ObjectiveTo explore the impact of urinary incontinence on women's quality of life, and the effective measures to improve it.MethodsWe conducted a comprehensive literature review to analyze the present research about quality of life on urinary incontinent women and interventions for improving it.ResultsUrinary incontinence influenced patients' quality of life in many aspects, especially in their physical health, mental health, daily living and sexual life. Regular pelvic floor muscle training could prevent and control the incontinence symptoms and improve patients' quality of life.ConclusionsIt is necessary to carry on a series of activities to propagandize that urinary incontinence can be treated, effective measures should be taken to prevent and manage urinary incontinence in order to improve quality of life in urinary incontinent women.

Objective To estimate the value of confocal laser endomicroscopy (CLE)for differential diagnosis of gastric ulcer. Methods Patients diagnosed as gastric ulcer by conventional endoscopic mode of CLE were enrolled. The eonfocal endoscopic mode of CLE was used to observe the borderline and/or the surface of the ulcers. Biopsy specimen was taken for histopathological examination and the result of CLE was compared with histopathological finding. Results A total of 12 769 CLE images were obtained from 150 sites of 43 patients. The sensitivity and specificity of CLE for phlegmonosis process were 83.54% and 85.92%, respectively, with positive predictive value of 86.84% and negative predictive value of 82.43%. Whereas the sensitivity and specificity of CLE for intraepithelial neoplasia were 53.57% and 88.52%, respectively, with positive predictive value of 51.72% and negative predictive value of 89.26%. As for diagnosis of gastric cancer, the sensitivity and specificity of CLE were 88.37% and 93.46%, respectively, with positive predictive value of 84.44 % and negative predictive value of 95.24%. The kappa values for agreement of histopathological findings and CLE for diagnosis of phlegmonosis process, intraepithelial neoplasia and gastric cancer were 0.69,0.42 and 0.81, respectively. Conclusions CLE can provide a real-time histopathological diagnosis of the gastrointestinal tract with high sensitivity, specificity, positive and negative predictive values. Targeted biopsy can be done under CLE and the detective rates of precancerous lesions and tumors will be increased.

Objective: To investigate the characteristics and trends of malaria cases in Lishui City, Zhejiang Province from 2012 to 2023, so as to provide a basis for improving malaria prevention and control measures. Methods: Case data of malaria in Lishui City from 2012 to 2023 were collected from the Parasitic Disease Control Information Management System of the National Information System for Disease Control and Prevention in China. The parasite species, source of infection, temporal distribution, population distribution, geographical distribution, and clinical diagnosis and treatment of the cases were descriptively analyzed. Results: A total of 169 malaria cases were reported in Lishui City from 2012 to 2023, and P. falciparum malaria was the main type, accounting for 79.88% (135 cases). The positive rate of Plasmodium detection was 3.30‰(169/51 212), the highest was 5.41‰ (18/3 327) in 2017, and the lowest was 0.38‰ (1/2 632) in 2021. Malaria cases were reported in every month from 2012 to 2023, with 91 cases (53.85%) reported from May to October. There were 168 imported cases, of which 163 (96.45%) originated from Africa. There were 127 male cases (75.15%), and the majority of cases were aged 20 to 49 years, with 138 cases accounting for 81.65%. The majority of the occupation was overseas labor export workers, with 164 cases accounting for 97.04%. A total of 161 cases (95.27%) were registered residents of Lishui City, and cases were reported from all nine counties (cities, districts), with Qingtian County and Liandu District having the higher numbers of 98 and 41 cases, respectively. The median interval from onset to hospital visit for malaria cases was 2.00 (interquartile range, 4.00) days, and the median interval from hospital visit to diagnosis was 0 (interquartile range, 1.00) day. The diagnostic rate of first-diagnosed malaria cases in municipal and county medical institutions was 95.90% (117/122) and 91.49% (43/47), respectively, with no statistical significance (P>0.05). Conclusions The P. falciparum malaria was the predominant type in Lishui City from 2012 to 2023, with the majority of cases being imported. Male overseas labor export personnel aged 20 to <50 were the key demographic.

Objective To investigate the regulatory effect of branched chain amino acids (BCAA) on the expression of apoptosis related proteins after cerebral ischemia reperfusion injury and the protective effects of BCAA on ischemic brain injury in rats.Methods 40 male SD rats were randomly divided into normal diet group (n =20) and branched chain amino acid (BCAA) group (n=20) according to the random number table,and each group was randomly divided into control group (n=6),sham operation group (n=6) and model group (n =8) which used suture method to make ischemia reperfusion model.After modeling,modified Neurological Severity Scores (mNSS) was used to access the neurological impairment degree of 2,6,24,48 and 72 h in each group.The expression of apoptosis related proteins (Cleaved,Bax/Bcl-2) after 72 h was detected by the method of immune protein imprinting (Caspase3) and compared between normal diet group and BCAA group.Results Compared with the normal diet rats,the mNSS of BCAA diet rats after modeling at 2,6,24,48,72 h decreased (11.35±2.78 vs.7.15±2.41,P=0.019;9.35±1.75 vs.5.82±1.17,P=0.002;6.11±1.16vs.4.39±1.46,P=0.048;5.87±1.32vs.3.55±1.94,P=0.036;4.98±2.24vs.2.09±1.33,P=0.022).The expression of cleaved caspase3 protein and the ratio of Bax/Bcl-2 decreased in BCAA group.Conclusion BCAA can alleviate the apoptosis of rats after ischemia and reperfusion,reduce the damage of nerve function,and has a positive protective effect on ischemic brain injury.

Objective To investigate the value of fluorescin-aided confocal laser endomicroscopy (CLE) for diagnosis of helicobacter pylori (Hp) infection. Methods From June 2009 to November 2009, patients undergone gastric endoscope examination with upper gastrointestinal symptoms (upper abdominal discomfort, abdominal distension, satiation, acid reflux and eructation) or screened for gastric cancer were enrolled. The gastric mucosa CLE image data of twenty diagnosed Hp positive patients and 10 Hp negative patients was analyzed retrospectively. By comparing with histological image of targeted biopsy tissue, the CLE diagnostic criteria for Hp infection were established. In the prospective study, CLE diagnose result was compared with Hp tested result. The consistency of CLE diagnostic criteria in different observers was also analyzed. The CLE image data with histopathology result were compared accordingly. Results Total 72 patients were enrolled in the prospective study,of 34 Hp positive patients, 31 patients were correctly diagnosed by CLE. The accuracy, sensitivity and specificity of CLE diagnosis were 88.9%, 91.2 and 86.8% respectively. CLE image displaying fluorescin leakage and cell shedding was the highest specificity for Hp infection diagnosis, (97.4 %);fluorescin leakage plus gastric pits distortion and cell edema was the highest sensitivity (88. 2%). The consistency of CLE diagnostic criteria in different observers was high (Kappa value 0. 72, 0.87). The CLE image of Hp infection was highly correlated with inflammation activity (P＜0. 001). Conclusion CLE can accurately distinguish normal mucosa from Hp infected mucosa at the cellular level. The diagnostic value for Hp infection was reliable.

Objective To assess the value of confocal laser endomieroscopy (CLE) in diagnosis of early esophageal squamous cell carcinoma and precancerous lesions. Methods CLE examination was performed in 41 patients who needed further examination because of lesions in esophagus during July 2008 to April 2009. The diagnosis was made based on the features of esophageal squamous cells which was defined as low grade intraepithelial neoplasia(LGIN), high grade intraepithelial neoplasia (HGIN) and early esophageal squamous cell carcinoma (EC). Biopsy specimens were taken precisely matched to the CLE imaging sites. The result was compared with that of histopathology. Results There were 7281 eonfocal images obtained from 60 target lesions in 41 patients. The sensitivity, specificity and accuracy of CLE were 75.0%, 88.6% and 85.0% in diagnosis of LGIN, respectively, 85.7% ,92.3% and 90.0% in diagnosis of HGIN, respectively,and 88.9% ,96.1% and 95.0%, in diagnosis of EC,respectively. Conclusions It is an effective method for diagnosis of esophageal neoplastic lesions using CLE, which has high accuracy in diagnosis of HGIN and early esophageal cancer.

Objective To clarify the interaction among the interests and strategic choices of multiple subjects of medical insurance for the older people in China,and to provide a decision-making basis for the improvement of medical insurance policy for the older people.Methods An evolutionary game model was constructed based on evolutionary game theory and its steady state was simulated using Matlab R2021b software for the health insurer,the health care provider and the elderly.Results There is a conflict of interest between health insurance providers,healthcare providers and older people when all three parties consider maximising their own utility.In order to reach an evolutionary equilibrium,the strategic choice of the health insurance provider is to take"cost-cutting"behaviour to control the expenditure of the health insurance fund;the strategic choice of the older people is to increase the use of medical services to meet the demand for medical services;and the strategic choice of the medical service provider is related to the quantitative relationship between the reimbursement ratio of the health insurance and the cost ratio of medical services.When the reimbursement rate is 0.95,the probability that the provider will choose rational behaviour to control health care expenditure is the highest.Conclusion Healthcare providers with higher reimbursement rates have a higher probability of choosing rational behaviour.At the same time,the medical insurance reimbursement ratio cannot be raised blindly.It is recommended that the level of health insurance benefits be reasonably adjusted,the construction of a differentiation of the reimbursement ratio of medical insurance should be improved,and the measures for the management of medical behaviors should be enhanced,so as to effectively meet the health needs of the elderly population while at the same time guaranteeing medical safety.

Objective To clarify the interaction among the interests and strategic choices of multiple subjects of medical insurance for the older people in China,and to provide a decision-making basis for the improvement of medical insurance policy for the older people.Methods An evolutionary game model was constructed based on evolutionary game theory and its steady state was simulated using Matlab R2021b software for the health insurer,the health care provider and the elderly.Results There is a conflict of interest between health insurance providers,healthcare providers and older people when all three parties consider maximising their own utility.In order to reach an evolutionary equilibrium,the strategic choice of the health insurance provider is to take"cost-cutting"behaviour to control the expenditure of the health insurance fund;the strategic choice of the older people is to increase the use of medical services to meet the demand for medical services;and the strategic choice of the medical service provider is related to the quantitative relationship between the reimbursement ratio of the health insurance and the cost ratio of medical services.When the reimbursement rate is 0.95,the probability that the provider will choose rational behaviour to control health care expenditure is the highest.Conclusion Healthcare providers with higher reimbursement rates have a higher probability of choosing rational behaviour.At the same time,the medical insurance reimbursement ratio cannot be raised blindly.It is recommended that the level of health insurance benefits be reasonably adjusted,the construction of a differentiation of the reimbursement ratio of medical insurance should be improved,and the measures for the management of medical behaviors should be enhanced,so as to effectively meet the health needs of the elderly population while at the same time guaranteeing medical safety.

Objective To clarify the interaction among the interests and strategic choices of multiple subjects of medical insurance for the older people in China,and to provide a decision-making basis for the improvement of medical insurance policy for the older people.Methods An evolutionary game model was constructed based on evolutionary game theory and its steady state was simulated using Matlab R2021b software for the health insurer,the health care provider and the elderly.Results There is a conflict of interest between health insurance providers,healthcare providers and older people when all three parties consider maximising their own utility.In order to reach an evolutionary equilibrium,the strategic choice of the health insurance provider is to take"cost-cutting"behaviour to control the expenditure of the health insurance fund;the strategic choice of the older people is to increase the use of medical services to meet the demand for medical services;and the strategic choice of the medical service provider is related to the quantitative relationship between the reimbursement ratio of the health insurance and the cost ratio of medical services.When the reimbursement rate is 0.95,the probability that the provider will choose rational behaviour to control health care expenditure is the highest.Conclusion Healthcare providers with higher reimbursement rates have a higher probability of choosing rational behaviour.At the same time,the medical insurance reimbursement ratio cannot be raised blindly.It is recommended that the level of health insurance benefits be reasonably adjusted,the construction of a differentiation of the reimbursement ratio of medical insurance should be improved,and the measures for the management of medical behaviors should be enhanced,so as to effectively meet the health needs of the elderly population while at the same time guaranteeing medical safety.

Objective To clarify the interaction among the interests and strategic choices of multiple subjects of medical insurance for the older people in China,and to provide a decision-making basis for the improvement of medical insurance policy for the older people.Methods An evolutionary game model was constructed based on evolutionary game theory and its steady state was simulated using Matlab R2021b software for the health insurer,the health care provider and the elderly.Results There is a conflict of interest between health insurance providers,healthcare providers and older people when all three parties consider maximising their own utility.In order to reach an evolutionary equilibrium,the strategic choice of the health insurance provider is to take"cost-cutting"behaviour to control the expenditure of the health insurance fund;the strategic choice of the older people is to increase the use of medical services to meet the demand for medical services;and the strategic choice of the medical service provider is related to the quantitative relationship between the reimbursement ratio of the health insurance and the cost ratio of medical services.When the reimbursement rate is 0.95,the probability that the provider will choose rational behaviour to control health care expenditure is the highest.Conclusion Healthcare providers with higher reimbursement rates have a higher probability of choosing rational behaviour.At the same time,the medical insurance reimbursement ratio cannot be raised blindly.It is recommended that the level of health insurance benefits be reasonably adjusted,the construction of a differentiation of the reimbursement ratio of medical insurance should be improved,and the measures for the management of medical behaviors should be enhanced,so as to effectively meet the health needs of the elderly population while at the same time guaranteeing medical safety.