Abstract：Objective To investigate the detection methods of newly discovered leprosy cases in Hunan Province in 2013-2022, and analyze the trend of changes, and provide scientific basis for the prevention and treatment of leprosy. Methods The detailed information of newly diagnosed leprosy cases in Hunan Province from 2013 to 2022 was collected through the Leprosy Management Information System (LEPMIS), and the descriptive epidemiological method was used to analyze the detection methods of newly discovered leprosy cases. Results From 2013 to 2022, a total of 250 newly diagnosed leprosy cases were detected in Hunan Province, including 143 cases (57.20%) were found in outpatient clinics, 33 cases (13.20%) were found in clue investigations, 27 cases (10.80%) were notifiable-reported, 23 cases (9.20%) were self-reported, 11 cases (4.40%) were found in other ways (e.g., group survey), 9 cases (3.60%) were found in contact examinations, 2 cases (0.80%) were found in census, and 2 cases (0.80%) were found in epidemic point inspection. From 2013 to 2022, the number of cases detected in outpatient clinics showed an upward trend (rs=0.515), while the cases detected in clue investigation (rs=-0.873), notifiable-reported (rs=-0.127), self-reported (rs=-0.301), contact examination (rs=-0.363), census (rs=-0.701) and epidemic point inspection (rs=-0.701) showed a downward trend. The majority of leprosy cases with different demography characteristics and clinical characteristics were found through outpatient clinics, except that the majority of leprosy cases in children were found by contact examination (66.76%). Of 165 male cases, 92 cases (55.76%) were found in outpatient clinics and 51 out of 85 female cases (60.00%) were found in outpatient clinics. Among age groups, 113 out of 187 cases aged 15 to 60 (60.43%) and 30 out of 60 cases aged over 60 (50.00%) were found in outpatient clinics. Among patients with differentoccupations, 112 out of 208 cases of farmers (53.85%) and 31 out of 42 cases of other occupations (73.81%) were found inoutpatient clinics. Among cases with different types of leprosy, 111 out of 185 cases of multibacillary leprosy (60.00%) and 32 out of 65 cases of paucibacillary leprosy (49.23%) were found in outpatient clinics. Among cases with different numbers of skin lesions, 4 out of 8 cases of skin lesion-free leprosy (50.00%), 3 out of 9 cases of single skin lesion leprosy (33.33%), and 136 out of 233 cases of multiple skin lesions leprosy (58.37%) were found in outpatient clinics. Of 72 cases without nerve damage, 48 cases (66.67%) were found in outpatient clinics. Of 27 cases with single nerve damage, 17 cases (62.96%) were found in outpatient clinics. Of 151 cases with multiple nerve damage, 78 cases (51.66%) were found in outpatient clinics. Among patients with different levels of malformation, 58 out of 102 cases with no malformation (56.86%), 28 out of 45 cases with Grade malformation (62.22%), 35 out of 68 cases with Grade Ⅱmalformation (51.47%), and 22 out of 35 cases with other types of malformation (62.86%) were found in outpatient clinics. Conclusions Outpatient clinics is the main way to detect newlydiagnosed leprosy cases under the low prevalence of leprosy in Hunan Province, and it is an important strategy to move the early detection of leprosy cases to comprehensive medical institutions in the future.

Objective To explore the effect of psychological intervention on knee osteoarthritis patients. Methods A total of 92 OA patients were included into a one-month randomized controlled followup study, 47 of them were treated with combined psychological intervention, the other 45 cases were routinely treated. All cases were investigated on their demographic information , physiological parameters and score of the short form-36 health survey questionnaires (SF-36), self-rating depression scale (SDS) and self-rating anxiety scale (SAS). Statistics method used t-test and variance analysis. Results There was no signi-ficant difference in terms of the physiologic parameters changes between before and after treatment (P＞0.05) of the two groups. ① The SDS scores of the two groups decreased gradually after the treatment (P＜0.05),while there was remarkable descending of SDS score in patients of psychological intervention group (P＜0.05). ② The SAS scores of the two groups decreased gradually after the treatment (P＜0.05). And there was no significant difference between the two groups (P＞0.05). Compared with the non-intervention group, the fourfactors scores including physical function, pain, vitality and role limitations due to emotional problems of the intervention group were significantly improved (P＜0.05). Anegative correlation was observed between SDS and PF, BP, GH, VT and SF (r=-0.739-0521,P＜0.05). SAS was correlated negatively with VT and SF (r=-0.699～-0.475,P＜0.05). Conclusion Psychological intervention could ameliorate the depression of knee osteoarthritis patients. The quality of life of knee osteoarthritis patients can be improved by psychological intervention.

Objective To investigate the effects of sensorimotor therapy on patients with knee osteoarthritis.Methods Ninety-two patients with knee osteoarthritis were divided into a treatment group and a control group by using random digits table. Both groups received conventional rehabilitation therapy, including knee isometric and isotonic contraction training, ultrashort wave diathermy as well as aerobic exercise. The treatment group was also administered with sensorimotor training, in addition to the conventional training,including the muscle strengthening and control training of quadriceps and hamstring muscle using sling exercise therapy system and on the Thera-band mattress. The visual analogue scale (VAS) for pain, manual muscle testing and knee range of motion as well as the Japanese Orthopedic Association knee function evaluation form were used to evaluate the patients. Results There was no statistic difference between the 2 groups before treatment, with regard to the evaluation parameters used in this study. After 2 months of treatment, both groups improved significantly (P ＜0.05),with the treatment group improved to a significantly greater extent (P ＜0.05). Conclusions Sensorimotor training in addition to the conventional rehabilitation treatment can further relieve the pain of patients with knee osteoarthritis joints arthritis and improve the function of patients with knee osteoarthritis.

Objective To explore the clinical effect of psychological rehabilitation on dysphagia with cognitive and psychological disorders post stroke. Methods 120 stroke patients with dysphagia complicated with cognitive and psychological disorders were divided into experimental group (n=60) and control group (n=60). Both groups received neurological routine medical treatment, swallowing function rehabilitation training, feeding training and low-frequency electrical stimulation. Cognitive and psychological therapy was additionally used in the experimental group. Both groups were assessed by Kubota DrinkingWater Test, Mini-Mental State Examination (MMSE), Hamilton Rating Scale for Depression (HAMD) and Hamilton Rating Scale for Anxiety (HAMA). Results 1 month after intervention, the score of Kubota Drinking Water Test improved significantly in both groups, and was higher in the experimental group than in the control group (P<0.001).The rate of clinical improvement was higher in the experimental group than in the control group (P<0.01). The scores of MMSE increased significantly in the experimental group (P<0.001). The scores of HAMD and HAMA decreased significantly in the experimental group (P<0.01). Only the scores of HAMA decreased in the control group (P<0.05). Conclusion Swallowing function rehabilitation training combined with cognitive and psychological therapy may facilitate to improve the cognitive function and psychological state and swallowing function for dysphagia with cognitive and psychological disorders post stroke.

BACKGROUND: Learning memory disorder is one of the major manifestations of aging. The model of aging induced by D-galactose is a commonly used animal model in recent years, and long-term D-galactose exposure may cause nerve cell morphological changes in animals.OBJETCIVE: To observe spatial learning memory behavior during Dgalactose-induced aging process in order to further explore in vivo evoked long-term potentiation in hippocampus dentate gyrus and synaptic morphological changes in hippocampal CA3 region.DESIGN: Randomized controlled observation.SETTING: Anatomical Teaching and Research Secti , Shanghai Second Medical University; Department of Physiology, Shanghai Traditional Chinese Medicine University.MATERIALS: The experiment was carried out at the Physiological Laboratory of Shanghai Traditional Chinese Medicine University between August 2000 and April 2001. Totally 22 male Wistar rats of 3-month birth age were included and randomized into normal group and D-galactose group with 11 rats in each group. D-galactose was produced by Shanghai No. 2 Chemical Reagent Factory, Morris water maze was home-made by the Institute of Geriatrics, Shanghai Traditional Chinese Medicine university.METHODS: Rats were subjected to hypodermic injection of 1 mL normal saline every day in normal group, or D-galactose of 800 mg/kg daily for 6consecutive weeks in D-galactose group. Rat spatial learning memory behavior was assessed by the latency of Morris water maze; hippocampal dentate gyrus community potentials evoked by monopulse stimulation on perforating fibers were recordedin vivo; meanwhile, the amplitude of monopulse evoked potentials was determined before and after high frequency stimulation, with the amplitude before high frequency stimulation taken as baseline. Transmission electromicroscope was applied in combination with imaging analysis to observe synaptic morphology and structure in rat hippocampal CA3 region. Water labyrinth latency was compared using the variance analysis of repetitive survey design, t-test was used to compare the differences of peak potential latency of community potentials at various time points after long-term potentiation. Moreover, inducing rate of longterm potentiation was compared by χ2-test, XY-540 type biological imaging processing system was used to analyze electromicroscopic pictures, and all available data were analyzed with t-test.MAN OUTCOME MEASURES: [1] Main outcomes: Changes of Morris water maze latency, as well as inducing rate of long-term potentiation and community potentials. [2] Secondary outcomes: Synaptic morphological and structural changes in hippocampal CA3 region.RESULTS: Totally 22 rats were enrolled in this study, with no one lost during water labyrinth test, but one rat in both normal group and D-galactose group died during electrophysiological experiment. Finally 3 rats were randomly selected from each group for electromicroscopic observation. [1]Comparison of the latency for Morris water maze: In contrast with that of normal group, latency for seeking submarine platform was obviously prolonged in D-galactose group [(14.77±10.10), (51.36±12.45) s, P ＜ 0.05].[2] Comparison of evoked potential in hippocampus dentate before high frequency stimulation: The two groups did not obviously differ in community potential amplitude and community potential latency [(1.05±0.47),(0.91±0.41) mV; (5.46±2.09), (5.38±2.26) ms; P ＞ 0.05]. [3] Inducing rate of long-term potentiation in hippocampal dentate gyrus: Compared to that of normal group, inducing rate in D-galactose group obviously reduced after high frequency stimulation (80%, 20%, χ2=7.20, P ＜ 0.01). [4] Comparison of community potential ratio at different time points after high frequency stimulation: Compared to that of normal group, it was notably reduced in D-galactose group at post-stimulation 20, 30, 60 minutes, respectively (1.104±0.196, 0.919±0.162; 1.354±0.212, 0.999±0.219; 1.236±0.174,0.875±0.311; P ＜ 0.05). [5] Comparison of synaptic struc tural parameters in hippocampal CA3 region: Compared to that of normal group, postsynaptic dense bodies became thickened in hippocampal CA3 region of D-galactose group [(40.60±18.26), (26.35±8.15) nm, P ＜ 0.05], the synapse gap increased [(17.69±6.28), (26.95±5.67) nm, P ＜ 0.05] while synaptic active zone was shortened [(265.13±76.50), (229.13±90.68) nm, P ＜ 0.05].CONCLUSION: Hypodermic injection of D-galactose does harm to rat spatial learning memory by reducing the long-term potentiation, inducing rate in rat hippocampal dentate gyrus, attenuating the increase of long-term potentiation-evoked potential amplitude, and even remarkably changing the synaptic ultrastructure in rat hippocampal CA3 region. It suggests that Dgalactose inhibits the long-term potentiation at hippocampal dentate gyrus and affects synaptic structure in hippocampal CA3 region, which is considered as the basis of spatial learning memory behavioral disorder.

Objective To study the action of aspirin, ticlopidine and cilostazol in inhibiting platelet activation in vitro. Methods Three kinds of anti platelet drugs, which inhibited the expression of fibrinogen receptor (FIB R) and P selectin (CD62P) on activated platelets surface in vitro, were analyzed by tri color flow cytometry. Results Three kinds of anti platelet drugs inhibited the expression of FIB R and CD62P on ADP activating platelet membrane surface differently. Cilostazol could inhibit the expression of FIB R and CD62P of the platelets markedly. Ticlopidine could inhibit the FIB R expression markedly, but CD62P indistinctly. Aspirin could not inhibit the expression of either FIB R and CD62P on ADP activating platelets. Conclusion Cilostazol is a strong anti platelet drug as compared with aspirin and ticlopidine. It could not only inhibit FIB R expression of activated platelets, which can prevent platelet aggregation, but also decrease the release reaction and procoagulative activities of activated platelets.

Objective To identify the genetic mechanism of fetuses with short limbs deformity.Methods From Aug.2008 to Aug.2011,ten fetuses with obvious short limbs were found in ultrasound screening performed at 18-24 and (or) 30-32 gestational weeks and underwent artificial induced labor with the patient' consent.Amniotic fluid or cord blood of the fetuses was collected for karyotyping analysis and detection of mutation point of fibroblast growth factor receptor 3 (FGFR3)gene by polymerase chain reaction and gene sequencing.One fetus (case 3) who presented with achondrogenesis underwent sequencing of SLC26A2 and Trip11 gene meanwhile.Results Among the 10 fetuses with short limbs deformity,five cases were found during second trimester and five during third trimester.Nine cases were identified as normal karyotype and one was chimera (46,XY/45,XY,- 18).One fetus carried a rare FGFR3 mutation of c.1108G＞T (G370C) and was diagnosed as thanatophoric dysplasia at 21+3 weeks.Three fetus carried c.1138G＞A (G380R) mutation and were diagnosed as achondroplasia.These four families had low recurrent risk because no gene mutations were found in the parents.Three mothers of these four fetuses were pregnant again and had normal neonates now.No mutations were found in all gene sequencing in case 3.Conclusions Karyotyping analysis and sequencing of FGFR3 gene could find causative gene mutations and provide genetic counselling and prenatal diagnosis for some fetuses with short limbs deformity.In the third trimester,achondroplasia is the most possible diagnosis when short limbs fetus is found by ultrasound.

Objective:To study the correlation of β-fibrinogen-854G/A,-455G/A,-249C/T,-148C/T,448G/A and BcI-1G/A polymorphisms, functional expression of plasma fibrinogen concentration, molecular reactivity, and the type of cerebral infarction.Methods: A casecontrol study was used to analyze 54 patients with main-think cerebral infarction(MCI), 106 patients with penetrating-arterial cerebral infarction (PCI)and 160 heathy cases as control group in Kailuan Hospital between July 2002 and June 2003.Gene polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP).Fg concentration, fibrin monomer polymerized velocity(FMPV), absorbance maximum(Amax), FMPV/Amax and biochemistry factors including TG were measured, Results: Fg concentration, FMPV, FMPV/Amax in the MCI group and TG, VLDL and FMPV in the PCI group were higher than in the control group(P＜0.05).The frequencies of854A and Bcl-1A alleles had significant difference among three groups,and the frequencies of GA and AA genotypes in the MCI and PCI groups were higher than in the control group(P＜0.05), however, no different genotypes and allele frequencies of the remaining sites were found in the three groups(P＞0.05).Fg concentration and FMPV of allele T carriers in the MCI group were less than that of-249C/C homozygous ones(P ＜0.05); FMPV/Amax of allele T carriers in the PCI group was higher than that of-148C/C homozygous ones(P＜0.05);with allele A carriers, Fg concentration of control group and FMPV of PCI group were higher than that of Bcl-1 wild homozygote(P＜0.05).Conclusion: Bβ-249 C/T polymorphism in the 5-flanking promoter region can influence the expression of plasma FMPV, Bβ-148 locus is the main regulation location of Fg molecular conglomerate function.Bcl-1 locus in the 3-flanking region is an important gene regulator of plasma Fg concentration, moreover,people with its mutated genotypes are susceptible to MCI.The abnormal plasma Fg concentration, FMPV/Amax and FMPV simultaneously are important risk factors for MCI, and only abnormal FMPV and TG are prone to PCI.

Objectives To report clinical,electrophysiological and pathological features of myopathy with tubular aggregates.Methods The onset of the disease was between 5-50 years old in the 6 sporadic male cases.Skeletal muscle biopsy was performed for all cases.Specimens were examined histochemically,enzymhistochemically and electromicroscopically.Results Case 1 and 2 presented with limb girdle myasthenic syndrome.The case 1 developed exercise-induced cramps in the late stage.Case 3 complained about persistent weakness and Dopa-responsive dystonia.Case 4 and 5 were characterized by periodic paralysis.Case 6 showed exercise-induced cramps.Serum potassium was normal in all patients. Slight elevation of serum creatine kinase appeared in 3 cases.Electromyography showed neurogenic pattern in case 1 and 6,myogenic changes in case 4 and 5,and no abnormality in other 2 cases.Marked decrement of active potential amplitude was noted with low frequency repetitive nerve stimuli in case 1 and 2.Four percent to forty percent of muscle fibers showed focal material accumulation in the fibers,which involved mainly type 2 fibers in all cases.The material was stained bright red material with modified gomori trichrome,intensive staining with nicotinamide adenine dinucleotide-tetrazolium reductase,lack activity of succinate dehydrogenase and ATPase.Electron microscopy confirmed bundles of parallel micro-tubular structure in the muscle fiber.Conclusions Myopathy with tubular aggregates has various clinical subtypes and electromyographic pattern.Dystonia or other systemic symptoms could be noted in this disease.The limb girdle myasthenic syndrome can also be accompanied with exercise-induced cramps.

Objective Through the practice of new practice teaching methods, to observe whether it can help students to strengthen their self-identity as ‘trainee doctors’. Methods By sim-ulating interrogation, building simulation medical environment and increasing operation project, the practice operation abilities and sense of identity were improved,The questionnaire were required to fill in at the beginning and at the end of the term, and the differences between two teaching methods in advantages, characteristics and the identity of ‘trainee doctors’by their own pairing were compared. Data were analyzed by software SPSS 18.0. Results The new teaching model, to a certain extent, alleviated the present situation of having relatively more students and insufficient source, which was superior to traditional teaching mode in improving students' initiative, enthusiasm, learning ability, practical ability, analysis of the problems, comprehensive ability and so on. It also enabled students to master some of doctor-patient communication skills(P<0.001), to realize the identity of‘trainee doctors’ (Z=-7.671, P<0.001). Conclusion The new practice teaching mode has solved the problems such as insufficient source in clinical teaching. It has also increased the initiative and enthusiasm of students' clinical learning, so that students can think, analyze and deal with the problems from the point of view of doctors, and implement the identity of a‘trainee doctor’.