Objective To investigate the health-related quality of life (HRQOL), demographic characteristics, and health behaviors of the Chinese elderly to find out high-risk population and behaviors. Methods Data was collected from a cross-sectional survey performed in Jiangsu, Anhui, Gansu,Qinghai, Fujian, Beijing, Jilin, Jiangxi, and Henan province. MOS SF-36 was used for HRQOL assessment, t test was used for HRQOL comparison between the elderly and the general population. Multiple stepwise linear regression analysis was used to evaluate the affecting factors. Results The HRQOL among the Chinese elderly were PF ( Physical Functioning) 79 ± 21, RP ( Role-Physical ) 68 ± 40, BP ( Bodily Pain) 72 ± 23, GH ( General Health) 57±22, VT ( Vitality ) 69 ± 20, SF ( Social Functioning) 79 ± 23, RE ( Role-Emotional ) 72 ±40, M H ( Mental Health)76 ± 18, which were lower than Sichuan Norm on 7 dimensions ( P ＜ 0. 05 ; except on M H dimension) and lower than Hangzhou Norm on 5 dimensions (P ＜ 0. 05 ;except on GH, VT, and MHdimensions). The important affecting factors included physical exercise, education level, medical history of chronic disease, age, race, marriage, body mass index ( BMI ), sleeping habits, and gender. Conclusions Compared with the general population, the HRQOL in the elderly might be lower. The health policy and community heahhcare services should focus on the elderly individuals with insufficient exercise, lower education level, chronic disease history, and ethnic minority, or widows. Health education should encourage them to improve physical exercise and sleeping behavior.

Characteristics of collapsed tibial plateau fracture determines that the joint surface must remain anatomical reduction,line of force in tibial must exist and internal fixation must be strong. However, while renewing articular surface smoothness, surgeons have a lot of problems in dealing with bone defect under the joint surface. Current materials used for bone defect treatment include three categories: autologous bone, allograft bone and bone substitutes. Some scholars think that autologous bone grafts have a number of drawbacks, such as increasing trauma, prolonged operation time, the limited source, bone area bleeding,continuous pain, local infection and anesthesia,but most scholars believe that the autologous cancellous bone graft is still the golden standard. Allograft bone has the ability of bone conduction, but the existence of immune responses, the possibility of a virus infection, and the limited source of the allograft cannot meet the clinical demands. Likewise, bone substitutes have the problem that osteogenesis does not match with degradation in rates. Clinical doctors can meet the demand of the patient's bone graft according to patient's own situation and economic conditions.
Bone Substitutes ; Bone Transplantation ; Humans ; Tibial Fractures ; surgery

Objective To investigate the clinical value of prenatal MRI in the diagnosis and differential diagnosis of congenital bronchopulmonary sequestration (BPS). Methods From January 2009 to December 2014, 16 fetuses with BPS were diagnosed by fetal MRI in Huzhou Maternity and Child Care Hospital and Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine. The clinical data of these cases were analyzed retrospectively. All were singleton pregnancy, and MRI was carried out within 24-48 hours after routine prenatal ultrasound. All the neonates underwent postnatal enhanced CT scan or surgical biopsy after birth, and the results were compared to prenatal MRI diagnosis. Results (1)With prenatal MRI, 16 cases were diagnosed BPS. The lesions located in left lung in 10 cases, and right lung in 6 cases. As the scope of the lesion, 3 cases located in the whole left lung, 6 cases limited to the left lower lobe, and 1 case was subdiaphragmatic on the left side. 2 cases located in the whole right lung and 4 cases limited to the right lower lobe. One case complicated oligoamnios, and one had pleural effusion. Supplying vessels could be found in 14 cases.(2)When the postnatal results were compared with prenatal MRI, 15 cases were comfirmed as BPS (15/16), including 10 intralobar cases 5 extralobar cases. One that was diagnosed as BPS by prenatal MRI was confirmed to be congenital cystic adenomatoid malformation (CCAM) by pathology. The accuracy of prenatal MRI diagnosis of BPS was 15/16. Prenatal ultrasound missed one case and misdiagnosed two cases, as one was mistakened as CCAM and the other as cystic teratoma. Conclusion Prenatal MRI has good clinical value in the diagnosis and differential diagnosis of fetal BPS.

Objective To investigate the relationship between cytochrome P 450 (CYP)2C19*2 / *3 gene polymorphism and antiplatelet effect of clopidogre in patients with ischemic stroke. Methods A total of 102 consecutive patients with acute ischemic stroke admitted to the Suzhou Integrated Traditional and Western Medicine Hospital from November 2012 to February 2014 were enrolled. The patients allergic to clopidogre,intolerant to clopidogrel,and recently using clopidogre were excluded. The patients were divided into a strong metabolic type group (n = 39),a moderate metabolic type group (n = 54),and a week metabolic type group (n = 9)according to the conditions of CYP2C19*2 and *3 locus mutation. The genotypes of the CYP2C19*2 and *3 were detected by the direct gene sequencing method in all patients. The maximum aggregation ratio (MAR)of platelet and platelet reactivity index (PRI)were detected beforeand 7 d after taking clopidogre 75 mg. Results (1)According to the CYP2C19*2 and CYP2C19*3, the genotyping was performed. The strong metabolic type group included *1 / *1 type 39 cases (38. 2%);the moderate metabolic type group included *l / *2 type 44 cases (43. 1%);*l / *3 54 cases, 10 (9. 8%);and the week metabolic type group included *2 / * type 27 cases (6. 9%);*2 / *3 type 2 cases (2. 0%). No *3 / *3 type was detected. (2)There were no significant differences in MAR before taking clopidogrel among the 3 groups (all P > 0. 05). After taking clopidogrel for 7 days,MAR and PRI were detected from strong to weak,followed by the week metabolic type group (49 ± 12% vs. 64 ± 15%), the moderate metabolic type group (42 ± 13% vs. 56 ± 14%),and the strong metabolic type group (33 ± 10% vs. 43 ± 12%);MAR was detected from high to low,followed by the strong metabolic type group (20 ± 12%),the moderate metabolic type group (10 ± 8%),and the week metabolic type group (7 ± 3%). Comparing the moderate metabolic type group and the week metabolic type group with the strong metabolic type group,there were significant differences between MAR,the decreased MAR and PRI (all P < 0. 01). Comparing the week metabolic type group with the moderate metabolic type group,there were no significant differences between MAR,the decreased MAR and PRI (all P > 0. 05). Conclusion The CYP2C19*2 and *3 gene polymorphisms may affect MAR and PRI after taking clopidogrel in patients with ischemic stroke.

Objective To explore the medical care and evacuation equipment at sea in China.Methods The present situation of the medical care and evacuation equipment at sea in China was discussed from the aspects of equipment system,medical service support,mechanism for utilization,management and maintenance as well as informatization.The problems were analyzed in equipment system,support ability,equipment integration and update as well as equipment performances.Results Some measures were put forward from the aspects of equipment system,support ability,equipment integration and update as well as equipment performances.Conclusion The development of medical care and evacuation equipment at sea has to take considerations on medical service requirements at sea,integrated civilian and military uses,personnel,innovation and etc.

Objective:To study the relationship between the expression of carnitine palmitoyltransferase 1α (CPT1α) and progression of renal interstitial fibrosis and chronic kidney disease (CKD), and to evaluate the value of CPT1α as a biomarker in pathological diagnosis of renal interstitial fibrosis and CKD.Methods:As a retrospective cohort study, information of CKD patients dignosed with tubulointerstitial fibrosis by renal biopsy and receiving follow-up from March 1, 2010 to July 30, 2017 in the Second Affiliated Hospital of Nanjing Medical University were collected. Renal tissues were stained by immunohistochemistry to detect the expression of CPT1α protein and then divided into three groups according to the quartile of proportion of CPT1α positive staining cells, including group Q1(>67.89%), group Q2(49.84%-67.89%) and group Q3(<49.84%). The degree of renal interstitial fibrosis was measured by Masson staining and lipid deposition was represented by Bodipy staining. Messenger RNA of CPT1α and collagen as well as other extracellular matrix genes were detected by real time-PCR. Relationships between proportion of CPT1α positive staining cells and renal interstitial fibrosis and renal function were analyzed by linear regression analysis. The relationship between CPT1α positive cell number ratio and renal function progression was measured by Pearson correlation analysis and generalized linear model. The effect of lipid-lowering medicine on renal function of CKD patients was analyzed by paired comparative analysis.Results:Ninety patients with CKD were included in this study. Renal interstitial fibrosis and lipid droplets deposition area increased in Q2/Q3 group compared with Q1 group by Masson and Bodipy staining (all P<0.05). Messenger RNA level of extracellular matrix-related proteins increased in Q2/Q3 group by real time-PCR than those of Q1 group (all P<0.05). Linear regression analysis showed that fibrosis area was negatively correlated with the proportion of CPT1α positive staining cells ( r=-0.309, P<0.01). The baseline expression of CPT1α in renal issues was negatively related with serum creatinine (Scr) ( r=-2.801, P<0.001), positively related with estimated glomerular filtration rate (eGFR) ( r=1.240, P<0.001). After a medium follow-up of 3.47 years, CPT1α positive cell number ratio was positively correlated with eGFR change rate by Pearson analysis ( r=0.220, P=0.038). Paired stratified analysis showed that taking lipid-lowering medicines attenuated the decrease of eGFR in Q2 group and Q3 group but not in Q1 group (both P<0.05). Conclusions:The decline of CPT1α in renal tissues of CKD patients is associated with the increase of Scr, the decrease of eGFR and renal interstitial fibrosis. CPT1α is a promising molecular marker to evaluate the degree of renal fibrosis and the progression of CKD.

OBJECTIVEThe biodegradation characteristics of di-n-butyl phthalate (DBP), an environmental endocrine disruptor, were studied by the method of dominant bacteria and immobilized microorganisms.

METHODSTaking DBP as the only carbon source to acclimatize the collected activated sludge, the concentration of DBP increased progressively in the process of acclimatization. Plate streaking was used to separate 1 strain of the degradation dominant bacteria after acclimatization. Better conditions to degrade DBP by the bacterium could be obtained through orthogonal experiments and the bacterium was identified. Then the acclimated activated sludge was made to immobilize the microorganism using polyvinyl alcohol as entrapment agent. The immobilized microorganism degraded DBP at different conditions.

RESULTSThe appropriate conditions to degrade DBP by the dominant bacteria were: degradation time, 32 h; DBP concentration, 200 mg/L; rate of shaking incubator, 100 r/min; pH, 7 and temperature, 30 degrees C. DBP could be degraded by more than 95% under such conditions. The bacteria were identified as Pseudomonas. The proliferated immobilized microorganisms degraded DBP more effectively and more adapted to temperature and pH than the free acclimated activated sludge.

CONCLUSIONOne strain of DBP degradation dominant bacteria was separated from the acclimatized activated sludge. It could grow with DBP as the only carbon source and energy, and degraded DBP effectively. After having been immobilized and proliferated, the dominant bacteria could keep a higher biological activity and degrade DBP more effectively than activated sludge.

Biodegradation, Environmental ; Dibutyl Phthalate ; analysis ; metabolism ; Hydrogen-Ion Concentration ; Pseudomonas ; metabolism ; Sewage ; microbiology ; Temperature ; Waste Disposal, Fluid ; Water Pollutants, Chemical ; analysis ; metabolism

Objective To investigate the effect of formative assessment on skill acquisition of basic life support (BLS) among medical students. Methods Totally 206 undergraduates were ran-domized into control group (C group) and interventional group (F group). A BLS lecture was given in both groups. And then, 45 min BLS training and BLS skill assessment (after training) were given in C group. Undergraduates in F group received BLS skill assessment (formative assessment) before training, and 15 min feedback was delivered based on the assessment, then 30 min BLS training was conducted. Skills assessment was conducted again in F group after the training. Student's-t-test was used to compare the difference of skills between the two groups and P<0.05 signifies statistically sig-nificant differences. Results Score of F group (85.2±7.3) were higher than that in C group (68.2± 13.2), with statistical difference. Conclusion A formative assessment could significantly improve skill acquisition of BLS among medical students.

Objective To evaluate the feasibility and safety of transumbilical laparoendoscopic sin-gle-site dismembered pyeloplasty ( U-LESS-P ) for the treatment of ureteropelvic junction obstruction (UPJO). Methods Between Mar.2011 and Mar.2012, U-LESS-P was performed in 8 consecutive pa-tients with UPJO by one experienced laparoscopic surgeon .The patients included 5 males and 3 females, with an average age of 28 (16-45) years.Of the 8 patients, six presented with flank pain , and two were a-symptomatic and discovered incidentally by health check .Of the 8 patients, seven had UPJO on the left side and one on the right side .The diagnosis was established by renal ultrasonography , diuretic renal scan , intra-venous urography (IVU) or/and computed tomography urography (CTU).Renal ultrasonography, IVU and ( or) CTU showed hydronephrosis and UPJO in the affected side , while diuretic renal scan demonstrated re-nal function deteriorated .No patients had undergone abdominal surgery previously .A 2-2.5 cm umbilical in-cision was made for single-port access .The procedures were performed using 30°5 mm or 10 mm laparoscope with a combination of conventional and bent laparoscopic instruments . Results All procedures were com-pleted successfully .None was converted to open surgery or traditional laparoscopic surgery .The mean opera-tive time was 153 (117-190) min, and the average estimated blood loss about 20 (10-40) ml.The mean time to resume oral diet was 1.5 days.The drainage remained 2-7 days.The mean hospital stay was 6 (4-8) days.With the follow-up of 3-6 months, symptom-free was investigated in all 8 cases.Ultrasonography , diuretic renal scan and IVU showed decreased or disappeared hydronephrosis .No operative complication , such as anastomotic stoma stenosis , was founded . Conclusions U-LESS-P is a safe and effective proce-dure for the treatment of UPJO , with the advantages of decreased operative morbidity , postoperative rapid re-covery and improved cosmetic result .

OBJECTIVE: To quantitatively investigate the association between the polymorphism of FokI of the VDR gene and the susceptibility of prostatic cancer. METHODS: Databases of Pubmed, EMBase, CBM, CNKI, VIP, and Wanfang Data were retrieved from the date they formed till May 2011. All randomized controlled clinical trials which matched both the inclusive criteria and exclusive criteria were subjected to meta-analysis, conducted on Revman 5.0.0 software. Stata 11.0 software was employed to process Begg's test. RESULTS: Ten studies were included. Total sample cases were 8360, with 3749 cases in the patient group and 4611 cases in the control group, respectively. The quantitative analysis showed there were no significantly differences between the polymorphism of VDR FokI alleles and the susceptibility of prostatic cancer (allele F to f: OR=1.00, 95% CI=0.94-1.06, P=0.96; genotypes FF/Ff to ff: OR=1.04, 95% CI=0.93-1.51, P=0.48; genotypes FF to Ff/ff: OR=0.97, 95% CI=0.89-1.06, P=0.53). Though one research on Indian people indicated that allele F was a risk factor for prostatic cancer, in Begg's test we observed relatively high publication bias. The subgroup analysis showed there were no significantly differences between the polymorphism of VDR FokI alleles and the susceptibility of prostatic cancer (allele F to f, white race: OR=0.91, 95% CI=0.88-1.02, P=0.17; yellow race: OR=1.09, 95% CI=0.95-1.24, P=0.22; Indian: OR=1.91, 95% CI=1.30-2.81, P=0.0009). CONCLUSION VDR FokI allele F might be a protective factor for European and American Caucasians.
Alleles ; Deoxyribonucleases, Type II Site-Specific ; genetics ; Genetic Predisposition to Disease ; Humans ; Male ; Polymorphism, Single Nucleotide ; Prostatic Neoplasms ; genetics ; Receptors, Calcitriol ; genetics