From the perspective of the physiological basis of liver and kidney sharing the common source in traditional Chinese medicine(TCM),and by integrating the theory of kidney dominating bone,liver dominating tendon,and meridian sinew of TCM as well as the bone resorption and collapse theory,and non-uniform settlement theory and lower-limb musculoskeletal bowstring structure theory of modern orthopedics,the pathogenesis of osteonecrosis of the femoral head(ONFH)under the system of non-uniform settlement during bone resorption and multidimensional composite bowstring working in coordination with the theory of liver-kidney and muscle-bone was explored.The key to the TCM pathogenesis of ONFH lies in the deficiency of the liver and kidney,and then the imbalance of kidney yin-yang leads to the disruption of the dynamic balance of bone formation and bone resorption mediated by osteoblasts-osteoclasts,which manifests as the elevated level of bone metabolism and the enhancement of focal bone resorption in the femoral head,and then leads to the necrosis and collapse of the femoral head.It is considered that the kidney dominates bone,liver dominates tendon,and the tendon and bone together constitute the muscle-bone-joint dynamic and static system of the hip joint.The appearance of collapse destroys the originally balanced muscle-bone-joint system.Moreover,the failure of liver blood in the nourishment of muscles and tendons further exacerbates the imbalance of the soft tissues around the hip joint,accelerates the collapse of the muscle-bone-joint dynamic and static system,speeds up the process of femoral head collapse,and ultimately results in irreversible outcomes.Based on the above pathogenesis,the systematic integrative treatment of ONFH should be based on the TCM holistic concept,focuses on the focal improvement of internal and external blood circulation of the femoral head by various approaches,so as to rebuild the coordination of joint function.Moreover,attention should be paid to the physical constitution of the patients,and therapy of tonifying the kidney and regulating the liver can be used to restore the balance between osteogenesis and osteoblastogenesis,and to reconstruct the muscle-bone-joint system,so as to effectively delay or even prevent the occurrence of ONFH.

Abstract: Objective　To analyze the epidemiological characteristics (season, age, gender, mixed infection and clinical manifestations, etc.) of Mycoplasma pneumoniae (MP) infection in children in Hainan Province, so as to provide epidemiological evidence-based medical basis for the prevention and control of MP infection in children in Hainan Province. Methods　The serum IgM antibodies of MP, Legionella pneumophila, Chlamydia pneumoniae, adenovirus, respiratory syncytial virus (RSV), Q fever Rickettsia, parainfluenza virus, influenza A virus and influenza B virus in children with respiratory tract infections (RTIs) who were hospitalized in pediatrics of many hospitals in Hainan Province from March 2012 to February 2020 were detected by indirect immunofluorescence method. The positive serum MP-IgM antibody was defined as MP infection. The epidemiological and clinical data of MP infected cases were analyzed retrospectively. Results　From March, 2012 to February, 2020, a total of 35 731 qualified pediatric inpatients with RTIs in many hospitals in Hainan Province were tested for serum MP-IgM with the total positive rate of 39.12% (13 978/35 731). The yearly positive rates of MP-IgM from 2012 to 2020 were 48.39%, 56.23%, 56.62%, 47.04%, 29.71%, 24.14%, 47.55%, 36.84% and 24.46% respectively. The positive rates of MP-IgM in 2013 and 2014 were significantly higher than those in other years (P<0.05). The positive rate of MP-IgM in summer in Hainan Province was the highest (41.34%) and the lowest in winter (35.77%) (P<0.05). MP infection occurred in all age groups, the positive rate of MP-IgM in children of preschool (51.80%) was significantly higher than that in other age groups (P<0.01), and the positive rate of MP IgM in children of infancy (15.36%) was lower than that in other age groups (P<0.01). The positive rate of MP-IgM in female was 44.77%, which was significantly higher than that in male (35.83%) (P<0.05). MP infection combined with positive IgM of another pathogen accounted for 32.63% (4 561 cases), positive IgM of another two pathogens accounted for 1.26% (176 cases). MP infection was mostly found in pneumonia (68.73%), and the main clinical symptoms were cough (84.72%), fever (51.01%) and wheezing (3.16%). Conclusions　MP is an important pathogen of respiratory tract infection in children in Hainan Province, and infection is more common in children in early school age and early childhood. Mp-specific tests should be performed to identify the pathogen in children suspected of MP infection. In the high incidence season, health education should be strengthened in kindergartens, schools and other places to prevent respiratory tract infection.

Objective: To investigate the distribution of blood pressure and analyze the associated factors of blood pressure of the elderly with type 2 diabetes in Jiangsu Province. Methods: The elderly over 60 years old participants with type 2 diabetes in the communities of Huai'an City and Changshu City, Jiangsu Province were selected in this study. They were divided into two groups: taking antihypertensive drugs and not taking antihypertensive drugs. The demographic characteristics, such as age and sex, and relevant factors were collected by questionnaire. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by physical examination. The percentile of SBP and DBP in each age group of men and women were described. The kernel density estimation curve was used to show the blood pressure distribution. The trend of blood pressure with age was fitted by locally weighted regression. The logistic regression model was used to analyze relevant factors of blood pressure. Results: A total of 12 949 participants were included in this study, including 7 775 patients in the antihypertensive drug group and 5 174 patients in the group without antihypertensive drugs. The SBP of participants was concentrated at 140-160 mmHg, and their DBP was concentrated at 75-85 mmHg. There were significant differences in the distribution of blood pressure among the subgroups of body mass index (BMI) and rural areas whether taking antihypertensive drugs and not. For participants aged under 80 years old, the SBP showed an increasing trend with age and the DBP showed a decreasing trend with age. Age, BMI ≥24 kg/m², fasting blood glucose ≥7.0 mmol/L, living in rural areas and no smoking were influencing factors of the elevated SBP; BMI ≥24 kg/m², male, living in rural areas, no smoking, drinking alcohol and not receiving drug hypoglycemic treatment were influencing factors of the elevated DBP. Conclusion: The SBP of older diabetic adults in Jiangsu Province is at a high level, and the distribution of blood pressure is significantly different between men and women in taking antihypertensive drugs group. The SBP presents a rising trend and the DBP is decreasing at the age of 60-80 years. The blood pressure level of this population are mainly affected by age, BMI, urban and rural areas, smoking.
Adult ; Aged ; Humans ; Male ; Female ; Middle Aged ; Aged, 80 and over ; Blood Pressure/physiology* ; Diabetes Mellitus, Type 2/epidemiology* ; Antihypertensive Agents/therapeutic use* ; Smoking ; Body Mass Index ; Hypertension/epidemiology*

Objective: To investigate the influence of extending the waiting time on tumor regression after neoadjuvant chemoradiology (nCRT) in patients with locally advanced rectal cancer (LARC). Methods: Clinicopathological data from 728 LARC patients who completed nCRT treatment at the First Affiliated Hospital, Naval Medical University from January 2012 to December 2021 were collected for retrospective analysis. The primary research endpoint was the sustained complete response (SCR). There were 498 males and 230 females, with an age (M(IQR)) of 58 (15) years (range: 22 to 89 years). Logistic regression models were used to explore whether waiting time was an independent factor affecting SCR. Curve fitting was used to represent the relationship between the cumulative occurrence rate of SCR and the waiting time. The patients were divided into a conventional waiting time group (4 to <12 weeks, n=581) and an extended waiting time group (12 to<20 weeks, n=147). Comparisons regarding tumor regression, organ preservation, and surgical conditions between the two groups were made using the t test, Wilcoxon rank sum test, or χ² test as appropriate. The Log-rank test was used to elucidate the survival discrepancies between the two groups. Results: The SCR rate of all patients was 21.6% (157/728). The waiting time was an independent influencing factor for SCR, with each additional day corresponding to an OR value of 1.010 (95%CI: 1.001 to 1.020, P=0.031). The cumulative rate of SCR occurrence gradually increased with the extension of waiting time, with the fastest increase between the 9^th to <10^th week. The SCR rate in the extended waiting time group was higher (27.9%(41/147) vs. 20.0%(116/581), χ²=3.901, P=0.048), and the organ preservation rate during the follow-up period was higher (21.1%(31/147) vs. 10.7%(62/581), χ²=10.510, P=0.001). The 3-year local recurrence/regrowth-free survival rates were 94.0% and 91.1%, the 3-year disease-free survival rates were 76.6% and 75.4%, and the 3-year overall survival rates were 95.6% and 92.2% for the conventional and extended waiting time groups, respectively, with no statistical differences in local recurrence/regrowth-free survival, disease-free survival and overall survival between the two groups (χ²=1.878, P=0.171; χ²=0.078, P=0.780; χ²=1.265, P=0.261). Conclusions: An extended waiting time is conducive to tumor regression, and extending the waiting time to 12 to <20 weeks after nCRT can improve the SCR rate and organ preservation rate, without increasing the difficulty of surgery or altering the oncological outcomes of patients.

Objective: To analyze the CD4+T cell count level of newly diagnosed HIV infected patients in Jiangsu province, and to understand their immune status and disease progression so as to provide scientific basis for HIV prevention and control strategy in the whole province. Methods: Flow cytometry was used to detect the absolute count of CD4+T lymphocytes in newly diagnosed patients who had not initiated ART in 2020. Multivariate Logistic regression was used to analyze the associated factors of CD4+T cell count. Results: In 2020, there were 2 175 new diagnosed cases with HIV infection in Jiangsu Province. Patients under 30 years old, infected by homosexual transmission, unmarried, with college degree or above, students, diagnosed in counseling and testing and floating population had a higher absolute count level of CD4+T cell count(P<0.05). Multivariate Logistic regression analysis showed that people aged ≥30 and diagnosed in medical institutions were more likely to be presented lately(P<0.05). Conclusion In recent years, the intervention strategy for men who had sex with men(MSM) in Jiangsu province had achieved remarkable results.In the future, much more attention should be paid for the population over or equal to 30 years old, married or divorced, infected by heterosexual transmission, with high school education or below, farmers or migrant workers, retirees and diagnosed in medical institutions so that the PITC service should be promoted, and the publicity and intervention should be strengthened to present cases as soon as possible.

Child ; Consensus ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional ; Respiratory System

Objective To conduct Meta analysis and trial sequential analysis (TSA) on warm acupuncture treatment on lumbar intervertebral disc protrusion (LIDP); To provide references for evidence-based medicine of this disease.Methods Articles about warm acupuncture treatment for LIDP clinical randomized controlled trials in CNKI, Wanfang database, Chonging Wepu, CBM, OubMed, Cochrane Library, and Emnase were retrieved by computer. The retrieval range was from the database establishing to March, 2017. According to Cochrane Handbook for Systematic Reviews of Interventions 5.2.0 Bias risk assessment tool, included articles were under quality evaluation. Revman5.2 software was used to carry out Meta analysis, and TSAv0.9 software was used to conduct TSA.Results Ten articles were included, involving 1035 cases. Meta analysis showed that the total effective rates of warm acupuncture treatment for LIDP [95％CI (2.43, 5.40),Z=6.31,P<0.00001], pain index [95％CI (-1.05, -0.58),Z=6.77,P<0.00001], lumbar function [95％CI (2.56, 8.61),Z=3.62,P=0.0003] were better than other therapies, with statistical significance. Funnels included in the study suggest publication bias. TSA results suggested that the total efficiency and pain index Meta analysis results of this study were reliable.Conclusion Warm acupuncture treatment for LIDP has confirmed efficacy, with certain advantages. However, the literature included is not with good quality, so more large sample, multicenter, methodological RCTs are needed for further validation.

Objective To compare the efficacy of traditional laparoscopic radical resection of sigmoid colon and rectal specimens without abdominal incision laparoscopic surgery. Methods From January 2015 to December 2016 in our hospital to implement selected laparoscopic assisted sigmoid colon cancer surgery patients in 34 patients with abdominal incision rectal specimens of laparoscopic sigmoid colon resection of colorectal cancer patients without abdominal incision group. As to the choice of 1 ~ 2 pairs in the same period of age, gender, as the control group were given laparoscopic assisted sigmoid colon body mass index similar to radical surgery in 68 patients with operation time. Comparing the two kinds of laparoscopic surgery, perioperative bleeding, postoperative exhaust time postoperative pain score, complications, surgery, postoperative hospital stay, additional analgesic treatment, length of bowel resection, proximal and distal margin, tumor size, lymph node dissection the number of pTNM staging. Results The abdominal surgery time without incision group of sigmoid colon cancer patients, intraoperative bleeding was significantly higher than control group, abdominal incision group of sigmoid colon cancer patients with postoperative exhaust time, postoperative pain awake score, postoperative 1 d pain score was significantly lower than the control group, there was statistical significance the difference (P < 0.05); the two group of sigmoid colon cancer patients with bowel resection length of proximal margin, tumor size, number of lymph node dissection, there was no significant difference in pTNM staging (P > 0.05). Abdominal incision group were followed up for 5~8 months, average 6 months; the control group were followed up for 6 ~ 9 months, an average of 7 in August, there were no tumor recurrence and metastasis. Conclusion Compared with traditional laparoscopic surgery, abdominal incision rectal specimens of laparoscopic radical resection of sigmoid colon cancer can significantly reduce the pain of patients, shorten the postoperative exhaust time, tumor root Treatment effect is similar

In order to analyze the temporal distribution characteristics of human rabies in China and explore the incidence forecasting,R3.3.2 software were used to establish the optimal ARIMA model of monthly incidences from 2004 to 2015 in Chi-na.Then the monthly incidences from January to November 2016 were forecasted with the model and the prediction accuracy was evaluated.The annual incidences of human rabies in China were decreasing tendency since 2007,and the monthly incidence reached highly during August to October.The optimal model was ARIMA(2,1,1)(2,0,0)12and the mean absolute error (MASE)was 0.755.The mean relative error was 15.61% when predicting the incidences from January to November 2016.In conclusion,there exists seasonal variation for human rabies in China and ARIMA model can be applied for the short-term fore-casting.