Objective To understand the equity and influencing factors of maternal health service utilization in Changning District, Shanghai. Methods A convenience sampling method was used to conduct a questionnaire survey among mothers of children aged 1 to 1.5 years old who received health services from the child health care clinics and EPI clinics of 10 community health service centers in Changning District, Shanghai from March to April 2022. Count data was expressed by frequency and percentage. Chi-square analysis, binomial logistic regression analysis, and multivariate logistic regression analysis were used to analyze fairness-related factors. Rate difference, rate ratio and concentration index were used to represent fairness. Results A total of 696 subjects were investigated, with an average age of (33.35±4.76) years. There were statistically significant differences in service utilization among women with different household registrations only in early pregnancy registration (χ²=11.026, P=0.001) and postpartum visits (χ²=4.989, P=0.026). Women with a career showed differently in folic acid supplement (χ²=6.247, P=0.012), early pregnancy registration (χ²=12.989, P=0.002), physical examination in 42 days postpartum (χ²=4.446, P=0.035) and postpartum contraception (χ²=4.061, P=0.044), and the differences were statistically significant. Women with different monthly family income had a statistically significant difference in pre-pregnancy examination (χ²=8.977, P=0.030) and postpartum visit (χ²=16.114, P=0.001). There was a statistically significant difference between women with maternity insurance or not in the early pregnancy registration (χ²=10.576, P=0.001) and physical examination in 42 days postpartum (χ²=8.166, P=0.004). The results of the multivariate analysis showed that occupation (OR=2.616, 95% CI: 1.142-5.990) and maternity insurance (OR=4.490, 95% CI: 1.992~10.120) affected the utilization of service in early pregnancy registration. The monthly household income (OR=0.278, 95% CI: 0.124-0.625) affected the utilization of services in postpartum visit. At the same time, the monthly household income (10,000-19,999: OR=0.286, 95% CI: 0.090-0.907; ≥30,000: OR=0.180, 95% CI: 0.041-0.801) also affected the utilization of service in physical examination in 42 days postpartum. Conclusion The equity of maternal health care service utilization overall is good in central area in Shanghai, but there is still room for improvement. It is necessary to strengthen community mobilization, propagandize maternal health services, and expand the coverage of maternity insurance to improve the equity of maternal health service utilization and provide equal access to maternity health services.

Based on the analysis of the relevant records of the contralateral bloodletting technique, it is believed that this needling technique has 3 key characteristics, including "contralateral selection of points", "points on the four extremities dominated" and "collaterals selected rather than meridian points". Through the studies on philology and the annotation by the doctors in the past dynasties, a part of point prescriptions for the contralateral bloodletting is investigated, and those not belonged to the category of this needling technique in Suwen: Miuci Lun (On Contralateral Bloodletting) are distinguished. It is concluded that the failure of consensus-making in classifying point prescriptions is due to the lack of understanding on the characteristics of contralateral bloodletting and the misunderstanding on the errors of sentences and words. It is suggested that the study on theoretic concepts should lay on the problems relevant with the generalization and alienation of concepts. The mode of "combination of the detail with the whole" should be adopted. It starts from grasping the overall by systematic review, and followed by deliberating in details, so as to correctly identify the original concept and connotation.
Humans ; Bloodletting/methods* ; Acupuncture Points ; History, Ancient ; Meridians ; China

OBJECTIVE: To describe survival trends and global patterns of esophageal cancer (EC) using survival data from population-based cancer registries. METHODS: We systematically searched PubMed, EMBASE, Web of Science, SEER, and SinoMed databases for articles published up to 31 December 2023. Eligible EC survival estimates were evaluated according to country or region, period, sex, age group, pathology, and disease stage. RESULTS: After 2010, Jordan exhibited the highest age-standardized 5-year relative survival rates (RSRs)/net survival rates (NSRs) at 41.1% between 2010 and 2014, while India had the lowest, at 4.1%. Survival rates generally improved with diagnostic age across most countries, with significant increases in South Korea and China, of 12.7% and 10.5% between 2000 and 2017, respectively. Survival was higher among women compared to men, ranging from 0.4%-10.9%. Survival rates for adenocarcinoma and squamous cell carcinoma were similar, differing by about 4%. In China, the highest age-standardized RSRs/NSRs was 33.4% between 2015 and 2017. Meanwhile, the lowest was 5.3%, in Qidong (Jiangsu province) between 1992-1996. CONCLUSION Global EC survival rates have improved significantly in recent decades, but substantial geographical, sex, and age disparities still exist. In Asia, squamous cell carcinoma demonstrated superior survival rates compared to adenocarcinoma, while the opposite trend was observed in Western countries. Future research should clarify the prognostic factors influencing EC survival and tailor prevention and screening strategies to the changing EC survival patterns.
Humans ; Esophageal Neoplasms/mortality* ; Registries ; Male ; Female ; Survival Analysis ; Middle Aged ; Survival Rate ; Aged ; Global Health

The discovery and application of Lanwei (EX-LE 7) was reviewed to elaborate its enlightenment on the inheritance and innovation of acupuncture. Literature published before April of 2017 was searched in CNKI and VIP database with"Lanwei (EX-LE 7)"and"acupuncture"as key words. Related references and publications were retrieved. According to the purpose, literature was screened and key information was extracted to perform systematic review and analysis. The results indicated Lanwei (EX-LE 7), reflection of relationship between organ and body surface under the guidance of acupuncture and meridians theory, was not a point, but an area. The discovery and application of Lanwei (EX- LE 7) was the product of western and Chinese combination. The best indication was simple appendicitis, but operation should be applied once adhesion, purulent and perforation occurred. It is indicated to improve clinical efficacy and avoid accident, the reasoned core of theory system should be insisted and the communication with modern medicine should be reinforced.

Objective To discuss the risk factors of iliaofemoral vein restenosis after percutaneous recanalization of post-thrombotic occlusion.Method From March 2006 to December 2014,44 limbs in 41 patients with chronic post-thrombotic iliaofemoral vein occlusion underwent endovascular treatment in our hospital.Post-operative patency was evaluated by ultrasonography and anterograde veinography.Results Initial technical success was 90.2％ (37/41).During the follow-up,5 cases of reobstruction were determined,2 were caused by insufficient stent extension into the inferior vena cave.Failure in two cases of intra-stent thrombosis were found due to arbitrary discontinuity of oral anticoagulative therapy.Moreover,2 of 9 cases with venous ulcers in lower extremities were exacerbated after failure of endovascular treatment,we therefore performed surgical ligation and endovenous laser treatment of circumambient perforating veins.Conclusion Insufficient lesion cover,not enough extension to interior vena cave and unreasonable post-operative anticoagulation discontinuity are major causes of intra-stent reobstruction in iliaofemoral venous occlusion.

Objective To discuss the therapeutic effect in the treatment of the acute limb arterial critical ischemia.Methods Collect thirty-nine cases of acute limb arterial critical ischemia in Renji Hospital from Janary 2014 to July 2016.According to the patients' manifestation,these operations were porfermed including thrombectomy,cathetery-directed thrombolysis,mechanical suction bolt,percutaneous angioplasty and stenting.The effect and complications were observed.Results The eighteen patients in 39 cases (46.2％) were dead,including 5 cases without operation,13 operation.The eight cases were amputated during 34 cases of operations.In the 21 out-patients safely,2 cases were not followed up.The time of follow-up was from 3 to 27 months,on average 14.3 months.During the 21 patients,5 cases died from heart cerebrovascular or tumor diseases,3 cases with footdrop,2 cases with toe amputations,3 cases with distal leg and foot anesthesias.Conclusions The patiens with acute limb arteries critical ischemia must be treated as early as,and reinforced the management of multiple organ function,which may improve the diseases' therapeutic effect.

Objective To investigate the effect of early enteral nutrition combined with synbiotics agents on normal intestinal flora,fecal SIgA and infectious complications in patients with hypertensive intracerebral hemorrhage.Methods Fifty-three patients with hypertensive intracerebral hemorrhage were randomly divided into early enteral nutrition group (control group,n =26) and early enteral nutrition combined with synbiotics group (study group,n =27).The patients in control group started receiving enteral nutrition (RuiSu) within 24 to 48 hours after injury ; Patients in study group received a enteral nutritional support which as well as control group,but added synbiotics (Golden Bifid) in the first 14 days of enteral nutritional support.Stool specimens were Collected on day 0,day 4,day 8,day 15 of enteral nutrition support for quantitative analysis of normal intestinal flora and detection of stool SIgA through enzyme-linked immunosorbent assay.The difference of two groups in infectious complications were observed.Results On nutritional support day 8 and day 15,escherichia coli (P =0.004,P =0.004) and enterococci (P =0.032,P =0.048) expression were lower in study group than the control group,bifidobacteria (P =0.046,P =0.024) expression were higher in study group than the control group.During the study period lactobacillus,bacteroides and clostridium were no statistically significant between the two groups (P ＞ 0.05).Fecal SIgA expression in study group was higher than control group (P =0.035) on nutritional support dayl5.The incidence of infectious complications in study group was lower than the control group (33.33％ vs.46.15％),but there was no significant difference (P =0.230).Conclusion compared with ordinary enteral nutrition,enteral nutrition combined with synbiotics agents can be effective in improving intestinal flora imbalance and increase intestinal immune function in patients with hypertensive intracerebral hemorrhage.

Objective To investigate the relationship between intima-media thickness(IMT)and pulse wave velocity(PWV)in patients with type 2 diabetes mellitus.Methods 100 cases with type 2 diabetes were randomly divided into:hydrochlorothiazide group of 35 cases,valsartan group of 35 cases,valsartan and hydrochlorothiazide combined treatment group(combined group)30 cases.All the patients were treated for 16 weeks,systolic blood pressure (SBP),diastolic blood pressure(DBP),24h urinary albumin,blood urea nitrogen(BUN),carotid IMT,PWV,fasting plasma glucose(FPG)were measured before and after treatment in each group.Results The SBP,DBP,24h urinary albumin before treatment compared with after treatment was significant differences in three groups(t =2.7875,2.755,2.733,2.645,all P ＜ 0.05); IMT associated with SBP(r =0.669,P =0.013),pulse pressure(r =0.581,P =0.015),FPG(r =0.337,P =0.018);PWV associated with SBP(r =0.759,P =0.001),pulse pressure(r =0.707,P=0.002),FPG(r =0.679,P =0.016).Conclusion The non-invasive indicators of PWV can be used as aortic compliance.The PWV measurement of its vascular complications has important clinical value.

ObjectiveTo explore the effect of different nutritional support mdoes on humoral immunity and outcomes after esophagectomy in patients with esophageal carcinoma.MethodsForty-six patients with middle or low thoracic esophageal carcinoma underwent Ivor Lewis esophagectomy.The patients were randomized into enteral nutrition group ( EN,n =23 ) and enteral combined parenteral nutrition group ( EN + PN,n =23 ) based on the nutrition support modes.Serum levels of immunoglobulin (IgG,IgA,IgM,IgE,κ/λ light chain) and comphments (C3/C4) were assayed and compared on the 1st pre-operative day and at 18 hours as well as 3rd and 7th day after operation.The clinical outcomes including infection-related complications and hospital stay were compared between two group s.ResultsThere was no significant difference in all humoral immunity indicators between two groups at the eachpost-operative time point.In both two groups,the levels ofIgG [ (8.90 ± 1.75),(7.53 ±1.41) g/Land (8.64±2.44),(7.48±2.16) g/L],κ [ (2.14±0.46),(1.78±0.41) g/L,and (2.15 ±0.63),( 1.86 ± 0.62) g/L] and λ light chain [ ( 1.34 ± 0.45 ),( 1.11 ± 0.31 ) g/L and ( 1.20 ± 0.32),( 1.08 ± 0.35 ) g/L] were significantly lower 18 hours and 3rd day after operation than the pre-operative levels [ (12.15±2.86)and (11.11±2.96) g/L,(2.90±0.77) and (2.77±0.79) g/L,(1.79±0.57) and (1.56±0.41) g/L] (P=0.000,P=0.000,and P=0.004,P=0.000,and P=0.000,P=0.000,and P=0.011,P=0.000,and P=0.004,P=0.000,and P =0.008,P =0.000),and returned to the preoperative levels by the postoperative 7th day (P＞0.05),except for the level of κ light chain 7th day after operation in EN group [ ( 2.42 ± 0.69) g/L] ( P =0.027 ).The levels of IgA,IgE,and C3 were not significantly different during the perioperative period ( P ＞ 0.05 ).The level of IgM was not significantly different during the perioperative period in EN group (P ＞0.05),and was significantly lower on the 3rd post-operative day [ ( 1.00 ±0.53) g/L] than the pre-operative level [ ( 1.47 ±0.76) g/L] in the EN + PN group (P =0.031 ),and were not significantly different on the other time points (P ＞ 0.05 ).In the EN group,the C4 level was significantly lower at the postoperative 18 hours [ (0.24 ±0.08) g/L] than the pre-operative level [ (0.37 ±0.36) g/L] (P =0.030),and were not significantly different at the other time points ( P ＞ 0.05 ).In the EN + PN group,the C4 level was not significantly different during the perioperative period ( P ＞ 0.05 ).There was no significant difference in the infection-related complications and hospital stay between these two groups ( P =0.300,P =0.371 ).ConclusionsThe effects of EN or EN + PN on humoral immunity and outcomes after esophagectomy in patients with esophageal carcinoma are not different.Both these two nutritional support modes can not completely alleviate the harm to the humoral immunity.The EN is more cost-effective.

BACKGROUND AND OBJECTIVEThe aim of this study is the clinical value of preoperative routine surgical staging to mediastinal lymph nodes on lung cancer.

METHODSSeventy-six cases underwent lymph nodes biopsy with mediastinoscopy. The diagnostic efficacy of thoracic CT scan and mediastinoscopy on mediastinal lymph nodes metastasis were compared.

RESULTSThe sensitivity, specificity, accuracy, positive predictive value and negative predictive value of thoracic CT scan and mediastinoscopy on diagnosing mediastinal lymph nodes metastasis were 68.5%, 66.7%, 68.4%, 84.6%, 16.7% and 87.5%, 100%, 84.2%, 100%, 60%, respectively.

CONCLUSIONRoutine preoperative mediastinoscopy had obvious advantage compared with thoracic CT scan on mediastinal lymph nodes staging. The routine preoperative surgical staging of mediastinal lymph nodes on lung cancer had high clinical value.

Aged ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Male ; Mediastinoscopy ; Mediastinum ; pathology ; Middle Aged ; Neoplasm Staging ; Tomography, X-Ray Computed