ObjectiveTo investigate risk factors for colorectal adenoma.Methods1260 subjects who received health check-ups were included.A questionnaire on life style was answered and anthropometric measurements including height, weight, waist circumference and blood pressure were taken.Fasting venous blood was obtained and fasting plasma glucose, total cholesterol, triglycerides(TG), highdensity lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured.Fatty liver was diagnosed by ultrasonography. Colonoscopy was performed on each subject. Categorical data were compared using Pearson's chi-squared test, and multivariate logistic regression analysis was used to estimate the strength of association between the colorectal adenoma and various factors. ResultsThe frequency of colorectal adenoma was significantly higher among males, older patients( ≥55 years), current smokers and subjects with less physical activity, abdominal obesity, fasting hyperglycemia or fatty liver (x2 =4.355, 11.549, 4.440, 4.608, 6.211, 4.510, 4.156, P＜0. 05). Male sex (OR: 1.61,CI:1.13 -2. 57), old age (OR: 4.41,CI:3.32- 10.27)and abdominal obesity (OR: 1.75,CI:1.21 -2.86)were independent risk factors for colorectal adenoma. However, the frequency of colorectal adenoma was not different in subjects above 55 years old according to gender and abdominal obesity( x2 = 1. 139, 3. 413 ,P ＞0. 05 ). ConclusionsAbdominal obesity, old age and male sex were significantly associated with colorectal adenoma. However, the effect of abdominal obesity and male sex on the development of colorectal adenoma is less significant in subjects above 55 years of age. It is especially important for people under 55 years old to prevent colorectal adenoma by avoiding abdominal obesity.

Objective To explore surgical management of bilateral thyroid papillary carcinoma. Methods The clinical data of 55 patients with bilateral thyroid papillary carcinoma were analyzed retrospectively. Among the 55 patients, total thyroidectomy was performed in 52 cases, total affected lobectomy plus isthmus and opposite near total lobectomy thyroidectomy was performed in 3 cases. Results Among the cases of bilateral functional neck lymph node dissection ,5 cases were all of bilateral neck lymph node metastasis, the positive rate was 100.0%(5/5);, among the cases of unilateral functional neck lymph node dissection,9 cases were found neck lymph node metastasis,the positive rate was 81.8%(9/11); among the cases of bilateral central region lymph node dissection, 1 case was of central region lymph node metastasis, the positive rate was 25.0% (1/4); among the cases of unilateral central region lymph node dissection, 14 cases were of central region lymph node metastasis, the positive rate was 66.7%(14/21). Fifty-three cases were tumor free survival, 2 cases accompanied distant metastasis also gained good effect Conclusions Total thyroidectomy should be performed for bilateral thyroid papillary carcinoma because of its characteristics of multiple tumors. It is considered that whether the neck lymph node dissection should be done depends on the stage of the tumor.

Objective To clarify the expression of Tbx3 gene in breast cancer tissues and its clinical significance, and the expression of Tbx3 gene in different clinical pathological characteristic breast cancer. Methods Expression of Tbx3 gene in 53 specimens of breast cancer and 28 specimens of normal breast tissues were investigated by immunohistochemistry, analysing the clinical significance. Meanwhile the correlation of expression of Tbx3 gene in breast cancer classified was investigated by estrogen receptor ( ER),lymph node metastasis, Her-2 status. Results Positive rate of Tbx3 gene in breast cancer tissues was significantly higher than that in normal breast tissues [73.58% (39/53) vs 14.29% (4/28)] (P ＜ 0.05).Positive rate of Tbx3 gene in ER positive breast cancer tissues was higher than that in ER negative breast cancer tissues [ 84.38% (27/32) vs 57.14% ( 12/21 ) ] (P ＜ 0.05 ). Positive rate of Tbx3 gene in breast cancer tissues with lymph node metastasis was higher than that in breast cancer tissues without lymph node metastasis [86.21%(25/29) vs 58.33% (14/24) ] (P ＜ 0.05). Positive rate of Tbx3 gene in Her-2 positive breast cancer tissues was higher than that in Her-2 negative breast cancer tissues[ 93.75%(15/16) vs 64.86% (24/37) ] (P ＜ 0.05). Conclusions Tbx3 gene is over expressed in breast cancer tissues. It is related to ER, lymph node metastasis, Her-2 status.

Objective:To investigate the values of immunophenotype and the Collagen type1 alpha1/Proto-oncogene Proteins c-sis (COL1A1/PDGFB) fusion gene in the diagnosis of dermatofibrosarcoma protuberans (DFSP). Methods:IHC markers and the COL1A1/PDGFB fusion gene were detected by IHC staining and interphase fluorescence in situ hybridization (FISH) in 73 cases previously diagnosed as DFSP. A total of 85 and 10 non-DFSP cases were also included as controls for IHC staining and FISH, respectively. Results:In the 73 DFSP cases, the positive detection rates for immunohistochemical marker vimentin, CD34, CD99, S100, desmin and SMA were 100%, 91.78%, 61.64%, 0, 0, and 6.85%, correspondingly. Protein expression levels in these cases varied from the control group, and CD34 ex-pression was significantly different among the differential diagnoses. The positive detection rate for the COL1A1/PDGFB fusion gene was 86.96%(60/69), whereas the gene expression in the control group was negative. Conclusion:The COL1A1/PDGFB fusion gene is a highly specific and sensitive marker in the diagnosis of DFSP. CD34 is a suitable marker for DFSP.

Objective: To optimize the ultrahigh pressure extraction ( UPE) process for forsythoside from Forsythia suspensa by Box-Behnken experimental design. Methods:On the basis of single factor screening, a three-factor and three-level Box-Behnken ex-perimental design was employed with liquid/material ratio( X1 ) , extraction pressure ( X2 ) and extraction time ( X3 ) as the independent variables. The response variable was the extraction yield of forsythoside. Results:The optimal UPE conditions for forsythoside were as follows:the ratio of solvent to material (ml·g-1) was 70, the extraction pressure was 151 MPa, and the extraction time was 114 s. With the optimal extraction process, the extraction yield of forsythoside was 13. 15 mg·g-1 . Conclusion:As a novel extraction tech-nology for Chinese herbal medicines, UPE procedure has higher extraction yield, lower extraction temperature, shorter extraction time and less power consumption, which provides a brand-new method for the extraction of forsythoside from Forsythia suspensa.

Objective To explore the application effects of plan-do-check-action ( PDCA) circle in home care for cerebral stroke patients. Methods We divided the stroke patients of Neurology Department into experimental group and control group with 80 cases in each group randomly. Patients in experimental group were cared by PDCA circle home care, while those in control group received conventional outpatient care which included telephone follow-up and outpatient care. Patients in two groups were compared from daily life ability, compliance, pressure ulcers incidence, and rehospitalization rates in 6 and 12 months after discharged. Results 12 months after discharged, daily life ability score in experimental group was higher than that of control group[(46. 60 ± 10. 98) vs(42. 88 ± 9. 80)] (t = 2. 26,P < 0. 05). Patient′s compliance in experimental group was better than that of control group(P<0. 05). Pressure ulcers incidence in experimental group was obvious lower than that of control group (3. 75% vs 16. 25%) (χ2 =6. 94,P<0. 05). Rates of readmission in experimental group was lower than that of control group (5. 00% vs 16. 25%) (χ2 =5. 33,P<0. 05). Conclusions PDCA circle home care is considered to be an advanced service model with continuing care which can improve the patient′s quality of life, improve patient′s compliance, reduce the incidence of pressure ulcers and readmission rates, reduce the family financial burden and save medical resources.

Objective To understand the status of knowledge, attitude and practice (KAP) about stroke among the residents in a community of Wenzhou, and to clarify the characteristics of the intervention population and the key points for intervention, so as to carry out health education and health promotion, and improve the prevention and treatment of stroke. Methods An investigation was conducted in a total of 658 residents in a community of Wenzhou, aged from 18 to 90. The content of the investigating included the general information, the KAP about stroke, the identification of stroke warning information and the behavior of seeking medical advice. Results The highest and lowest rate of the knowledge about stroke prevention and treatment was 88.68% and 33.54%; the highest and lowest rate of the correct attitude was 79.75% and 32.67%; and the highest and lowest rate of the correct behavior was 56.17% and 10.89%. The differences of KAP in populations with different characteristics were statistically significant (P< 0.01). The top three stroke warning symptoms were one side of the face or limb numbness or weakness (59.57%), consciousness disturbance (59.42%) and comprehension disturbance (59.12%). The thop three emergency seeking hospital service behaviors of stroke were immediate delivery to hospital (19.60%), continued observation (18.54%) and calling ambulance (18.24%). Conclusions The status quo of community residents' KAP of stroke in Wenzhou is at a low level. It is suggested to carry out targeted health education to improve the residents' knowledge of stroke and promote the change of attitude and behavior, so as to prevent or delay the incidence of stroke.

Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.