclusion:No sharing of GMV abnormalities in GAD and OCD was observed in the current study.The traits of brain structure and the potential neural substrate of anxiety symptom in GAD and OCD may be significantly different.