Objective: To analyze the mediating effect of social support between family resilience and quality of life among elderly patients with Alzheimer's disease (AD), so as to provide the basis for improving the quality of life among elderly patients with AD. Methods: Elderly patients with AD who aged >60 years admitted to Wenzhou Seventh People's Hospital from August 2017 to June 2021 were selected. Data on demographic information, the severity of AD, and the profile of the primary caregivers were collected through questionnaire surveys. Social support, family resilience, and quality of life were assessed using the Social Support Rating Scale, the Shortened Chinese Version of the Family Resilience Assessment Scale, and the Chinese Version of the Quality of Life in Alzheimer's Disease Scale, respectively. The Process macro program was used to analyze the mediating effect of social support between family resilience and quality of life. Results: A total of 137 elderly patients with AD were surveyed. The mean age of the participants was (69.26±10.93) years. Among them, there were 63 males (45.99%) and 74 females (54.01%). The mean scores for social support, family resilience, and quality of life were (27.93±4.28), (97.34±10.06), and (27.82±7.27) points, respectively. The results of the mediating effect analysis indicated that family resilience could directly and positively affect the quality of life, with an effect value of 0.319 (95%CI: 0.122-0.491). It could also indirectly and positively affect the quality of life through social support, with an effect value of 0.118 (95%CI: 0.030-0.248). The mediating effect accounted for 26.42% of the total effect. Conclusion Social support plays a positive mediating role between family resilience and quality of life among elderly patients with AD.

Colorectal cancer (CRC) is a prevalent malignant tumor often leading to liver metastasis and mortality. Despite some success with PD-1/PD-L1 immunotherapy, the response rate for colon cancer patients remains relatively low. This is closely related to the immunosuppressive tumor microenvironment mediated by tumor-associated macrophages (TAMs). Our previous work identified that a phosphoglycerate mutase 1 (PGAM1) allosteric inhibitor, HKB99, exerts a range of anti-tumor activities in lung cancer. Here, we found that upregulation of PGAM1 correlates with increased levels of M2-like tumor-associated macrophages (TAMs) in human colon cancer samples, particularly in liver metastatic tissues. HKB99 suppressed tumor growth and metastasis in cell culture and syngeneic tumor models. M2-polarization, induced by colon cancer cell co-culture, was reversed by HKB99. Conversely, the increased migration of colon cancer cells by M2-TAMs was remarkably restrained by HKB99. Notably, a decrease in TAM infiltration was required for the HKB99-mediated anti-tumor effect, along with an increase in CD8⁺ T cell infiltration. Moreover, HKB99 improved the efficacy of anti-PD-1 treatment in syngeneic tumors. Overall, this study highlights HKB99's inhibitory activity in TAM-mediated colon cancer progression. Targeting PGAM1 could lead to novel therapeutic strategies and enhance the effectiveness of existing immunotherapies for colon cancer.

OBJECTIVE: To estimate the social and economic burden of Downs syndrome for patients and their families residing in Changsha, China. METHODS: An 160-item self-administered questionnaire was designed and distributed to the primary caregivers of the patients in March 2020. A total of 81 eligible participants had completed the questionnaire, among which 20 were excluded for incomplete data. A patient perspective was taken to estimate the economic burden of the disease. The social impact of the disease on the patient's family was evaluated through questions adapted from the Stanford Psychological Wellbeing (PWB) Scale. RESULTS: The estimated life-course cost of a Downs syndrome patient in Changsha is 4 985 659 RMB, with the patient and caregiver's loss of income taking the greater proportion. In addition, as the majority of the patients' primary caregivers, female caregivers experienced not only considerable financial hardship caused by the care provision, but also a significant amount of psychological pressure and social discrimination. CONCLUSION Increased level of social welfare for the patients and social support for their female caregivers are essential for reducing economic burden and improving their quality of life in the area. In addition, prenatal screening and diagnosis for Downs syndrome are important for reducing both the social and economic burden of the disease by preventing its occurrence.
Caregivers ; China ; Down Syndrome ; Female ; Financial Stress ; Humans ; Quality of Life ; Social Discrimination ; Surveys and Questionnaires

OBJECTIVE: To compare the clinical application and health economic values of non-invasive prenatal testing (NIPT) and second trimester serum screening (STSS). METHODS: A retrospective analysis was carried out on 54 026 singleton pregnant women undergoing NIPT and STSS from March 1, 2018 to December 31, 2019 in Changsha Maternal and Child Health Care Hospital. For pregnant women with high-risk results of NIPT, prenatal diagnosis and follow-up of pregnancy outcomes were conducted. The data was grouped to 4 screening models, and their cost-benefit was analyzed. RESULTS: The sensitivity, specificity and positive predictive value of NIPT were all higher than STSS. Screening models 1 to 4 have prevented the birth of 71, 29, 52 and 54 patients with Down syndrome, respectively. The safety index of screening models 1 to 4 were 0.0036, 0.3944, 02215 and 0.1281, respectively. When the price of NIPT was decreased to 600 RMB, the cost-benefit of the screening models 1 to 4 was 0.46, 0.65, 0.44 and 0.40 million RMB, respectively. CONCLUSION NIPT has a better detection performance than STSS. When the price of NIPT is 600 RMB, screening model 1 has the best screening effect and the highest accuracy, safety index and health economical value.
Child ; China ; Cost-Benefit Analysis ; Down Syndrome/diagnosis* ; Female ; Humans ; Pregnancy ; Prenatal Diagnosis/methods* ; Retrospective Studies

The ongoing development of high-throughput sequencing technology and continuous decline of sequencing cost have made it possible to carry out large-scale screening for genetic diseases, which are the main component of birth defects. The screening of genetic diseases is expected to significantly reduce the rate of birth defects and the burden of genetic diseases to the affected families and the society. Taking Down syndrome as an example, through the analysis of the cost-benefit ratio of relevant screening programs, this article has summarized the socio-economic indicators to be considered during the design and development of genetic disease screening.
Cost-Benefit Analysis ; Down Syndrome/genetics* ; Genetic Testing ; Humans

Objective: To compare the surgical accuracy of the 3D printing surgical guide and traditional occlusal splint in the treatment of skeletal facial asymmetry cases. Methods: 12 facial asymmetric patients underwent joint orthognathic and orthodontics treatments were included in this research. In the 3D printing group (n=6) the pre-surgical CT scan for the skeleton and laser scan for the dentures were performed and 3D orthognathic procedures including Le FortⅠ and BSSRO combined with genioplasty were planned. The 3D printing surgical guides were manufactured and applied during surgeries. Another 6 cases were received same procedures by traditional occlusal splint techniques as the control group. Post-surgical CT reconstruction and 3D superimposition with pre-surgical planning was carried out for outcome comparison. Results: The maximal error of maxillar was 0.65 mm and average error was less than 1 mm in 3D printing group, while the maxillary maximal error was 2.11 mm and average error was greater than 1 mm in traditional group which showed the statistical significance (P<0.05). Conclusions The usage of 3D printing surgical guide could improve the orthognathic surgical precision by controlling the jaw bone in a three-dimensional way.

Objective To evaluate the efficiency and safety of corticosteroid therapy for IgA nephropathy.Methods Pubmed,Medline/embase,and Te Cochrane Library databases were searched for randomized controlled trials (RCTs) of hormone therapy for IgA nephropathy from database establishment to September 2017.According to the Cochrane system evaluation method,two reviewers independently screened the literature,extracted data,evaluated the quality of the included studies and cross-checked them according to inclusion and exclusion criteria.The Cochrane bias risk method was used to evaluate the quality of the included studies.The fixed effect model was used to assess the risk of serum creatinine change and progression to end-stage renal disease (ESRD).The random-effect models were used to assess 24-hour urinary protein quantification and the incidence of adverse events leading to drug withdrawal or hospitalization.The data were pooled using RevMan 5.3 software.The quadratic variables were odds ratio (OR) and the continuous variables were mean difference (MD).The odds ratio was used as the effect variable for the two variables,and the mean variance was used as the effect variable for the continuous variable data.Results A total of 9 RCTs were enrolled.Meta-analysis showed that compared with the control group,the steroid treatment group could slow down the increase of serum creatinine by more than 50％ in IgA nephropathy patients (OR =0.15,95％ CI:0.04-0.53,P =0.003) and delay the progression to ESRD (OR =0.38,95％ CI:0.16-0.87,P =0.02),but there was no significant difference in the level of serum creatinine (MD =-0.03,95％ CI:-0.29-0.24,P =0.85),the 24 hour urinary protein quantification (MD =-0.55,95％ CI:-1.42-0.31,P =0.21),and the incidence of adverse reactions (OR =1.68,95％ CI:0.69-4.11,P =0.26).Conclusions The meta analysis showed that there was no significant difference in the safety of steroid treated IgA nephropathy compared with the control group,and may be beneficial to the long-term prognosis of patients with IgA nephropathy.

Objective To develop and validate a new genioplasty templates system for monoblock osseous genioplasty.Methods Thirty-six patients with chin deformities were enrolled in this study.The chin template system included a cutting guide and a repositioning guide for a genioplasty.Chin templates were designed in a computer and fabricated using a three-dimensional printing technique.The accuracy of the genioplasty templates were assessed by comparing the actual postoperative outcomes with the virtual plan.Results All genioplasty was successfully completed by the template system.The largest linear rootmean-square deviation(RMSD) between the planned and the postoperative chin segments was 1.16 mm and the largest angular RMSD was 3.06°.Conclusions The results showed that the chin template system provides a reliable method for transfer of genioplasty planning.The operation precision of the genioplasty can be improved by using the surgical templates system.

Objective To evaluate the results of the orthognathic surgery with computer aided simulation-three-dimensional(3D) printed surgical guide and dental model surgery in the treatmemt of patients with mandibular excess and facial asymmetries.Methods The coordinate system was built in ProPlan CMF 2.0 software,and the horizontal plane consisted of PoL,PoR,OrL,middle sagittal plane through nasion point and basion point and the plane perpendicular to the horizontal plane,coronoid plane through nasion point and the plane perpendicular to the horizontal plane and middle sagittal plane.The orientation of maxilla and mandibular distal segment was calculated by each triangle(U 1-U6L-U6R,L1-L6L-L6R,Me-M5L-M5R) before and after orthognathic surgery.A total of 60 mandibular excess patients with facial asymmetries were enrolled in this retrospective study.They were divided into two groups,group I with computer aided simulation,group Ⅱ with dental model surgery.The difference of maxillary occlusal plane roll and yaw angle,mandibular occlusal plane roll and yaw angle,and mandibular body plane roll and yaw angle were calculated.Statistical analysis was performed with SPSS 17.0 software.Results The yaw angle of mandibular occlusal plane of the dental model surgery and computer aided simulation was 0.36°± 0.48° and 0.84° ±0.36° (P=0.043),respectively.The roll angle of mandibular occlusal plane of the dental model surgery and computer aided simulation was 0.26°±0.79° and 0.54°±0.40°(P=0.032),respectively.The yaw angle of mandibular body plane of the dental model surgery and computer aided simulation was 0.60°± 1.04° and 0.23°±0.52°(P=0.008),respectively.The roll angle of mandibular body plane of the dental model surgery and computer aided simulation was 0.82°± 0.72° and 0.53°± 0.37° (P=0.028),respectively.The changes in computer aided simulation group were more obvious than that in the dental model surgery group,but the difference was not significant in the yaw angle of maxillary occlusal plane and the roll angle of maxillary occlusal plane between the two groups(P ＞ 0.05).Conclusions It was more effective to correct mnandibular asymmetry by computer aided simulation than dental model surgery.

Objective To investigate the micro-anatomical approach to resect both intracranial and extracranial jugular foramen tumors in one-stage. Methods With the aid of surgical microscope, fifteen cadaver heads were used to study the microsurgical anatomy of high cervical part and jugular foramen, measure relative data. Results Detailed dissection was performed on high cervical part between the 1st cervical vertebra and the 4th cervical vertebra, resect foramen processus transversi of the 1st cervical vertebra, free vertebral artery 2nd and 1st cervical vertebra segment and horizontal segment. The jugular tubercle, jugular tunisia and part of the occipital condylus was drilled away as much as possible, total exposure of lateral semicircular canal was completed after the removal of the mastoid revealed labyrinthinem. Then the sigmoid sinus and jugular bulb were skeletonized. The vertical of segment of facial nerve was fully skeletonized to study the necessity of the facial nerve translocation. Full exposure to the sigmoid sinus, open jugular foramen. JF areas expanded, and the measured parameters revealed. The distance was (29.65 ± 3.24)mm from mastoidalec to oncentrated focus of condyle (10.18 ± 0.81)mm from hinder margin of condyle to endostoma of hypoglossal canal. The left distance was (6.8 ± 0.35)mm from jugular foramen to perpendicular part of facial nerve, right was (4.6 ± 0.33)mm. Conclusions Total exposure of JF can be achieved through the approach we described, and will enable the facial nerve, cochlea, and the structure of the vertebral artery to be performed. Both intracranial and extracranial tumors can be removed in a one-stage procedure related to anatomical parameters. Improve the cure, reduce complication and lower mortality.