Objective To evaluate the curative effects of intravenous methylprednisolone (IVMP) during the conservative management for patients with indirect optic nerve injury (ONI),and to analyze the benefits of visual evoked potential (VEP) monitoring in prognosis assessment.Methods Among the 253 patients with cranial-facial injury,108 sufferred from optic nerve injury including 89 cases without optic nerve decompression treatment.These 89 patients were randomly divided into:group A,in which patients were given methylprednisolone intravenously for 7 days; and group B,in which patients without methylprednisolone treatment.The extent of and time required for eyesight recovery were recorded.VEP measurement was carried out in all cases.Results No differences in gender,age and BMI (Body Mass Index,all P ＞ 0.05) were observed.The incidence of ONI was higher in patients with motorcycle accident than that in those with car accident (P ＜0.01).In the motorcycle accidents,casualties wearing a helmet had lower incidence of ONI (P ＜ 0.01).Patients treated with methylprednisolone had a shorter recovery time (P ＜ 0.01) from blindness,however there was no difference in long-term outcome between group A and B.In patients with visual improvement in the “ non-extinguished” group,the amplitude and latency of the P wave of VEP were markedly ameliorated after the treatments (P ＜ 0.01).Conclusions Most of the ONI casualties in our study were resulted from motorcycle accidents,and wearing a helmet is an effective protection measure.The intravenous methylprednisolone (IVMP) showed no effect on improving the prognosis in patients with conservative treatment.The IVMP shortened the recovery time at the expense of increase in risk of complications.VEP examination is beneficial in prognosis assessment for non-operative ONI patients.The improvement of the amplitude and latency of P wave has close correlations with patients'visual recovery.

Objective:To evaluate the expression of CXCR4 and the migration rate of bone marrow stromal CD34+cells in differ-ent risk groups with myelodysplastic syndromes (MDS) using correlation analysis. Methods: Forty MDS patients were divided into low-and high-risk groups based on the International Prognosis Scoring System (IPSS). The former was composed of 20 patients with IPSS<1.5, whereas the latter was composed of 20 patients with IPSS≥1.5. Bone marrow (BM) samples of these patients and 10 nor-mal controls were collected. CD34+cells were separated and purified. The expression of CXCR4 was determined by flow cytometry. The migration rate of CD34+cells on the chemotactic effect of SDF-1αand on the effect of bone marrow stromal cells were measured. Results:The expression rate of CXCR4 was higher in the high-risk MDS group than in the low-risk and control groups (P<0.000 1). No significant differences existed between the low-risk and the control groups (P>0.05). The migration rate of CD34+cells on the ef-fects of SDF-1αand marrow stromal cells were significantly increased in the high-risk MDS group compared with those in the low-risk and control groups (P<0.000 1). Migration rate of CD34+cells on the effect of marrow stromal cells was positively correlated with CX-CR4 expression (P=0.000 1). Conclusion:The CXCR4 expression and migration rates of CD34+cells on the effect of marrow stromal cells are significantly higher in the high-risk MDS group than in the low-risk group. Migration rate has a positive correlation with the CXCR4 expression, which further indicates that MDS is a heterogeneous group of hematopoietic stem cell malignancies. The expres-sion and function of SDF-1 and its receptor CXCR4 differ within each group with various risks. SDF-1 and CXCR4 may be involved in MDS pathogenesis.

Objective:To improve the centralized bidding procurement practice of essential medicine in China. Methods:By using literature review, comparative analysis and field investigation, implementation plans and regula-tions of the centralized bidding procurement of essential medicines in 30 provinces were collected and analyzed. Re-sults:There are differences in the operating organization, scope of implementation, purchasing cycle, bidding pro-curement mode, judgment criteria and other aspects among provinces. Conclusion: The progress of the implementa-tion of the centralized bidding procurement practice of essential medicine under the request of Document No. 56 of the State Council differed greatly among the provinces. The government should adhere to the centralized bidding procure-ment practice of essential medicine, give full play to the advantages of group purchasing, explore approaches of medi-cal insurance institutions participating in the centralized bidding procurement practice, and perfect the assessment of drug quality to assure the quality of essential medicine.

Promoting equity and access to medicine is important to guarantee health equity. The international communities commonly guarantee equity and access to medicine through free pharmaceutical policy. In most coun-tries, free pharmaceutical policy covers patients who cannot afford, children under 5, pregnant women and elderly people. The free medicines include essential medicines, medicines for chronic and infectious diseases, vaccines, etc. Financing of free medicines comes from health insurance, direct government investment and international aid, and the medicine delivery mainly depends on the public medical institutions. Free pharmaceutical policy in China mainly refers to medicines for infectious diseases and vaccines, and the coverage is narrow. This paper argues that since China has been becoming one of the middle income countries, the amount of free medicines should be in-creased, especially for chronic diseases, such as diabetes, hypertension, etc. The equity and access to medicine in China should be further promoted by providing all essential medicines for free.

Objective: To detect the mutation of epidermal growth factor receptor (EGFR) gene in peripheral blood of non-small cell lung cancer (NSCLC) patients in Yunnan area with Super-ARMS, and to explore its correlation with clinicopathological characteristics. Methods: A total of 222 blood samples from patients with NSCLC were collected between January 2017 to December 2018 in the Molecular Diagnostic Center of Yunnan Cancer Hospital. The EGFR gene mutation in peripheral blood samples was detected by SuperARMS, and the relationship between EGFR gene mutation and clinicopathological features was analyzed. Meanwhile, the independent risk factors influencing EFGR mutation were also analyzed. Results: In the peripheral blood of 222 NSCLC patients, there were 81 cases (36.5%) with EGFR gene mutation. Among them, exon 19 deletion and L858R gene point mutation were the most common (75.3% of total mutation); female patients had a higher mutation rate than male patients (45.9% vs 27.0%); patients <60 years old had a higher incidence of mutation than patients≥60 years old (43.2% vs 28.8%) (P<0.05 or P<0.01); moreover, patients with no history of smoking, no history of radical surgery, adenocarcinoma, advanced stage and no history of chemotherapy had higher incidence of EGFR mutation (43.9% vs 21.6%, 39.2% vs 21.2%, 43.9% vs 4.8%, 39.7% vs 23.3% and 44.0% vs 23.5%) (P<0.05 or P<0.01). Multivariate logistic analysis showed that young, no smoking history, adenocarcinoma and no surgical history were independent risk factors for EGFR gene mutation (all P<0.01). Conclusion: In the peripheral blood of patients with NSCLC in Yunnan, the mutation rate of EGFR gene is higher in patients with age<60 years old, adenocarcinoma and non-smoking. Super-ARMS method is more sensitive in the detection of EGFR mutation in peripheral blood of lung cancer patients.

Background:Epidemiological studies suggest considerable overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS).Increased duodenal eosinophil counts have been observed in patients with FD,and the density of chromogranin A (CgA)-positive cells was reduced in duodenum in patients with IBS.Aims:To investigate the alterations and significance of duodenal eosinophils and CgA-positive cells in patients with FD and FD-diarrhea-predominant IBS (IBS-D) overlap.Methods:Outpatients with FD and FD-IBS-D overlap who fulfilled Rome Ⅲ criteria from Aug.2014 to Mar.2015 at the First Affiliated Hospital of Fujian Medical University were enrolled.Biopsy specimens were collected from the duodenal bulb for HE staining and CgA immunohistochemical staining.Eosinophils and CgA-positive cells were counted,and their associations with clinical symptoms were analyzed.Results:Twenty-eight FD patients and twelve FD-IBS-D overlap patients were enrolled in this study.Duodenal bulb eosinophil counts were significantly higher in FD-IBS-D overlap patients than in FD patients [(43.83 ± 7.34)/5HPF vs.(22.90 ± 8.93)/5HPF,P ＜ 0.05],while the density of duodenal bulb CgA-positive cells were significantly lower in FD-IBS-D overlap patients than in FD patients [(13.03 ±5.87)/HPF vs.(19.85 ± 9.18)/HPF,P ＜ 0.05].Spearman correlation coefficient analysis revealed that duodenal eosinophil counts were positively correlated with lower gastrointestinal symptoms such as abdominal pain/discomfort and diarrhea,whereas no correlations were found between density of duodenal CgA-positive cells and both upper and lower gastrointestinal symptoms.Conclusions:Duodenal bulb eosinophil counts are increased and CgA-positive cells are reduced in FD-IBS-D overlap patients than in non-overlap FD patients,which may implicate the difference in clinical symptoms between these two functional gastrointestinal disorders.

Objective To analyze the epidemiological characteristics and risk factors of gastric cancer after eradication of ( Helicobacter pylori , Hp) in Fuzhou area, to provide a theoretical basis for reducing the incidence and mortality of gastric cancer after eradication of Hp, and to provide effective suggestions for the prevention of gastric cancer in residents in Fuzhou. Methods A total of 699 patients with Hp eradication admitted to our hospital from January 2020 to December 2020 were selected. According to whether the patients had gastric cancer after eradication, they were divided into control group (no gastric cancer) and observation group (gastric cancer). The serum levels of tumor markers including CEA, CA125 and CA199 were detected and compared between the two groups. Clinical data of the two groups, including age, sex, family history of gastric cancer, course of Hp infection, open atrophy, severe atrophy of gastric mucosa, presence of intestinal metaplasia (IM) of gastric mucosa, xanxoma of gastric mucosa, and long-term use of proton pump inhibitors (PPIs), were analyzed using the self-made survey scale in our hospital. Univariate analysis and logistic regression were used to analyze the risk factors for gastric cancer after Hp eradication. Results Among of 699 patients with Hp eradication, 48 cases (6.96%) developed gastric cancer, including 29 male cases and 19 female cases. The incidence rate of males was significantly higher than that of females (P<0.05). The incidence rate of elderly patients was significantly higher than that of non-elderly patients (P<0.05). Serum CEA, CA125 and CA199 levels in the observation group were significantly higher than those in the control group (P<0.05). There were statistically significant differences in open atrophy, severe atrophy of gastric mucosa, presence of IM, xanxoma of stomach and PPIs use time >3 years between the two groups (P<0.05). The presence of IM (OR=4.874), severe atrophy of gastric mucosa (OR=4.412) and the time using PPIs >3 years (OR=3.631) were independent risk factors for gastric cancer after Hp eradication (P<0.05). Conclusion There is a high risk of gastric cancer after HP eradication in Fuzhou, mainly in elderly male patients, especially in patients with IM, severe atrophy of gastric mucosa and long-term use of PPIs, often accompanied by elevated levels of tumor markers. Close gastroscopy follow-up examination must be conducted within 4 to 5 years after Hp eradication, which is helpful for screening high-risk groups of gastric cancer, preventing gastric cancer and treating gastric cancer as early as possible after Hp eradication.

Objective:To understand the epidemiological characteristics of an outbreak of Chikungunya fever (CHIK) in Ruili city at Sino-Myanmar border area in Yunnan province, China, 2019.Methods:The data of CHIK cases in Ruili city were collected. Serum samples were collected from acute phase of the patients for the detection of the viral nucleic acid with real-time reverse transcription PCR assay.Results:A total of 121 CHIK cases (laboratory-confirmed cases) were reported in Ruili city in 2019, in which 98 were indigenous cases (80.99%) including 2 pregnant women and 3 neonatal cases (twin boys and 1 girl) were observed with vertical mother-to-child transmission), and 23 were imported cases (19.01%) from Myanmar. CHIK mainly occurred in Urban area (Mengmao town) and port area (Jiegao development zone) of Ruili city. The epidemic of CHIK lasted from September to November. The epidemic peak was in October (74.38%). The majority of patients were aged from 20—59 years (77.69%), in addition to 3 cases of mother-to-child transmission, the youngest was 3 months and the oldest 72 year-old. The male to female ratio was 1∶1.28 (53∶68). Occupational distribution of CHIK cases was mainly for the commercial service personnel (33.06%), home workers and unemployed persons (21.49%) and retiree (11.57%).Conclusions:During the outbreak of CHIK in Ruili in 2019, both indigenous and imported cases were detected. The imported CHIK cases from Myanmar were the main sources for local transmission of CHIK in Ruili city. This is the first time that a local epidemic of CHIK has occurred in Yunnan Province. It is necessary to strengthen control of the cross-border spread of CHIK in this area.

Objective:To investigate the diagnostic value of magnetically controlled capsule gastroscope in elderly patients with suspected upper gastrointestinal bleeding.Methods:A total of 102 patients with suspected upper gastrointestinal bleeding who underwent magnetically controlled capsule gastroscopy (MCCG) in General Hospital of Ningxia Medical University from October 2020 to September 2022 were enrolled. Patients were divided into two groups according to age: 38 patients in group A (≤65 years old) and 64 patients in group B (> 65 years old). The case data, changes of vital signs, detection of lesions and adverse reactions of the two groups were compared.Results:There were significant differences in combined diseases between group A and group B. The stomach examination time in group A was significantly shorter than that of group B (15.49±2.04 min VS 16.61±2.02 min, t=-2.685, P=0.009). There was significant difference in small intestine examination time between the two groups (331.69±14.96 min VS 337.83±14.28 min, t=-1.229, P=0.227). The incidence of adverse reactions in group A was significantly lower than that in group B [0.00%(0/38) VS 6.25%(4/64), χ2=6.186, P=0.013]. The changes of vital signs before, during and after examination were not statistically different. The detection rates of upper gastrointestinal lesions were 92.1% (35/38) and 98.4% (63/64), respectively. The positive rates of upper gastrointestinal bleeding under MCCG were 60.0% (21/35) and 50.8% (32/63), respectively. Patients with unexplained upper gastrointestinal bleeding under MCCG received small intestine examination. The detection rates of small intestinal lesions by small intestine examination were 84.6% (11/13) and 91.7% (22/24), respectively. Conclusion:MCCG demonstrates excellent diagnostic accuracy in elderly patients with suspected upper gastrointestinal bleeding. Additionally, it is safe and suitable for use in elderly patients with multiple comorbidities, allowing for concurrent small intestine examination.

Objective:To analyze the EGFR mutation profile of lung cancer patients in Yunnan, and to provide evidence for clinical personalized treatment.Methods:Demographic and clinical data of 2 967 lung cancer patients undergoing EGFR identification were collected and analyzed from January 2014 to August 2019 in Yunnan Cancer Hospital.Results:The proportion of EGFR mutation in 2 967 patients with lung cancer was 46.2%. Univariate analysis showed that the proportion of EGFR mutation in women was higher than that in men ( P<0.001) and displayed a downward trend with age ( P=0.03). The mutation rate of ethnic minorities was higher than Han ( P=0.012). Mutation rate in patients without smoking history was higher than those with smoking history ( P<0.001), and patients without drinking history was higher than patients with drinking history ( P<0.001). Mutation rate in patients without family history of lung cancer was higher than those with family history ( P=0.008). The mutation rate of adenocarcinoma was higher than other pathological types ( P<0.001). The mutation rate was different among stages, and it was higher in early patients than that in advanced patients ( P<0.001). The mutation rate of tissue specimens was higher than those of cytology and peripheral blood samples ( P<0.001). The mutation rate of Xuanwei area was lower than that in non-Xuanwei area ( P<0.001). Multivariate analysis showed that gender ( P<0.001), age ( P=0.036), smoking history ( P<0.001), pathological type ( P<0.001), specimen type ( P<0.001), and whether or not Xuanwei area ( P<0.001) were the independent factors of EGFR mutation.The EGFR mutation was more common in female, non-smokers, adenocarcinoma, non-Xuanwei area, tissue specimen and young lung cancer patients.The mutation types of EGFR in 1 370 cases mainly included 19-Del and L858R. The predominant mutation of EGFR in Xuanwei area was L858R, while in non-Xuanwei area was 19-Del.The mutation rates of G719X, G719X+ L861Q, G719X+ S768I, and S768I in Xuanwei were higher while the mutation rates of 19-Del, L858R, and 20-ins were lower than non-Xuanwei area ( P<0.05). The 19-Del mutation rate of ethnic minorities is higher than that of Han ( P<0.001). The combined mutation rate of G719X, L861Q in Han was higher than that of ethnic minorities ( P=0.005). Conclusions:The EGFR mutation rate in lung cancer patients in Yunnan is similar to Asian and Chinese, and higher in female, non-smokers, adenocarcinomas, young and non-Xuanwei area patients. The most common types of EGFR mutation in Yunnan are 19-Del and L858R. The predominant mutation of EGFR in Xuanwei area is L858R, while in non-Xuanwei area is 19-Del. The mutation rates of G719X, G719X+ L861Q, G719X+ S768I and S768I are higher in Xuanwei patients than those in non-Xuanwei patients. The combined mutation rate of G719X and L861Q in Han nationality is higher than that of ethnic minorities.