Objective To evaluate the impacts of comprehensive diabetes intervention to provide evidence for effective diabetic control in rural communities.Methods Diabetic patients from four communities at Wujin District of Changzhou City were selected.One hundred and seventy-three patients from two communities received comprehensive intervention,including medication therapy,diabetes education,and diet.exercise,and behavior instruction(intervention group);142 patients from the other two communities got medication therapy only (control group).All the participants were interviewed with structured questionnaire and phyrsical examination.The second epidemic investigation was conducted at 4 years to evaluate the effects of the intervention.Results At the end of the intervention,the awareness rates of normal fasting plasma glucose,major diabetes risk factors,healthy diet,and therapeutic strategies in the intervention group were 90.8%.74.6%,89.6%,and 59.5%,respectively,which were significantly higher than those in the control group (all P<0.05).For the intervention group,the rates of diet behavior or physical exercise change were 68.8% and 58.4%.respectively.which were much higher than those of the control group(all P<0.05).The average levels of systolic pressure,diastolic pressure,fasting plasma glucose,and total cholesterol were (130.6±10.4)mm Hg(1 mm Hg=0.133 kPa),(78.4±7.5)mm Hg,(6.2±3.1)mmol/L,and (4.5±0.9)mmol/L,respectively,in the intervention group,which were lower than those in the control group(all P<0.05).Conclusion Comprehensive intervention shows significant effects on rural community patients with diabetes.

Objective To study the CT features of small hepatocellular cancer.Methods 37 patients with small hepatocellular cancer proved histopathologically underwent spiral CT examinations including plain scans and contrast-enhanced scans.The arterial phase scan,the portal phase scan and delayed phase scan started at 25th second,70th second and 5th minute respectively after injecting the contrast medium with the high pressure syringe,the velocity was 2.5 ~3 ml/s,and the dose was 1.5 ml/kg.Results 73% (27/37) of tumors showed hyperdensity in arterial phase,65%(24/37) of tumors was hypodensity and 35% (13/37) had hyperdensity during portal phase,of which eight showed hypodensity in equilibrium phase.Conclusion Spiral CT can display the features of blood supply of small hepatocellular carcinoma that is of benefit in early diagnosis.

Objective To investigate the prevalence and influencing factor of metabolic syndrome(MS)in rural elderly population. Methods With randomized cluster sampling,investigations including questionnaires,physical examination,fasting plasma glucose,blood lipids were performed in rural population aged over 60 years in Changzhou city in 2004-2005. Results A total of 4976 elderly people were enrolled in the study.The prevalence of MS was 24.1%,and 10.3%in men,34.3%in women by international diabetes federation(IDF)2005 definition.86.2%individuals had one or more of the metabolic disorders.Logistic regression analysis showed that sex,smoking,sweetmeat,family history of essential hypertension(EH)and tea drinking were influencing factors of MS. Conclusions The prevalence of MS is high in rural elderly population,especially in females.

AIM:ToobservetheeffectofcepharanthineonhumanlungadenocarcinomaLTEP-a-2cellgrowth, and to explore the changes of related microRNA ( miRNA) expression in the cells .METHODS:LTEP-a-2 cells were trea-ted with cepharanthine at concentrations of 0μmol/L, 10μmol/L, 20μmol/L and 40μmol/L.The growth inhibition rate was detected by MTT assay , and the cell morphological changes were observed under light microscope .The cell apoptosis was analyzed by flow cytometry .The expression of let-7c, miR-34a and miR-34b was measured by real-time PCR.RE-SULTS:Cepharanthine inhibited the cell activity of LTEP-a-2 cells in a dose-dependent manner .With the increase in cepharanthine concentration , the pyknosis of the cells was visible under the inverted microscope .Flow cytometry analysis found that different concentrations of cepharanthine induced the increase in the apoptotic rates of LTEP -a-2 cells.The re-sults of real-time PCR showed that the cepharanthine also increased the expression of let -7c, miR-34a and miR-34b.CON-CLUSION:Cepharanthine inhibits the growth of LTEP-a-2 cells, and induces apoptosis .Cepharanthine increases the ex-pression of let-7c, miR-34a and miR-34b, indicating that these miRNAs in LTEP-a-2 cells has the function as tumor sup-pressor genes .

Objective The application of intraoperative evoked EMG monitoring during lumbar pedicle screw fixation and to find new stimulus threshold criterion.Methods The validity of the evoked EMG monitoring in detecting the malposition of the pedicle screws was tested again by animal experiment.Nineteen patients was inserted pedicle screws with persistent evoked EMG monitoring via tap stimulator,and the electric current was set at 30% of bone threshold of the same pedicle,all patients were ohecked by CT scan to prove the outcome.Results Thirty-two pedicles of six dogs were inserted Kirchner wires.The stimulate thresholds of mal-position wires had significant difference with those of normal-position wires.During clinical trial,122 screws were inserted in to nineteen patients.Four screws were positive during intraoperative evoked EMG monitoring.Of which one screw was confirmed as mal-position during operation and was then adjusted;another screw was found to be mal-positioned by CT scan post-operation;the other two screws were found normal by CT scan.The sensitivity of this technique was 100% and the specificity was 98%.Conclusion Intraoperative evoked EMG monitoring during lumbar pedicle screw fixation can detect the mal-positioned screws and to protect the nerve roots.The stimulate current may set at 30% of the bone threshold of the relevant pedicle.

Objective To investigate the prognostic value of CDKN2A mRNA in glioblastoma (GBM).Methods CDKN2A gene mRNA data were obtained from three different GBM database online (TCGA,REMBARNDT and GSE16011).The correlations between overall survival (OS) and CDKN2A expression were analyzed by Kaplan-Meier method and multivariate Cox regression analysis.Results In the TCGA database (n =358),patients with high CDKN2A mRNA level got longer OS than those with low expression level [median OS:18.0 months (95 ％ CI 15.0-21.0 months) vs 13.9 months (95 ％ CI 12.4-15.4 months),P =0.001].In another two validation datasets,patients with high CDKN2A mRNA level had longer OS than those with low expression level [median OS in REMBRANT:16.6 months (95 ％ CI 13.3-19.8 months) vs 11.8 months (95 ％ CI 7.3-16.4 months),P =0.019; in GSE16011:11.9 months (95 ％ CI 8.3-15.6 months) vs 8.4 months (95 ％ CI 6.2-10.5 months),P =0.005].CDKN2A mRNA level was an independent prognostic factor for GBM.The combination of CDKN2A mRNA expression with MGMT promoter methylation status or G-CIMP status/IDH1 mutations provided an optimized prognostic factor in GBM patients.Conclusion The CDKN2A mRNA has prognostic value in GBM patients,which provided an optimized stratification strategy based on multiple biomarkers.

Objective To observe the effect of brain-derived microvesicles (BDMVs) on cytoskeleton in human umbilical vein endothelial cells (HUVECs).Methods BDMVs were prepared in vitro and identified by transmission electron microscopy and particle size identification.HUVECs were co-cultured with PKH26-1abeled BDMVs for 0.5,1,and 2 h;flow cytometry was used to detect the phagocytosis of HUVECs for BDMVs at different time points.HUVECs cultured in vitro were divided into control group,BDMVs treatment group and nimodipine treatment group;cells in the BDMVs treatment group were given 1.5× 107/mL BDMVs;cells in the nimodipine treatment group were pretreated with 2 μg nimodipine (0.2 mg/mL) for 10 min,and then,given 1.5×107/mL BDMVs.After being stained with rhodamine-labeled phalloidin,the fluorescence intensity and number of stress fibers of fibroactin in HUVECs were observed by laser confocal microscopy.Results BDMVs had complete membrane structure with a diameter of 100-1000 nm under transmission electron microscopy.The proportion of cells phagocytizing BDMVs increased significantly with prolonged incubation time,enjoying significant differences (0.5h:22.7％±1.2％;1 h:52.3％±1.3％;2h:71.6％±1.9％,P＜0.05).Laser confocal microscopy showed that,as compared with the control group,the fluorescence intensity ofcytoskeletal protein was obviously increased and the number of stress fibers increased was obviously larger in the BDMVs treatment group.As compared with those in the BDMVs treatment group,the fluorescence intensity of cytoskeletal protein was decreased and the number of stress fibers was obviously smaller in the nimodipine group.Conclusion The role of BDMVs in phagocytosis of HUVECs becomes stronger as time being prolonged,and BDMVs phagocytosis leads to cytoskeletal remodeling,which can be partially blocked by nimodipine.

Objective:To investigate the epidemiological characteristics of infant dyschezia in Xi′an city based on the Rome Ⅳ Criteria for Functional Gastrointestinal Disorders in Infants/Toddlers, and to analyze the related risk factors so as to provide epidemiological basis for clinical diagnosis and treatment.Methods:It was a cross-sectional survey conducted in the child health department of community health service center or hospital in Xi′an from October 2020 to October 2021 using the multi-stage cluster random sampling method.Infants aged 0-12 months were enrolled and their caregivers were interviewed by face-to-face electronic questionnaire.The prevalence and influencing factors of defecation difficulty in infants aged 0-9 months were analyzed according to the Rome Ⅳ Criteria for Functional Gastrointestinal Disorders in Infants/Toddlers.The prevalence of dyschezia in infants aged over 9 months was explored as well.The counting data were compared by Chi- square test.Univariable and multivariate Logistic regression analysis were performed to identify risk factors for dyschezia. Results:A total of 1 446 infants were collected, including 735 boys (50.8%) and 711 girls (49.2%), with an average age of (5.94±3.27) months.The prevalence of dyschezia aged 0-9 months in Xi′an was 3.46% (42/1 215), which gradually decreased with the increased age.Infants with dyschezia could defecate 2-3 times a day, or once a few days.Family history of defecation disorders ( OR=3.785, 95% CI: 1.912-7.494) was the risk factor for infant dyschezia, while complementary food ( OR=0.193, 95% CI: 0.075-0.495) was the protective factor for infant dyschezia ( P<0.05). Breastfeeding ( OR=8.126, 95% CI: 2.258-29.236) was the risk factor for dyschezia in infants who defecated less frequently ( P<0.05). Only 2 cases of 10-month-old infants had defecation-like symptoms, manifested as crying for a long time before defecation. Conclusions:The prevalence of dyschezia in infants aged 0-9 months in Xi′an is 3.46%.Dyschezia infants may also have a lower frequency of defecation.Timely addition of complementary food is beneficial to alleviate infant dyschezia, while infant who defecated less frequently are more likely to have dyschezia while breastfeeding.

Objective: To explore the effects of anteriolateral thigh perforator flap and fascia lata transplantation in combination with computed tomography angiography (CTA) on repair of electrical burn wounds of head with skull exposure and necrosis. Methods: Seven patients with head electrical burns accompanied by skull exposure and necrosis were admitted to our burn center from March 2016 to December 2017. Head CTA was performed before the operation. The diameters of the facial artery and vein or the superficial temporal artery and vein were measured, and their locations were marked on the body surface. Preoperative CTA for flap donor sites in lower extremities were also performed to track the descending branch of the lateral circumflex femoral artery with the similar diameter as the recipient vessels on the head, and their locations were marked on the body surface. Routine wound debridement and skull drilling were performed successively. The size of the wounds after debridement ranged from 12 cm×8 cm to 20 cm×12 cm, and the areas of skull exposure ranged from 8 cm×6 cm to 15 cm×10 cm. Anteriolateral thigh perforator flaps with areas from 13 cm×9 cm to 21 cm×13 cm containing 5-10 cm long vascular pedicles were designed and dissected accordingly. The fascia lata under the flap with area from 5 cm×2 cm to 10 cm×3 cm was dissected according to the length of vascular pedicle. The fascia lata was transplanted to cover the exposed skull, and the anteriolateral thigh perforator flap was transplanted afterwards. The descending branch of the lateral circumflex femoral artery and its accompanying vein of the flap were anastomosed with superficial temporal artery and vein or facial artery and vein before the suture of flap. The flap donor sites were covered by intermediate split-thickness skin graft collected from contralateral thigh or abdomen. Results: The descending branch of the lateral circumflex femoral artery and its accompanying vein were anastomosed with superficial temporal artery and vein in six patients, while those with facial artery and vein in one patient. All the flaps survived after the operation, and no vascular crisis was observed. Wound healing was satisfactory. One patient was lost to follow up. Six patients were followed up for 6 to 10 months. The patients were bald in the head operation area with acceptable appearance. No psychiatric symptom such as headache or epileptic seizure was reported. The flap donor sites were normal in appearance. The muscle strength of the lower extremities all reached grade V. The sensation and movement of the lower extremities were normal. Conclusions Anterolateral thigh perforator flap with fascia lata transplantation can effectively repair electrical burn wounds of head with skull exposure and necrosis. The fascia lata can be used to protect the vascular pedicle of flaps, which is beneficial to the survival of the flap. Preoperative head and lower extremities CTA can provide reference for intraoperative vascular exploration in donor site and recipient area, so as to shorten operation time.

Objective To explore the clinical application and effect of induced membrane technique com-bined with anteriolateral thigh(ALT)flap transfer for repair of complex tissue defect of the lower extremity. Methods From June,2011 to June,2014,induced membrane technique combined with ALT flap transfer were applied to repair complex tissue defect of the lower extremity in 12 cases. Of the 12 cases, there were 11 males and one female(their ages ranged from 18 to 45 years, 35 years on average). One caused by road accident,4 cases were caused by crush injury, 7 cases were caused by squeeze injury. First stage, the soft tissue defect were repaired by ALT flap transfer, the bone defect were filled with antibiotic cement after debridement and fixed with external or internal fixation. The area of the ALT flap ranged from 9.0 cm×15.0 cm to 15.0 cm×20.0 cm. The length of bone defect ranged from 3.0 cm to 14.0 cm,one of them was muscucaneous flap. Second stage,bone defect were filled with cancellous bone following cement removal in 6 to 12 weeks,8 weeks on average. Results All cases were successfully repaired. Twelve cases were followed up. A mean follow-up was 20 months. All flaps survived,11 cases were healed in first stage. One case were healed in second stage,healing time ranged from 12 to 18 days; bone healing time ranged from 6 to 9 months, 7 months on average. The functions of supplied regions were not found malfunctional. Conclusion Induced membrane technique combined with anteriolateral thigh flap transfer reduce patient treatment time,improve the ability of resis-tance to infection of bone transfer,is an optimal method to repair the complex tissue defect of the lower extremity.