Objective To provide scientific support for the prevention and control of expressway traffic injury by analyzing the epidemiological features of expressway traffic injury in China.Methods The secular trend and epidemiologic features of expressway traffic injury from 1994 to 2009 in China were analyzed.The indicators including mortality of mileage,accident rate of mileage,and accident mortality were used to evaluate the severity of expressway traffic injury in China.Cluster analysis was used to compare the differences of accident rate of mileage and accident mortality from 29 provinces,municipalities and autonomous regions.Results Except for the yearly increase of the accident mortality and the fluctuant decrease of the mortality and accident rate of mileage,other indicators reflecting the domestic expressway traffic injury from 1994 to 2009 were increased and then decreased,when the decreased indicators were still higher than those in 1994.In addition to the number of accidents of the four basic traffic injury indicators,the proportions of other three indicators(number of wounded and death,direct property damage)in the road traffic injury were increased year by year and the increase was the most obvious in regard of the direct property damage which had accounted for more than 30％ since 2006.The data from 2007 to 2009 showed that the peak time of traffic accidents was at around 4:00 am and around 4:00 pm.The traffic accidents caused by the drivers accounted for 93.02％ and the drivers with less than five years of driving accounted for 40.92％.Pedestrians and passengers were vulnerable to the expressway traffic injury and the accident mortality was the highest(72.75 per 100 accidents).Rear collision(44.17％)and bumping the fixed objects(16.35％)were the major accident types.There was a high accident proportion on the dry road(77.60％)and sunshine day(65.39％).Conclusions With worsening situation of the expressway traffic injury in China,we should,based on the epidemiological features of traffic injury on expressway,take appropriate measures such as strengthening traffic management of expressway and education of road users and improving the emergency medical service level.

BACKGROUND:With the wide application of bone repair scaffold in the field of medicine, nano-hydroxyapatite (nHA) and silk fibroin (SF) both of which have good biological properties have become research hotspots in recent years.OBJECTIVE:To study the feasibility of nHA/SF composite materials loaded with recombinant human bone morphogenetic protein 2 (rhBMP-2) to restore the initial stability of the spinal segment in rabbits.METHODS: Thirty-six male health New Zealand rabbits were randomly divided into three groups, followed by preparation of spinal instability models. Autogenous iliac bone, nHA/SF composite, and rhBMP-2/nHA/SF composite were implanted into the L4/5 spinal segment in autologous bone group, nHA/SF group and rhBMP-2/nHA/SF group, respectively. X-ray exmaination was performed at 12 weeks postoperatively, and then the animals were killed for gross observation. The stability of the fusion segments was tested through a tensile machine. Histologically, bone graft fusion at the surgical site was observed.RESULTS AND CONCLUSION:(1) Findings from the gross specimen observation showed that the specimens at the fusion site presented with a hard texture. Obvious signs of fusion were visible in the autologous bone group, followed by the rhBMP-2/nHA/SF group, while no signs of fusion were detected in the nHA/SF group. (2) At 12 weeks postoperatively, a large number of trabecular bones grew into the boundary between the vertebral body and the iliac crest graft block in the autologous bone group. A little trabecular bone was found in the boundary in the nHA/SF group, while a lot of trabecular bone tissues were found in the boundary in the rhBMP-2/nHA/SF group. In accordance with the standard of fusion, there were 10, 3, and 9 rats in the autologous bone, nHA/SF and rhBMP-2/nHA/SF groups, respectively. (3) The range of motion of the spine in the rhBMP-2/nHA/SF showed no statistical difference from that in the autologous bone group, but was significantly higher than that in the nHA/SF group (P < 0.05). (4) Osseous connection was found around the bone graft in the autologous bone and nHA/SF groups, but no mature bone tissue was visible in the latter group. In the rhBMP-2/nHA/SF group, a large number of new capillaries was found and permeated into the spinal tissues. In summary, nHA/SF composite materials loaded with rhBMP-2 possess good biocompatibility, mechanical properties and bone induction ability, which can rebuild the initial stability of the spine in a short time.

Objective To observe the post-systolic shortening (PSS) during isovolumic relaxation phase and its clinical significance in regional myocardium in chronic heart failure (CHF) patients.MethodsLeft ventricular regional myocardium movement in 60 CHF patients (CHF group) and 30 healthy volunteers (control group) were assessed with tissue velocity imaging (TVI). QLAB software was used to measure the systolic peak velocity (V_s), regional systolic time (T_s), post-systolic shortening velocity (V_(pss)) and post-systolic shortening time (T_(pss)) at the basal and middle levels of left ventricle. Results In CHF patients, the rate of isovolumic relaxation phase PSS was 34.44% both in basal and mid segments, the rate of pathological PSS was 29.44% and 29.72%, respectively. The rate of isovolumic relaxation phase PSS in control group was 26.11% and 20.56%, respectively; none pathological PPS occured. Compared with the physiological PSS of control group, the pathological PSS of CHF group had a higher peak velocity and a longer time (P<0.05). Conclusion The pathological PSS of CHF patients has high peak velocity and long duration, which may be one of the causes leading to the asynchronous movement of left ventricle in CHF.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.