This review focuses on the fetal origins of adult disease hypothesis put forward by David Barker and his colleagues,recent advances in epidemiological studies and experimental research in this field.Barker Hypothesis states that environmental factors,particularly intrauterine nutrition,as indicated by birth weight,operate in early life to program the risks for adverse health outcomes in adult life.A large growing body of reports described the association between the early development and adult diseases,such as diabetes,hypertension,coronary heart disease,abnormal lipids metabolism,obesity and cancer,etc.Experimental studies show that the changes of some key genes' expression,caused by epigenetic modifications,lead to a permanent alteration of cellular proliferation and differentiation and finally the genesis in key tissues and organs.These results bring about the impairment in structures and functions and the increased susceptibility to chronic diseases in adult life.The hypothesis provides a new perspective for the prevention and therapy of chronic diseases.

Objective To summarize the onset and the management of serious responsiveness during the tilt table test (TTT), and the prevention measures. Methods Thirty six elderly patients (26 males and 10 females, aged between 60 70) were tested with a tilt angle of 70 degrees for a maximum of 45 minutes and then processed with isoproterenol provocative tilt testing. ECG and blood pressure were monitored during the test and the peripheral intravenous cannula were maintained for all patients with normal saline. Results Twenty one of the 36 patients were defined as positive including 10 showing serious responsiveness. Of the 10 patients, 3 had a history of atherosclerosis involving internal carotid arteries; among the 3 with bradycardia, 2 were associated with II? A V block, and another one was with chronic atrial fibrillation. The serious reponsiveness included asystole for more than 5 seconds(3 cases) , serious bradycardia for more than 1 minute(3 cases) , and serious hypotension for more than 1 minute (4 case), respectively. Those with serious responsiveness were managed with returning to supine position, or intraveneous atropine, or CPR (2 cases), or oxygen given(4 cases). Only 2 hypotensive patients recovered gradually in 10 minute emergent management while others recovered rapidly and with no complication. Conclusions TTT may result in serious responsiveness especially in elderly patients though it is non invasive method. Therefore, proper patient selection according to the indications, control of isoproterenal infusion and close observation of vital signs are important for a safe consequence.

Objective To learn the overall results of the final test paper in nursing undergraduates of Peking Union Medical College, and to provide the theoretical support for teaching quality assessment of nursing undergraduates.Methods The difficulty coefficient, the discrimination index, the reliability (Cronbach α coefficient) and the degree of coverage were analyzed based on education measurement and education statistical methods.Results The mean total score was 67.8±12.5, ranged from 38 to 95.The difficulty coefficient, the discrimination index and the Cronbach α coefficient were 0.68, 0.30 and 0.71 respectively.The rates of loss score were 33.8% for choice questions, 37.2% for completion questions, 22.5%for true or false questions and 24.8% for calculation questions respectively.Among the total 30 examination questions, the proportions of the most difficult ones, the difficult ones, the moderate ones, the easy ones and the easiest ones were 30.0%,13.3%,20.0%,20.0% and 16.7% respectively.28 examination questions (93.3%) had the best or better discrimination.Conclusions The test paper held the moderate difficulty and the good discrimination, reliability and the degree of coverage.The results of the examination accurately reflect the knowledge and ability of the students.In addition, more attention should be paidto improve the knowledge of nursing undergraduates on the importance of the medical statistics in medical scientific research.

Objective To investigate the protective effect of nimodipine on neuron of the rats with focal cerebral ischemia-reperfusion injury and the expressions of Bax and Bcl-2,and to clarify their mechanisms.Methods The focal cerebral-ischemia reperfusion model was induced by the middle cerebral artery occlusion(MCAO)method. 30 male Wistar rats were randomly divided into sham operation,model,and nimodipine groups(n=10).The neurological deficit score was performed after 2 h ischemia following 2 h reperfusion.The infarction was observed by TUNEL staining and the expressions of Bax and Bcl-2 were detected by SP immunohistochemistry method. Results Compared with model group, the number of apoptotic cells of the rats in nimodipine group was significantly decreased(P<0.05),the expression of Bax was significantly decreased (P<0.05),and the Bcl-2 expression was increased significantly(P<0.05).The morphological examination showed that the neurons of the rats in model group had serious necrosis and edema while the number of dead cells in nimodipine treatment group was reduced and the edema was improved.Conclusion Nimodipine has a protective effect on brain tissue of the rats with focal cerebral ischemia-reperfusion inj ury, which is closely related to the down-regulation of Bax and up-regulation of Bcl-2 and inhibition of the apoptosis of neuron.

Adolescent ; Adult ; Aged ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Occupational Diseases ; epidemiology ; Wounds and Injuries ; epidemiology ; Young Adult

Objective To explore the anti-inflammatory and analgesic effects of Shuangwu numbness-relief decoction. Methods The anti-inflammatory effect was assessed by xylene-induced mouse auricular swelling and peritoneal capillary permeability;and the analgesic effect was assessed by hot plate method and acetic acid-induced twisting method. Results Shuangwu numbness-relief decoction at moderate or high dose had a significant inhibitory effect on mouse auricular swelling, with a significant difference as compared with the control group (P<0.01);the decoction at low , moderate , or high dose group played a marked inhibitory role in the increase in mouse peritoneal capillary permeability (P<0.01). Shuangwu numbness-relief decoction at moderate or high dose effectively reduced the writhing frequency in mice (P < 0.01). The decoction at high dose increased the pain threshold in mice one hour after intragastric administration (P < 0.05), and the decoction at moderate or high dose increased the pain threshold two hours after administration (P < 0.05). Conclusions Shuangwu numbness-relief decoction has an obvious anti-inflammatory and analgesic effect.

Liver transplantation is the best treatment for end-stage liver disease.Because of the severe shortage of donor sources,most of the patients died while waiting for liver grafts.Artificial liver support system can improve the liver function in a short time,and help patients to pass the waiting periods.Artificial liver support system takes place of composition,detoxification and metabolism function of liver,stabilizes the physiological and biochemical index of liver,relieves the burden of liver and helps patients to prepare for the liver transplantation.With the wide application of artificial liver support system,new types of the artificial liver support systems gradually conquered the defects of the old types,but they still have their own defects.This review concludes the merits and demerits of artificial liver systems,its clinical application and the problems so as to help the treatment of end-stage liver disease.

Objective To compare the efficacy of lymph nodes(LNs) dissection between video-assisted thoracic surgery (VATS) and thoracotomy in the treatment of clinical stage Ⅰ lung cancer.Methods A comprehensive search of PubMed,Ovid Medline,EMBASE,Web of Science,ScienceDirect,the Cochrane Library,Scopus database and Google Scholar was performed to identify studies comparing VATS and thoracotomy in LNs dissection.The data was analyzed by RevMan 5.3 software and SPSS 18.0.Results After selection,23 articles met the inclusion criteria.2 316 patients were involved in VATS group and 3 346 patients were involved in Open group.Meta analysis showed that less total LNs(95％ CI:-1.64--0.60,P ＜ 0.0001),totalLNsstations(95％CI:-0.61--0.01,P=0.04) andN1 LNs(95％CI:-0.28--0.02,P=0.02)were dissected in VATS group.On the left side,more LNs were dissected in VATS group(95％ CI:0.51-3.22,P =0.007).The same number of mediastinal LNs (95％ CI:-0.74-0.15,P =0.20),mediastinal LNs stations (95％ CI:-0.20-0.14,P =0.76),right side LNs (95 ％ CI:-1.52-2.23,P =0.71) were harvested in both groups.Conclusion In the surgical treatment of clinical stage Ⅰ lung cancer,less total LNs,total LNs stations and N1 LNs were dissected in VATS group,while more left side LNs were harvested by VATS.The same number of mediastinal LNs,mediastinal LNs stations right side LNs were harvested in the two groups.This conclusion still needs to be further proved by more high-quality and large-scale RCTs.

Purpose To investigate the diagnostic value of dual energy CT spectrum curve combined with CT morphology in central lymph node metastasis of papillary thyroid carcinoma (PTC).Materials and Methods Thirty-one PTC patients who accepted dual energy CT double-phase enhanced scan before surgery were analyzed.Central lymph nodes with short diameter ＞ 5 mm were labelled using axial plus 3D positioning.Preoperative labelled lymph nodes were collected and marked during operation.The CT morphology of metastatic lymph nodes was analyzed.The spectrum curve slope (K) difference between metastatic and non-metastatic lymph nodes of arterial-phase and venous-phase primary lesion was compared.The critical K value and the diagnostic efficacy of K value combined with morphology were obtained according to receiver operating characteristic (ROC) curve.Results A total of 73 central lymph nodes were obtained from 31 patients,among which 51 were metastatic and 22 were non-metastatic.There was no significant difference in K value between metastatic and non-metastatic lymph nodes of arterial phase group (P＞0.05).While,there was a significant difference in K value between metastatic and non-metastatic lymph nodes of venous phase group (P＜0.05).For venous phase,the sensitivity and specificity of the K value in diagnosing central lymph node metastasis were 62.7％ and 59.1％,respectively,and combined with morphology,the sensitivity and specificity reached 76.5％ and 81.8％,respectively.Conclusion The K value of CT spectrum curve is of certain significance in predicting PTC central lymph node metastasis,and the K value combined with CT morphology can improve the accuracy of diagnosis.

Abstrac:Objective To analyze the efficacy and safety of medpor-coated tear drain in lacrimal bypass surgery without skin incision. Methods The data of 7 patients(7 eyes) who underwent no skin incision of lacrimal bypass surgery with medpor-coated tear drain were ret-rospective reviewed. The operation result and complications were observed. Results All patients were followed up for 5~17 months. Com-plete or significant improvement of epiphora was achieved in 5 cases at the last follow-up. Complications included conjunctival granulation hy-perplasia (3 eyes),nasal mucosal granulation hyperplasia (2 eyes),and discomfort (4 eyes). Conclusion The lacrimal bypass surgery with medpor-coated tear drain could be expected to improve epiphora of refractory lacrimal obstruction. The main complications are granulation hyperplasia and discomfort.