ObjectiveTo summarize the clinical features of ulcerative eolitis (UC) complicated by toxic megacolon for early diagnosis and proper treatment. MethodsSix cases of toxic megacolon in the patients suffered from UC in Peking Union Medical College Hospital from 1983 to 2010 were analyzed,and related literature was searched and reviewed.ResultsThe incidence of the toxic megacolon in the patients with UC in our center was 0.7％ (6/824),which was lower than those reported in the literature.There were always risk factors triggering the disease.The prognosis of the patients was poor,even after medical care and surgery intervention.Evaluation of the patients and making right timing to perform the surgery would improve the prognosis of the patients in foreign literature. ConclusionIt's crucial to make early diagnosis of the toxic megacolon in the patients suffered from UC. The right choice and timing to perform urgent surgery or selective surgery may improve their prognosis.

Objective To observe the clinical role of Qiliqiangxin capsules uniting conventional western medicine interfering with chronic heart failure(CHF).Methods 61 cases of CHF were randomly recruited into a control group(31 cases)and a treatment group(30 cases).The control group was treated with conventional anti-hean failure treatment,and the treatment group was added Qiliqiangxin capsules on the treatment of the control group.After having been treated for 2 courses (fonr weeks),such indexes as clinical efficacy,body weigbt,urine volume,6 min walking distance(6MWD),electrocardiogram,and cardiac ultrasound were measured for both groups.Results The overall efficiency of cardiac function was 93.33%for the treatment group and 74.19%for the control group.There was significant difierence between the two groups(χ~2=4.07985,P＜0.05).The enhance rate of left ventricular ejection fraction(LVEF)was(16±4)%in the treatment group as compared to(11±3)%in the control group,also showing statistical difierence between the two groups(t=5.509,P＜0.001).Conclusion Qiliqiangxin capsules combined with conventional western medicine could effectively improve the cardiac function,LVEE clinical symptoms,and quality of life in the patients with ehronic heart failure.

Objective:To construct a new home nursing service model based on information platform grid management, in order to effectively solve the medical care needs of home rehabilitation groups.Methods:In November 2018, Taizhou City, Zhejiang Province established the Municipal Home Care Service Center and Home Rehabilitation Nursing Skills Training Center, and established a gridding home nursing service model, and implemented the sinking of high-quality nursing resources, and made community nurses the main force of home care. In November 2019, a home nursing service information platform was established to create an online and offline integrated home nursing grading management system. The high quality, convenience and safety of home nursing services was ensured through information sharing and graded orders. We recorded the development of gridding home nursing services and patient satisfaction from January to May 2020, and evaluated the implementation effects. χ 2 test was used for statistical analysis. Results:Totals of 28 hospitals above ClassⅡ, 123 primary medical institutions, and 1 171 community nurses in Taizhou have settled on the home nursing information platform. From January to May 2020, nursing staff provided 5 274 cases of home care, including 4 472 cases of home care and 802 cases of online care. The patient satisfaction of home care was 98.73% (4 415/4 472) , and the patient satisfaction of online care was 98.25% (788/802) , there was no significant difference between the satisfaction of two service types (χ 2=1.136, P=0.286) . No complaints, adverse events and nurse safety issues occurred. Conclusions:The gridding home nursing service model based on information platform can give full play to the role of community nurses, broaden the scope of home care services, rationally allocate medical resources, solve medical care problems for home rehabilitation groups, and effectively promote hierarchical diagnosis and treatment.

OBJECTIVETo investigate the expressions of glucose-6-phosphatase (G6Pase) and phosphoenolpyruvate carboxykinase (PEPCK) in the liver of mice with hyperhomocysteinemia (HHcy) and explore the mechanism of gluconeogenesis induced by homocysteine.

METHODSFifty mice were randomly divided into normal control group (n=25) and HHcy group (n=25) and fed with normal food and food supplemented with 1.5% methionine, respectively. After 3 months of feeding, the fasting blood glucose and insulin levels were determined, and HOMA insulin resistance index (HOMA-IR) was calculated. The expressions of G6Pase and PEPCK in the liver of mice were detected using RT-PCR and Western blotting.

RESULTSThe fasting blood glucose and insulin levels and HOMA-IR were significantly higher in HHcy group than in the control group (P<0.05). RT-PCR and Western blotting showed that the hepatic expressions of G6Pase and PEPCK mRNA and proteins increased significantly in HHcy group compared with those in the control group (P<0.05).

CONCLUSIONHomocysteine promotes gluconeogenesis to enhance glucose output and contribute to the occurrence of insulin resistance.

Animals ; Gluconeogenesis ; Glucose-6-Phosphatase ; metabolism ; Homocysteine ; blood ; Hyperhomocysteinemia ; metabolism ; Insulin Resistance ; Liver ; metabolism ; Male ; Mice ; Mice, Inbred Strains ; Phosphoenolpyruvate Carboxykinase (ATP) ; metabolism

Objective: To probe the feasibility of decitabine (DAC) combined with micro-transplantation as consolidation treatment for older patients with acute myeloid leukemia (AML). Methods: Between November 2012 and September 2015, 37 consecutive patients with AML ≥60 years of age were analyzed. Of them, 19 patients received consolidation therapy with DAC followed by micro-transplantation (microtransplant group). Another 18 ones (chemo group) were treated with DAC plus priming regimen as consolidation chemotherapy in the same period. Results: There were no significant differences in terms of age, WBC count, and disease status of onset between the microtransplant and chemo groups (P>0.05). The two regimens were well tolerated. There was no difference of CTC grade 3-4 nonhematologic toxicities between the microtransplant and chemo groups (36.8% vs 27.8%, χ²=0.347, P=0.728). The median recovery durations for neutrophil and platelet in the microtransplant group were similar to those in the chemo group (12 vs 13 days, z=1.599, P=0.110; 14 vs 12 days, z=-1.314, P=0.189, respectively). No graft-versus-host disease was observed in the microtransplant group. The 2-year leukemia-free survival and overall survival were better in microtransplant group (50.7% and 54.9%, respectively) than in chemo group (24.3% and 30.0%, respectively) (P=0.047 and P=0.071, respectively). Conclusion DAC combined with micro-transplantation as a consolidation regimen may be a safe and promising option for older patients with AML.

Objective To observe the effects of pretreatment with dimethyloxalylglycine (DMOG) on the survival of multi-territory perforator flap and the vessels of choke zone (CZ) 2 in rat,and to explore related mechanism.Methods Sixty adult SD rats were divided into group DMOG and normal saline group (NS) according to the random number table,with 30 rats in each group.Perforator flap with three angiosomes was made on the right dorsal side of rat,including deep iliac circumflex artery perforator,intercostal artery perforator,thoracodorsal artery perforator,as well as CZ 1 and CZ 2.Rats in group DMOG were intraperitoneally injected with 2 mL NS containing DMOG (40 mg/kg) 2 days before operation,2 hours before operation,and 2 days after operation.Rats in group NS were intraperitoneally injected with equivalent volume of NS at the same time point.On post operation day (POD) 7,gross observation was conducted,and the survival rate of flap was calculated.On POD 7,the vascularity in CZ 2 and potential zone of flap was observed using angiography.On POD 7,new vessel in CZ 2 of flap was observed with HE staining,and the microvessel density (MVD) was calculated.On POD 7,the expression of vascular endothelial growth factor (VEGF) in CZ 2 of flap was detected by immunohistochemistry and Western blotting (respectively denoted as integral absorbance values and ratio of gray value),and blood flow volume of vessel in CZ 2 of flap was examined by laser Doppler perfusion imager.The sample number of each index was 6 in each group.Data were processed with t test.Results (1) On POD 7,rats in two groups all survived,and the flaps were not infected.In group DMOG,the necrotic area of flaps of rats with dark yellow crust and soft texture was observed approximately at the distal end of skin entry point of thoracodorsal artery perforator.In group NS,the necrotic area of flaps of rats with brownish black crust and hard texture was observed approximately at the distal end of CZ 2.The survival rate of flap of rats in group DMOG was (88 ± 3) ％,which was significantly higher than that in group NS [(82 ± 3) ％,t =3.38,P ＜ 0.01].(2) On POD 7,there were clear vascular structure and many new vessels in CZ 2 of flaps of rats in group DMOG,with intact vascular structure in potential zone.On POD 7,there were unclear vascular structure and few new vessels in CZ 2 of flaps of rats in group NS,with disorder vascular structure in potential zone.(3) On POD 7,MVD in CZ 2 of flaps in rats of group DMOG was (29.2 ± 2.2)/mm2,which was significantly higher than that of group NS [(20.3 ± 3.6)/mm2,t =5.10,P ＜0.01].(4) On POD 7,the expressions of VEGF in CZ2 of flaps in rats of group DMOG detected by immunohistochemistry and Western blotting were 5 060 ± 432 and 0.48 ± 0.04 respectively,which were significantly higher than those of group NS (2 811 ± 382 and 0.26 ± 0.06,with t values respectively 9.54 and 5.67,P values below 0.01).(5) On POD 7,blood flow volume of vessel in CZ 2 of flaps in rats of group DMOG was (58 ±4) perfusion units (PU),which was significantly more than that of group NS [(46 ± 4) PU,t =5.20,P ＜ 0.01].Conclusions DMOG can increase the survival rate of multi-territory perforator flap through promoting angiogenesis in CZ 2 of flap on the back of rat and improving blood supply of flap.

OBJECTIVE：To evaluate the price and affordability of rare disease drugs in China and provide the suggestions for the improvement of rare disease drug affordability in order to provide reference for the relevant decision-making of government departments. METHODS ：According to the List of the First Batch of Rare Diseasesand Diagnosis and Treatment Guideline for Rare Diseases（2019 edition），rare disease drugs were selected. The median price ratio （MPR）was used to evaluate the drug price level ， and the ratio of the annual drug costs to the annual disposable income of urban or rural residents was used to evaluate the affordability，and the impact of price management policieson drug prices and affordability. RESULTS and CONCLUSIONS ：A total of 71 kinds of rare disease drugs were included ，and the median MPR of them was 0.83；among them ，the median MPR of the original drugs was 1.13，and the median MPR of the generic drugs was 0.37. The annual cost of 71 rare disease drugs was 0.001-178.43 times the average annual income of urban residents ，and 0.003-456.57 times the average annual income of rural residents. There were 21 and 28 drugs whose annual cost exceeded the annual income of urban and rural residents.After the implementation of national medical insurance negotiation or volume based procurement of 14 drugs，the median MPR of these drugs decreased from 1.71 to 0.46. For urban residents ，the number of unaffordable drugs had been reduced from 8 to 0；for rural residents，it had been reduced from 10 to 5. In summary ，the price level of orphan drugs in China was slightly lower than international reference price ，but the price level of original drugs was higher than the international reference price ，and the cost of some drugs far exceeded the residents ’ability to pay. It is suggested that the government should strengthen the price management of original drugs ，promote the substitution of high-quality generic drugs for original drugs ，and improve the payment system for high-value rare disease drugs.