Objective To comprehensively evaluate the effectiveness of health education interventions on endemic fluorosis for Chinese students and housewives,and to provide a basis for prevention and control of the disease.Methods A computerized literature search was carried out in CBM(Chinese Biomedical Database),CNKI (Chinese National Knowledge Infrastructure),Wan-fang,VIP,Pub-Med,Web of Knowledge and EBSCO to collect articles published at home and abroad between 1994-2012 concerning the effectiveness of health education interventions on endemic fluorosis for Chinese students and housewives.The study was a self-controlled intervention study.The quality of literature was evaluated using the standards of Cochrane and EPOC.Meta-analysis was performed to assess the knowledge about fluorosis prevention using Rev-Man 5.0.Homogeneous data(P ＞ 0.05) was analyzed using a fixed effects model,and heterogeneous data (P≤ 0.05) was analyzed using a random effects model.Results A total of 146 Chinese research papers and 192 English research papers were retrieved.By screening,35 Chinese research papers meet the standards.After reading the full text,6 papers were selected.English literature was not found.According to EPOC criteria all the six literatures included were grade B.Because heterogeneity of the literatures was higher,knowledge point was stratify analyzed according to the study subjects.The intervention effect of students was higher than that of the housewives.After the intervention,the fluorosis disease prevention knowledge awareness of schoolchildren and housewives were increased by 28％ and 26％.Conclusions Health education has a good effect in improving the knowledge of fluorosis for Chinese students and housewives.

Objective To test whether the prophylactic small dose amitriptyline has any beneficial influence on the rate of poststroke depression (PSD) by clinical experiment. Methods All 123 patients with first stroke were divided into the intervention group and the control group according to the block randomization tables. The patients in the intervention group were treated with 12. 5 mg amitriptyline every night for more than 1 month and the control group was blank Before and at the end of the observation, the rate of PSD and activities of daily living (ADL), degree of neurological deficit (NIHSS) of all the subjects were assessed. Results At the end of the one-month treatment, the intervention group had lower rate of PSD (16. 4% ) than the control (51.6%);and they had lower score in NIHSS (2. 83 ± 1.74 vs 3. 64 ±1.93) and higher score in ADL (93.0 ± 16. 1 vs 87.0 ± 37. 1) than the control. Multivariate Logistic regression analysis showed: the change of ADL score was closely related to the rate of PSD (RR =3.01 ,P =0. 04); the change of NIHSS score was closely related to the rate of PSD ( RR = 2. 42, P = 0. 03 );prophylactic small dose amitriptyline was closely related to PSD ( RR = 3.11, P = 0. 01 ). Conclusions Prophylactic small dose amitriptyline can decrease the rat of PSD, reduce the neurologic impairment and improve the activity of daily living.

Objective To study on quenching free radical substances in antarctic ice alga.Methods Antarctic ice alga Berkeleya rutilans H-15 used as material,complete experiment of preparation free radical scavenging substances was established.All of these include the extraction of active substances by methanol,then pursuing and determination of the separation effect and change of active substances by DPPH and Godin method;the primary separation and purification by silica gel 60 column chromatogram;the farther purification by Sephadex LH column chromatogram and the purity determination of compound by HPLC.The type of compound and functional group of high pure compound were determined by the IR spectrum,HPLC-MS.Results One pure compound with strong activity was obtained from Berkeleya rutilans H-15,and it was confirmed to belong to phenol derives by analysis of IR spectrum and HPLC-MS.Conclusion It was completely feasible to find and acquire quenching free radical substances in antarctic ice alga,which initiated a new way to obtain natural antioxidant active substances from antarctic microorganism.

Objective To understand the etiology of acute hepatitis B (AHB) in adults and investigate the mechanisms of hepatic injury and viral clearance in AHB. Methods One hundred and twenty adult AHB patients were enrolled. Epidemiological and clinical data were collected from the case history records or face-to-face inquiry, and serum samples were collected during hospitalization and follow-up. To observe dynamic patterns of AHB etiology, the markers of hepatitis B virus (HBV) were detected by enzyme-linked immunosorbent assay (ELISA); the level of HBV DNA and HBV genotype were determined by real-time polymerase chain reaction (PCR). Enumeration data were analyzed by non-parametric rank sum test. Comparison between groups was done by t test and that between rates of samples was done by Pearson χ2 test. Results Serum HBV DNA was positive in 48.33% of patients at the time of diagnosis with mean level of 9.84×04 copy/mL, and became undetectable after 12.5 days on average. The median levels of serum alanine aminotransferase (ALT) were 1600 U/L and 1490 U/L in HBV DNA positive and negative groups, respectively (z=-0. 678, P=0. 498). However, the mean levels of serum ALT were (2058±123) U/L and (1393±139) U/L in groups of HBV DNA<1×104 copy/mL and>1×104 copy/mL, respectively, which was significantly different (t=-2.17, P=0. 049). Genotype B accounted for 52.5%, genotype C 42.5 and genotype B and C mixed type 5.0% in 58 patients with HBV DNA positive. Eight patterns of serum HBV markers were presented at first visiting. HBsAg(+), HBeAg(+), anti-HBc(+), anti-HBc IgM(+) and HBsAg(+), anti-HBe(+), anti-HBc(+), anti-HBc IgM(+) were the most common patterns, which accounted for 38.3% and 30.0%, respectively. The dynamic patterns of serum HBV markers of 28 AFIB patients were prospectively followed up. The rate of serum FIBsAg loss was 100. 0% and the median time of negative-conversion was 3 weeks. The cumulative positive rate of anti-HBs was 85.7% after 52 weeks of follow-up. The rate of serum HBeAg loss was 100.0%. HBeAg was negative in 53.6% of patients at first visiting and the rest of patients achieved negative within 4 weeks after onset. The positive rate of anti-HBe was 82.1% during 52 weeks of follow-up. Total anti-HBc (including IgG and IgM) was keeping positive in all patients within 52 weeks, and the negative rate of anti-HBc IgM was 39. 3% after followed up for 52 weeks. Conclusions Rapid HBV clearance andserum HBV marker conversion are significantly different between AHB and chronic hepatitis B.

Objective To compare the clinical effect of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) in the treatment of locally advanced esophageal squamous cell carcinoma.Methods The retrospective cohort study was conducted.The clinicopathological data of 156 patients with local advanced esophageal squamous cell carcinoma who were admitted to the Zhongshan Hospital of Fudan University from January 1,2010 to December 31,2015 were collected.Among 156 patients,59 undergoing nCRT were allocated into the nCRT group and 97 undergoing nCT were allocated into the nCT group.Patients in the nCRT group and nCT group respectively received 2 cycles chemotherapy by the TP regimen+40 Gy radiotherapy (2 Gy/d) and 2 cycles chemotherapy by the TP regimen.Patients were evaluated by imaging examinations after 6 weeks neoadjuvant therapy completion,and then underwent abdominal and right chest-left cervico three-incision thoracoscopic surgery.Observation indicators:(1) treatment situations;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed once every 3 months within 2 years and once every 6 months after 3 years up to January 2017.Follow-up included levels of tumor markers [carcinoembryonic antigen (CEA) and SCC-Ag],thoracic or abdominal computed tomography (CT),neck and abdominal ultrasonography and gastroscopy or PET/CT examination if necessary.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed using the nonparametric test.Count data were analyzed using the chi-square test or Fisher exact probability.Comparison of ordinal data was done by the nonparametric test.The survival rate was calculated using the life table method and survival was analyzed by the Log-rank test.Results (1) Treatment situations:all the patients in the 2 groups were able to burden neoadjuvant therapy and thoracic esophagectomy.Six patients in the nCRT group and 15 in the nCT group had conversion to open surgery.Operation time,volume of intraoperative blood loss,cases with postoperative readmission of ICU,cases with complications,cases with perioperative death and duration of hospital stay were (201 ± 25) minutes,(137± 66)mL,5,24 (10 with pulmonary complications,8 with anastomotic leakage,3 with hoarseness,2 with cardiovascular complications and 1 with chylopleura),0,12 days (range,9-93 days) in the nCRT group and (195±20) minutes,(133±58) mL,8,30 (11 with anastomotic leakage,10 with pulmonmy complications,4 with hoarseness,2 with cardiovascular complications,1 with postoperative hemorrhage,1 with delayed gastric emptying and 1 with chylopleura),1,11 days (range,9-78 days) in the nCT group,respectively,with no statistically significant difference between the 2 groups (x2 =0.883,t =0.102,0.692,x2 =0.048,1.541,Z =0.225,P＞ 0.05).(2) Postoperative pathological examination:R0 resection rate was 96.6％ in the nCRT group and 93.8％ in the nCT group,with no statistically significant difference between the 2 groups (x2 =0.589,P＞0.05).Results of postoperative pathological examination showed that G0,G1,G2 and G3 of tumor regression grade were respectively detected in 18,16,7,18 patients in the nCRT group and 4,5,4,84 patients in the nCT group,with a statistically significant difference between the 2 groups (Z=-7.151,P＜0.05).Stage 0,Ⅰ,Ⅱ,ⅢA,Ⅲ B and ⅣA of postoperative ypTNM stage were respectively detected in 16,9,23,4,6,1 patients in the nCRT group and 4,9,37,6,34,7 in the nCT group,with a statistically significant difference between the 2 groups (Z=-4.890,P＜0.05).The down-staging was detected in 48 patients of the nCRT group and 50 patients of the nCT group,with a statistically significant difference between the 2 groups (x2=13.957,P＜0.05).(3) Follow-up and survival situations:of 156 patients,153 were followed up for 12-82 months,with a median time of 36 months.The 1-,3-,5-year overall survival rates were 88.1％,61.4％,34.9％ in the nCRT group and 81.4％,43.8％,23.1％ in the nCT group,with a statistically significant difference between the 2 groups (x2=4.336,P＜0.05).Conclusion The nCRT in the treatment of locally advanced esophageal squamous cell carcinoma can enhance postoperative pathological response rate,down-staging rate and overall survival rate compared with nCT,without increasing incidence of perioperative complications.

Objective To investigate the inhibitive effects of Ad-PUMA combined with temozolomide on human glioblastoma cells growth in vivo experiments. Methods The nude mouse model with human glioblastoma cells subcutaneous transplantation was established. The mice were randomly divided into 4 groups to receive subcutaneous injection at the 14th day separately with: Normal saline 100 μl (control, n=8), Ad-PUMA 2×108 pfu/100 μl (PUMA group, n=8), 10 mg/kg TMZ (TMZ group, n=8) and 2×108 pfu/100 μl Ad-PUMA + 10 mg/kg TMZ (combined group, n=8). Mice were killed after 20 days treatment.Tumor volume, inhibition rates and apoptotic index (AI) were measured, meanwhile, apoptotic tumor cells were detected by TUNEL technology respectively. The expression of MGMT mRNA and MGMT protein were revealed by the methods of RT-PCR and Western blot. Results According to the order: control group, AdPUMA group, TMZ group, combined group, tumor volumes were (3.68±0.09), (2.63±0.13), (2.13±0.07),(0.97±0.02) cm3 respectively (P＜0.05); the inhibitive rates were 0, 28.5 %, 42.1%, 73.6 % respectively and AI were (2.0±1.2) %, (11.4±2.6) %, (7.6±3.2) %, (20.6±8.6) % (P＜0.05). The results of Western blot and RT-PCR showed that MGMT mRNA and MGMT protein levels in TMZ group were higher than other groups (all P＜0.01). Conclusion Ad-PUMA combined with TMZ greatly enhances the sensitivity of human glioblastoma cells to TMZ and could effectively inhibit the proliferation and promote the apeptosis of glioblastoma cells, its mechanism was probably related Ad-PUMA promote apoptosis and inhibit MGMT expression.

Objective To investigate the clinical features and genetic mutations of spinocerebellar ataxia type 17 (SCA17).Methods The pathological CAG triplet repeat expansions of the SCA3,SCA1,SCA2,SCA6,SCA7,SCA8,SCA12,SCA17 and dentatorubral pallidoluysian atrophy genes were analyzed in 708 probands of autosomal dominant familial SCA and 1 19 sporadic SCA cases.The CAG repeats of TATA-binding protein (TBP) gene were amplified by means of polymerase chain reaction and agarose gel electrophoresis.For the samples with two alleles,fragment analysis based on CEQ8000 sequencer was applied to analyze the CAG repeat numbers.Furthermore,the correlation between clinical features and CAG repeat in the TBP gene was studied carefully.Results The expanded CAG repeats in the TBP gene was detected in 5 cases with 37/50,36/45,38/52,38/53,36/54 separately.And the main clinical manifestations were ataxia and memory impairment.Conclusion These findings indicate that SCA17 might be a rare subtype of SCA in the Chinese population and the clinical features of SCA17 cover a wider spectrum than previously reviewed.

Objective To investigate the role of methylation of genomic DNA and connective tissue growth factor (CTGF) gene promoter in the pathogenesis of diabetic nephropathy (DN). Methods According to the WHO 1999 guideline for diabetes mellitus diagnosis and classification standard,90 patients diagnosed as diabetes mellitus and 30 healthy volunteers were enrolled in this study.All the participants were divided into diabetes mellitus without DN (DM) group (n=48),DN group (n=42) and healthy control group (n=30) accordingly.DNA was extracted from the peripheral blood and high pressure liquid chromatography (HPLC) was used to measure the overall methylation level of genomic DNA.The methylation status of CTGF gene promoter was determined by PCR and sequencing analysis.Serum CTGF protein level was measured by ELISA.Results The overall methylation level of genomic DNA was 5.23％±0.09％ for DN group,4.71％ ±0.03％ for DM group,and 4.37％±0.01％ for healthy control group,with no significant differences among three groups (all P＞0.05).The CTGF promoter methylation level in DN group (22.02％± 12.90％) was significantly decreased,compared to DM group (49.18％±8.01％,P=0.019) or healthy control group (72.18％±19.30％,P=0.000).Moreover,the serum CTGF protein level in DN group [(193.44±11.90) mg/L] was significantly increased,compared to DM group [(127.65±10.30) mg/L,P=0.031] and healthy control group [(95.84±5.10) mg/L,P=0.001]. Conclusion In DN patients,CTGF gene promoter methylation level is significantly decreased,but CTGF protein level is higher as compared to non-DN patients,which indicates that CTGF gene promoter demethylation may be involved in the pathogenesis of diabetic nephropathy.

As a heteronomy,the code of medical ethics plays an important role in sustaining the trust between physicians and patients.Based on a comparative analysis of the domestic and foreign codes of medical ethics,and field survey on such trust at tertiary hospitals in Beijing,as well as medical providers’moral characteristics,this article analyzed the causes that “goodwill”is insufficient in the trust in terms of internal and external factors;and then,in respect of heteronomy as a basis,it put forward suggestions to improve code of medical ethics in order to rebuild such trust.

Physician-patient trust is the basis of informed consent,and the informed consent institution is supposed to strengthen the trust.However,it affects trust in an opposite way in practice. This research aimed to analyze the relationship between informed consent and physician-patient trust,and provide with the advice,recommending on such rebuilding.