Objective To exploer the function and underlying mechanism of Lunasin on sports articular cartilage injury.Methods Wistar rats were randomly divided into control group and model group;after injection molding for 3 times, the model rats were feed for 28 days.Then the model rats were divided into sham model group, 0.01, 0.05 and 0.1 mmol/L Lunasin treatment group respectively.After treatment, ELISA was used to analyze the production of IL-1β,IL-6,TNF-α,MMP-6 and MMP-8.SOD activity and iNOS were evaluated by their ELISA kit.Western blot was used to detect the expression of NRF2, Keap1, LC-3Ⅱ, Bax, Beclin1, p-AMPK, AMPK.Results Compared with control, the dose of IL-1β,IL-6,TNF-α,MMP-6 and MMP-8 in serum of model rats were significantly increased (P<0.05), however, after treatment with Lunasin for 1 month, these inflammatory factors were obviously reduced then that of model rats (P<0.05);Furthermore Lunasin treatment obvi-ously increased SOD activity,up-regulated NRF2 expression and down-regulated the generation of nitric oxide synthase (iNOS) (P<0.05);Additionally, Lunasin can raise the expression of autophagy-related protein(beclin1 and LC-3Ⅱ), reduce the expression of apoptosis protein (Bax) in damaged articular cartilage.ConclusionsLunasin benefits the repair of damaged joints by reducing the production of inflammatory mediators, activating of oxidative stress system and autophagy pathway.

Objective To investigate the levels of literacy and numeracy in type 2 diabetes patients with poor glycemic status in communities of Shanghai,China,and to evaluate their associations with blood glucose level.Methods A total of 800 type 2 diabetes patients with recent HbA1c≥7.5％ or fasting plasma glucose level ≥10 mmol/L were recruited from 8 communities in Minhang district and Changning district of Shanghai,China,and were interviewed using a structured questionnaire during February 2015 and March 2016.Literacy and numeracy levels of all patients were evaluated using the validated Health Literacy Management Scale (HeLMS) and the 5-item version Diabetes Numeracy Test (DNT-5),respectively.Results The patients included in this study were observed to have higher levels of health literacy,with a median score of HeLMS being 116 [interquartile range (IQR),108-120] and a median correct rate of DNT-5 of 80％ (IQR,60％-100％).Age,educational level and occupation were significantly related with health literacy levels and numeracy.Sex and income were closely related with health literacy levels.HeLMS score was not significantly associated with HbA1c level (P =0.383),while the lower correct rate of DNT-5 was linked with a higher level of HbA1c.The median HbA1c level was 8.3％ (IQR 7.7％-9.4％) in the patients with the lowest tertile of DNT-5 correct rate,significantly higher than 8.2％ (IQR:7.5％-9.2％) in the medium and 8.0％ (IQR:7.5 ％-8.8 ％) in the highest tertile group (P =0.009).Conclusions Diabetes patients with poor glycemic status in communities of Shanghai have high levels of health literacy,which was significantly related with age,sex,educational level,occupation and income.Ability in numeracy may be a more important influence factor than health literacy for glycemic status of diabetes patients.

OBJECTIVETo evaluate the cost-effectiveness of two breast cancer screening modalities conducted in Minhang district of Shanghai, China.

METHODSAn organized and an opportunistic breast screening programs were implemented among women aged 35-74 years in Minhang district of Shanghai between May 2008 and Oct 2010, and were compared with the results obtained without screening. Costs related to screening were obtained by access to finance data of the screening programs, and costs of first treatment were collected through patient survey and medical reimbursement system query. Information on breast cancer stage was obtained from Shanghai Cancer Registry and confirmed by medical chart review. The effectiveness of screening was evaluated by breast cancer stage improvement.Cost-effectiveness ratios (CERs) were computed as costs of gaining a stage improvement from a specified screening strategy when compared with the results obtained without screening. Incremental cost-effectiveness (ICER) which compares the two screening strategies was calculated by dividing the difference in total net costs and the difference in stages improved between the two screening strategies.

RESULTSThirty-five, one hundred and ninety-three and four hundred and seventy-nine breast cancer cases were identified in the organized screening, opportunistic screening and control groups, with an early detection rate of 46.9%, 40.7% and 38.9%, respectively. The costs of screening were 208 yuan per person or 72 453 yuan per case detected in the organized screening group and were 21 yuan per person or 11 640 yuan per case detected in the opportunistic screening group. The total cost was 103 650 yuan per case in the organized screening group, significantly higher than 50 712 yuan in the opportunistic screening group and 35 413 yuan in the control group. However, the average direct medical cost was significantly lower in the organized screening group than that in the opportunistic screening group and control group, with median costs of 11 024 yuan, 13 465 yuan and 14 243 yuan per case, respectively (P<0.001). The additional cost per case detected was 68 237 yuan for the organized screening and 15 299 yuan for opportunistic screening. The CERs were 135 291 yuan and 152 179 yuan per stage improved in the organized screening and opportunistic screening relative to the control group, with ICER of organized versus opportunistic screening being 131 086 yuan per stage improved.

CONCLUSIONSThe organized screening modality and the opportunistic one are both effective in early detecting breast cancer in Chinese women. The organized screening costs more than opportunistic screening, but with a better cost-effectiveness. It may be used as an option in economically developed areas of China.

Adult ; Aged ; Breast Neoplasms ; diagnosis ; pathology ; China ; Cost-Benefit Analysis ; Early Detection of Cancer ; economics ; Female ; Humans ; Mass Screening ; economics ; Middle Aged ; Program Development ; economics ; Surveys and Questionnaires

Objective : To investigate the current status of gingival bleeding and dental calculus in the 12- to 74-year old population in Guangdong Province with the aim of providing information to support oral health care. Methods : A stratified, multistage, random sampling design was used to obtain 7 provincially representative sample groups consisting of 8, 544 Guangdong residents aged 12, 13, 14, 15, 35-44, 55-64 and 65-74 years old with a 50/50 gender ratio. The status of gingival bleeding and dental calculus in the whole mouth was assessed according to the Guidelines of the Fourth National Oral Health Survey using a CPI probe. The resulting data were analyzed using the SAS9.2 package. Results : The prevalence of gingival bleeding in residents aged 12, 13, 14, 15, 35-44, 55-64 and 65-74 years old was 43.75%, 42.76%, 49.06%, 39.38%, 81.94%, 90.97%, and 84.03%, respectively, while the average number of teeth with gingival bleeding per person was 1.95, 2.07, 2.59, 2.39, 9.62, 10.36, and 9.98, respectively. In the 12-, 13-, 14-, and 15-year-old groups, peak prevalence was observed at age 14 (P < 0.05). In the 35-74-year-old group, the prevalence and mean number of teeth with gingival bleeding per person increased with age, and both parameters reached a peak in the 55-64-year-old group. The prevalence of dental calculus in the 12-, 13-, 14-, 15-, 35-44-, 55-64- and 65-74-year-old group was 40.57%, 41.09%, 45.05%, 54.84%, 98.96%, 97.22%, and 92.01%, respectively, and on average, each person had 1.61, 1.71, 2.14, 3.52, 20.30, 20.55, and 17.26 teeth, respectively, with dental calculus. The prevalence and mean number of teeth with dental calculus increased with age. In the 35- to 74- year-old group, the prevalence of dental calculus was higher in urban areas than in rural areas and the mean number of teeth with dental calculus was higher in males than in females. Otherwise, there were no significant differences in the prevalence or the mean number of teeth with dental calculus or gingival bleeding between urban and rural areas or between males and females. Conclusion There is a high prevalence of both gingival bleeding and dental calculus in all 7 age groups in Guangdong, indicating that poor oral hygiene and gingival inflammation are common in Guangdong Province.

Objective To determine the most cost-effective modality for breast cancer screening in women living in Shanghai.Methods A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district,Shanghai,during 2008 to 2012.Parameters of the model were derived from literatures.General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years.Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality.Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness.Results The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one.The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved,which were within the threshold of 2-3 times of local per capita Gross Domestic Product.Results from sensitivity analysis showed that,due to higher incidence rate of breast cancer in Shanghai,the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China.Conclusion Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai,and thus be widely promoted in this population elsewhere.

Objective : To investigate current status of periodontal health in the population at the age of 15-74 in Guangdong province and provide information for oral health care in Guangdong. Methods: A stratified multistage randomly sampling design was applied to obtain 4 provincially representative sample groups consisted of 2784 Guangdong residents, aged at 15, 35-44, 55-64 and 65-74 respectively, with a gender ratio of half to half. The status of probing depth (PD) and loss of attachment (LOA) of the whole mouth were assessed according to the Guideline for the fourth National Oral Health Survey by using a CPI probe, and the data obtained were analyzed with SAS9.2 package. Results : The prevalence of shallow periodontal pocket in the 15, 35-44, 55-64 and 65-74 years old group were 0.52%, 38.54%, 49.65%, 47.22% with 0.02, 2.05, 3.74, 2.80 affected teeth on average. The corresponding percentages of deep periodontal pocket in the 4 groups were 0.05%, 3.47%, 15.97%, 9.03% with 0, 0.07, 0.31, 0.16 affected teeth on average. Prevalence and the mean affected teeth of 4-5 mm LOA were 0.10%, 26.74%, 33.68%, 35.07% and 0, 1.54, 4.33, 4.05. The prevalence and the mean affected teeth of 6-8 mm LOA were 0, 6.94%, 32.29%, 27.08% and 0, 0.24, 1.23, 0.97. The prevalence of LOA≥4 mm were 0.10%, 35.07%, 79.17%, 74.65% and the prevalence of LOA≥6 mm were 0, 8.33%, 45.49%, 39.58%. In the 35-74 years old group, the prevalence and the mean teeth with PD and LOA increased with age and reached a peak in 55-64 years old group (P < 0.05). There were no significant differences in the prevalence and the mean teeth of PD and LOA between urban and rural areas. The mean teeth of PD in 35-44 and 55-64 years old groups were significant higher in the male than the female. The prevalence and the mean teeth with LOA were both significant higher in the male than the female. Conclusion The periodontal diseases indications are common in 35-74 years old people and most necessary at the age of 55-64 in Guangdong. The periodontal health may have extensive influence on oral health status in the middle-aged and the elder population in Guangdong.

Morita therapy has been bom for more than 100 years.Inpatient Morita therapy is highly oper-able and easy to master.It can improve many refractory neuroses through four-stage treatment.But more neuroses are treated in outpatient clinics,and Morita therapy cannot be used in hospitalized patients.Therefore,the formula-tion of expert opinions on outpatient operations is particularly important.This paper is based on domestic and for-eign references,and after many discussions by domestic Morita therapy experts,and then drew up the first version of the expert opinions on operation of outpatient Morita therapy.Meanwhile the operation rule of Morita therapy in three stages of outpatient treatment was formulated:in the etiological analysis stage,under the theoretical guidance of Morita therapy,analyze the pathogenic factors,to improve treatment compliance and reduce resistance;during the operating stage,guide patients to engage in constructive and meaningful actions,realizing the achievement of letting nature take its course principle;in the cultivating character and enriching life stage,pay attention to positive infor-mation,expanding the scope and content of actions,improving the ability to adapt to complex life,and preventing recurrence caused by insufficient abilities.It will lay a foundation for the promotion of Morita therapy in domestic outpatient clinics,so that more patients with neurosis and other psychological diseases could receive characteristic Morita therapy treatment in outpatient clinics.

Objective: To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China. Methods: In this cluster randomized controlled trial, a total of 799 T2DM patients with most recent hemoglobin A1c (HbA1c) ≥ 7.5% (or fasting plasma glucose level ≥10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai, and randomized into a health literacy intervention group, an exercise intervention group, a comprehensive intervention group and a control group. After baseline survey and examination, a one-year intervention and 3 times (at 3(rd), 6(th), and 12(th) month) follow-up surveys were conducted. Results: The follow-up rates for all the subjects were 99.4%, 98.4% and 95.2%, respectively, at 3(rd), 6(th) and 12(th) month. Patients in intervention groups were more likely to achieve a goal HbA1c level (HbA1c <7.0%) than those in control group, with the highest glycemic control rate (25.3%) observed in comprehensive intervention group at 3(rd) month and then in exercise intervention group (25.3% and 34.6%) respectively, at 6(th) month and 12(th) month. The average levels of HbA1c in three intervention groups were lower at each follow-up time point than those at baseline survey. However, the decreases in HbA1c were obvious only at 6(th) month (P<0.001), with ls-mean (95%CI) of -0.48% (-0.71%, -0.25%), -0.33% (-0.55%, -0.11%) and -0.70% (-0.92%, -0.48%), respectively, in comprehensive, health literacy and exercise intervention groups, but it increased slightly by 0.03% (-0.19%, 0.25%) in control group. Compared with control group, the interventions were significantly associated with the decrease of HbA1c level, with the most improvement observed in comprehensive group (β=-0.47, 95% CI: -0.73, -0.20) at 3(rd) month, and in exercise intervention group at 6(th) month (β=-0.73, 95%CI: -0.98, -0.47) and at 12(th) month (β=-0.75, 95%CI: -1.05, -0.45) of follow-up. Stratified analyses showed that patients with lower health literacy level could benefit from any intervention, while those with higher numeracy skill benefited more from exercise intervention. Conclusion: Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM, which would be helpful in reducing the risks of complications and deaths in diabetes patients.
Blood Glucose/analysis* ; China ; Diabetes Mellitus, Type 2/therapy* ; Disease Management ; Exercise ; Follow-Up Studies ; Glycated Hemoglobin/analysis* ; Health Literacy ; Humans ; Patient Education as Topic ; Self Care ; Surveys and Questionnaires ; Treatment Outcome

Objective: To understand the health literacy and relevant factors of cancer prevention consciousness in Chinese urban residents from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The self-designed questionnaire was used to collect the information of demographic characteristics and cancer prevention consciousness focusing on nine common risk factors, including smoking, alcohol, fiber food, food in hot temperature or pickled food, chewing betel nut, helicobacter pylori, moldy food, hepatitis B infection, estrogen, and exercise. The logistic regression model was adopted to identify the influencing factors. Results: The overall health literacy of the cancer prevention consciousness was 77.4% (24 980 participants), with 77.4% (12 018 participants), 79.9% (6 406 participants), 77.2% (1 766 participants) and 74.5% (4 709 participants) in each group (P<0.001). The correct response rates for nine risk factors ranged from 55.2% to 93.0%. The multivariate logistic regression analysis showed that compared with community residents, people with primary school level education or below, and the number of people living together in the family <3, the cancer risk assessment/screening intervention population, cancer patients, those with junior high school level educationor above and the number of people living in the family ≥3 had better health literacy of the cancer prevention consciousness (all P values <0.05). Compared with females, 39 years old and below, government-affiliated institutions or civil servants, from the eastern region, males, older than 40 years, company or enterprise employees, and from the middle or western region had worse health literacy of the cancer prevention consciousness (all P values <0.05). Conclusion The health literacy of the cancer prevention consciousness in Chinese urban residents should be improved. The cancer screening intervention, gender, age, education, occupation, the number of people co-living in the family, and residential region were associated with the health literacy of the cancer prevention consciousness.