[Objective] To search a suitable preoperative intestinal cleansing method for the operation of colon and rectum. [Methods] A randomized controlled trial was applied in 70 cases before colic and rectal operations. Group A was give:n decoction of Folium Cassiae for oral use and saline enema and Group B was treated with saline enema only. The effect on intestinal cleansing was observed during the operation. [Results] In Group A, 26 cases were remarkably effective in intestinal cleansing, 8 effective, and 1 ineffective and 14, 16 and 5 in Group B respectively ( P

Objective To evaluate the safety of cetuximab combined with intensity-modulated radiotherapy (IMRT) plus concurrent cisplatin chemotherapy in locoregionally advanced nasopharyngeal carcinoma (NPC) in a Chinese multicenter clinical study.MethodsFrom July 2008 to April 2009,100Patients with primary stage Ⅲ- Ⅳb non-keratinizing NPC were enrolled.The planned dose of IMRT to gross tumor volume and positive cervical lymph nodes was 66.0-75.9 Gy and 60-70 Gy in 30-33 fractions.Cisplatin (80 mg/m2,q3 week (w)) and cetuximab (400 mg/m2 one w before radiation,and then 250mg/m2 per w) were given concurrently.The adverse events (AEs) were graded according to common terminology criteria for adverse events v3.0.ResultsThe compliance of the entire group of patient was satisfactory.Actual median dose to gross tumor volume was 69.96 Gy,and the median dose to positive cervical lymph nodes was 68 Gy.Median dose of cisplatin was 133 mg,median first-dose of cetuximab was 690 mg,and median weekly dose was 410 mg.AEs were well tolerated and manageable,mainly consisting of acneiform skin eruptions,dermatitis and mucositis.Grade 4 mucositis was observed in 2％ of the patients and no other grade 4 AEs were observed.ConclusionsThe combined treatment modality of IMRT +concurrent chemotherapy + cetuximab in loco-regionally advanced NPC is well tolerated.

Objective:To review the process, contents, theoretical basis, and evaluation methods for constructing the framework of entrustable professional activities (EPAs) in the stage of undergraduate medical education (UME) in foreign medical colleges and universities.Methods:PubMed, Web of Science, Embase, and Scopus databases were searched to obtain the articles on EPAs in the stage of UME published up to May 2022, and then a systematic review was performed.Results:A total of 17 articles were included, and the analysis showed that the framework of EPAs in the UME stage was mainly constructed by referring to the existing framework of EPAs and conducting multiple rounds of consultation and revision. The contents of EPAs include core basic EPAs, core specific professional EPAs, and individual selective EPAs. The theoretical basis for developing the EPAs framework mainly include the Miller's Pyramid of Assessment model and Dreyfus and Dreyfus's Model of Skills Acquisition. The mainstream frameworks of EPAs competency include Canadian CanMEDS, six core competencies of American ACGME and their corresponding milestones. The confidence level of EPAs evaluated at the UME stage is highlighted as 9 levels of stratification, and the evaluation methods for confidence decision mainly include observation, communication, and review of results.Conclusion:Foreign EPAs-related research in the UME stage has become more mature, but there is a lack of related studies in China. Chinese medical education researchers can learn from the experience in the development of EPAs in foreign countries and combine it with China's actual situation to construct an integrated EPAs framework for medical education covering the UME stage and the evaluation criteria for confidence level, so as to promote competency-oriented evaluation and feedback and accelerate the construction of a medical talent training system that serves the whole life cycle and the whole health process.

Objective To explore the control levels of blood glucose,blood lipid,blood pressure(BP),and body mass index(BMI)in the community-managed patients with type 2 diabetes in Jiangsu and to provide the basis for better management of type 2 diabetes in communities. Methods From December 2013 to January 2014,20 053 patients with type 2 diabetes and have received disease management according to the National Basic Public Health Service were recruited in Changshu County of Suzhou City, Huai'an and Qinghe Districts of Huai'an City. Questionnaire survey, anthropometric and laboratory measurements were conducted. According to the Chinese guidelines for type 2 diabetes prevention and treatment(2013),the control levels of blood glucose,blood lipid,BP, and BMI were assessed. Results Among 20 053 patients with type 2 diabetes,the proportions for controlled fasting plasma glucose(FPG) and HbA1Cwere 31.4% and 41.9% respectively,and 25.3% of the patients simultaneously achieved goals of FPG and HbA1Ccontrol. There were 23.9%,55.7%,75.5% and 24.2% of the patients met goals for total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol(LDL-C), respectively. Only 10. 3% of the patients achieved all the 4 targets of blood lipid. Furthermore,there were 25.4% and 35.9% patients achieved BP and BMI targets respectively,and the control rates for BP and BMI of females were higher than those of males(all P<0.05). Less than 1% of the patients had all eights indices controlled at target levels. Conclusions The achievement of comprehensive targets among community patients with type 2 diabetes remains poor in Jiangsu. Follow-up and management of type 2 diabetes should be strengthened in communities,health education and comprehensive intervention on disease complications should also be reinforced accordingly.

Recurrent laryngeal nerve (RLN) injury can result in unilateral or bilateral vocal cords paralysis, thereby causing a series of complications, such as hoarseness and dyspnea. However, the repair of RLN remains a great challenge in current medicine. This study aimed to develop human umbilical mesenchymal stem cells (HuMSCs) and nerve growth factor (NGF)-loaded heparinized collagen scaffolds (HuMSCs/NGF HC-scaffolds) and evaluate their potential in the repair of RLN injury. HuMSCs/NGF HC-scaffolds were prepared through incorporating HuMSCs and NGF into heparinized collagen scaffolds that were prefabricated by freeze-drying in a template. The resulting scaffolds were characterized by FTIR, SEM, porosity, degradation in vitro, NGF release in vitro and bioactivity. A rabbit RLN injury model was constructed to appraise the performance of HuMSCs/NGF HC-scaffolds for nerve injury repair. Electrophysiology, histomorphology and diagnostic proteins expression for treated nerves were checked after application of various scaffolds. The results showed that the composite scaffolds with HuMSCs and NGF were rather helpful for the repair of broken RLN. The RLN treated with HuMSCs/NGF HC-scaffolds for 8 weeks produced a relatively normal electromyogram, and the levels of calcium-binding protein S100, neurofilament and AchE pertinent to nerve were found to be close to the normal ones but higher than those resulted from other scaffolds. Taken together, HuMSCs/NGF HC-scaffolds exhibited a high score on the nerve injury repair and may be valuable for the remedy of RLN injury.
Collagen* ; Dyspnea ; Electrophysiology ; Heparin* ; Hoarseness ; Humans* ; In Vitro Techniques ; Intermediate Filaments ; Mesenchymal Stromal Cells* ; Nerve Growth Factor* ; Paralysis ; Porosity ; Recurrent Laryngeal Nerve Injuries* ; Recurrent Laryngeal Nerve* ; Spectroscopy, Fourier Transform Infrared ; Umbilical Cord* ; Vocal Cords

Objective To estimate the dose-response relationship between sedentary behavior with mortality in patients with type 2 diabetes. Methods A total of 17786 type 2 diabetic patients were recruited as participants, who were included in National Basic Public Health Service in Changshu County of Suzhou City, Qinghe District and Huai'an District in Huai'an City of Jiangsu Province. Cox proportional hazards regression model and restricted cubic spline model were employed to estimate the dose-response relationship between sedentary behavior with all-cause and cause specific mortality in patients with type 2 diabetes. Results Among 78114.34 person-years of the fo1low-up, the median of follow-up time was 4 years, and 1285 deaths occurred during that period. Compared to patients with sedentary behavior≤2 h/d, the multivariate adjusted hazard ratios of all-cause death associated with sedentary behavior levels of 3-4 h/d, 5-6 h/d, and≥7 h/d were 1.05(95％CI 0.92-1.20), 1.20(95％CI 1.03-1.42), and 1.39 (95％CI 1.16-1.65), respectively. Eevry increase of 1 h/d in sedentary behavior was associated with an increased hazard of death from cardiovascular disease(CVD) of 4％(HR=1.04, 95％CI 1.01-1.07) and from other causes of 6％( HR=1.06, 95％CI 1.03-1.09) . However, no significant association between sedentary behavior and malignant tumor death was found. The multivariable restrictive cubic spline regression indicated that the linear dose-response relationships were found between sedentary time with the all-cause, CVD cause, and other cause of mortality ( Non-linear test, P>0.05) . Conclusion Longer sedentary behavior could increase the risk of mortality in patients with type 2 diabetes.

Major infectious disease epidemic continues to pose a threat to human health and society, and the effective establishment and implementation of an early warning system plays a key role in addressing public health security risks. At present, the research on early warning of infectious diseases in the academic community mainly focuses on early warning information system, early warning mechanism, laws and regulations of early warning of infectious diseases, and some studies lack specific suggestions on operation methods. By collating and summarizing the literature from 2002 to 2022, regarding the early warning system and mechanism of major infectious diseases, this paper focused on analyzing the public health ethical dilemmas existing in the early warning process and discussing how to strengthen the construction of the early warning system of infectious diseases, so as to lay the foundation for creating more scientific early warning schemes of infectious diseases.

Objective: To investigate the association between fresh fruit consumption and status of glycemic control, among patients with type 2 diabetes mellitus (T2DM). Methods: Using the stratified cluster sampling method, a cross-sectional study was conducted among 19 473 diabetic patients who were under the Disease Management Program related to the National Basic Public Health Service in Changshu county, Huai’an and Qinghe districts of Huai’an city from December 2013 to January 2014, under the combination of fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) methods, the glycemic control status in T2DM patients was assessed. Multiple logistic regression method was used to explore the relationship between fresh fruit consumption and status of glycemic control among T2DM patients. Results: 62.4% of the T2DM patients reported their amount of fruits intake in the past year. Both the levels of FPG and HbA1c decreased in T2DM patients, when the frequency and amount of fresh fruit consumption were increasing. Compared with patients who did not take fresh fruits, the risk of poor glycemic control in patients with fresh fruit consumption of 1-4 times/week and ≥5 times/week decreased 20% (OR=0.80, 95%CI: 0.73-0.87) and 30% (OR=0.70, 95%CI: 0.62-0.80), respectively. Patients with fruit consumption of 50-99 g/day and ≥100 g/day had lower risk of poor glycemic control, with ORs (95%CI) as 0.71 (95%CI: 0.62-0.83) and 0.68 (95%CI: 0.59-0.78), respectively. Conclusions The association of fresh fruit intake and glycemic control was statistically significant in patients with type 2 diabetes. With the increase of frequencies and amounts of fresh fruit consumption, the levels of FPG and HbA1c showed a decreasing trend. Our findings suggested that fresh fruit intake seemed helpful for glycemic control.

Objective: To investigate the relationship between duration of sleep and all-cause mortality in patients with type 2 diabetes. Methods: A total of 17 452 type 2 diabetic patients who were under the National Basic Public Health Service Project, in Changshu county, Qinghe district and Huai’an district in Huai’an city of Jiangsu province, were recruited as participants. Cox proportional hazards regression models were used to estimate the associations between different levels on the duration of sleep and all-cause mortality. Stratified analysis was performed according to factors as gender, age, and lifestyle. Results: Among the 67 912 person-years of observation, from the fo1low- up program, the median time of follow-up was 4 years, with 1 057 deaths occurred during the follow-up period. Taking patients with duration of sleep as 7 h/d for reference, the multivariate adjusted hazard ratios (95%CI) of all-cause mortality appeared as ≤6, 8, 9 and ≥10 h/d were 1.14 (0.94-1.37), 1.10 (0.91-1.32), 1.33 (1.05-1.70), and 1.52 (1.24-1.87), respectively which were associated with the duration of sleep. Data from the subgroup analysis showed that this was consistent with the whole population. Longer duration of sleep was associated with the all-cause mortality but no significant association was found between shorter duration of sleep and the all-cause mortality. Conclusion Longer duration of sleep seemed to have increased the risk of all-cause mortality in type 2 diabetic patients.

Objective: To evaluate the risk of 10-year risk of ischemic cardiovascular disease (ICVD) in patients with type 2 diabetes aged 35 years old and above in two cities of Jiangsu province. Methods: From December 2013 to January 2014, a total of 15 624 patients with type 2 diabetes aged 35 years old and above, who received national basic public health service in Changshu county of Suzhou city, Huai′an and Qinghe districts of Huai′an city, Jiangsu province, were recruited by cluster sampling method. Face-to-face questionnaire survey, anthropometric and laboratory measurements were conducted to collect exposures to ICVD risk factors. Improved Ten Year Risk Assessment Table of ICVD in Chinese was used to assess the risk score and the absolute risk of developing ICVD. Results: The participants were (62.2±9.7) years old, of which 6 137 were men (39.3%). Among the participants, the highest rate of exposure to ICVD risk factors was high systolic blood pressure (74.8%, n=11 685), followed by high total cholesterol (70.7%, n= 11 051).The score of 10-year risk for ICVD was (10.4±3.3) and the median (P₂₅-P₇₅) value of absolute risk was 15.6% (6.8%-32.7%). 16.7% (n=2 602) participants were under extremely high risk of 10-year risk for ICVD, 23.8% (n=3 714) under high-risk and 24.0% (n=3 746) under middle-risk. Among the total risk score of ICVD, age (49.1%), hypertension (17.7%) and diabetes (15.5%) accounted for relatively high proportion, however, smoking (11.0%) was the most important risk factor except for age (47.4%) and systolic blood pressure (20.5%) in male participants. Conclusion Patients with type 2 diabetes aged 35 years old and above in two cities of Jiangsu Province have a high risk of developing ICVD for 10 years, especially in elderly, female, hypertension patients and male smokers.