ABSTRACT:Objective To evaluate the clinical therapeutic effect and safety of tumor necrosis factor alpha (TNF-α)blockers in treating moderately to severely active ulcerative colitis (UC)by meta-analysis.Methods Such databases as the Cochrane Central Register of Controlled Trials,PubMed,OVID,Embase,ISI,CBM,CNKI, VIP,and WanFang Data were searched from establishment to June 2013.All randomized clinical trials (RCTs)on tumor necrosis factor alpha blockers in treating UC were collected,and then selected on the basis of the inclusion and exclusion criteria.We assessed the methodological quality,extracted the data from the included articles and performed the meta-analysis with Revman 5.1.Results A total of 13 RCTs involving 3334 patients were analyzed.TNF-αblockers group was superior to the control group in the short-term clinical response (OR =2.5 1, 95% CI 1.73,3.64),short-term clinical remission (OR =2.74,95% CI 1.80,4.1 6),long-term clinical response (OR =2.98,95% CI 1.98,4.47),1ong-term clinical remission (OR =2.64,95% CI 1.89,3.67),and mucosal healing (OR =1.89,95% CI 1.39,2.59)compared with control group.TNF-αblockers could also reduce the rate of colectomy (OR =0.61,95% CI 0.41,0.89)and improve inflammatory bowel disease questionnaire scores (MD=14.74,95% CI 1 1.43,18.06 ).There was no significant difference between the two groups in all reported adverse effects (OR =1.14,95% CI 0.97,1.34)and serious adverse effects (OR=0.78,95% CI 0.56,1.09).Conclusion Compared with conventional therapy or placebo,TNF-αblocking agents can improve the therapeutics effect on UC in clinical response,clinical remission and mucosal healing,and also can reduce the rate of colectomy. In patients with moderately to severely active UC treated with TNF-α blocking agents,it is easier to achieve the improvement of life quality.TNF-αblocking agents treatment is safe for UC.This conclusion should be verified with more large-scale and high-quality RCTs.

In our gastroenterology clinic from Jun. 2008 to Jan. 2009, 20. 9% (277/1320) patients were diagnosed with functional dyspepsia (FD) and 14. 8% (41/277) of them with psychological problems according to Minnesota Multiphasic Personality Inventory (MMPI). In those with psychological disorders,92.7% were found with somatization, 60. 9% with depression and anxiety, 97.6% with abdominal pain,75.6% with bloating, 63.4% with early fullness and 36. 6% with nausea. More than 80% patients with anxiety and depression complained irritability, worry, fatigue, poor concentration, memory loss and insomni.a. After 4 weeks of psychological consultation and anti-depression treatment, 5 patients had significant improvement, 31 had improvement and 3 had no response. The overall response rate was 87. 8%.In summary,there is a high prevalence of depression and anxiety in population with FD. Hypochondria and somatization are common among these patients. Psychological consultation with anxiolytic drugs may have good therapeutic effects.

Objective To investigate the rates of depression and its risk factors in elderly hypertensive patients and healthy residents in Fuzhou.Methods 882 elderly primary hypertensive patients aged 60 years and over and 1230 healthy elderly residents were assessed by the geriatric depression scale (GDS) and a self-made general information questionnaire, and SPSS 16.0 was used to analyze data.Results The average score of depression and the incidence of depression were higher in elderly hypertensive patients than in healthy elderly residents [(12.43±5.01) vs.(11.53±5.13), 64.4％ vs.55.3％, t=-3.849, x2=16.386, P＜0.01].Compared with healthy controls, scores of depression were higher for all age groups in elderly married male patients, with low levels of education (junior middle school or below), a monthly income less than 2000 yuan, and partial or no medical insurance coverage (P＜ 0.05 for all).Scores of depression were higher in elderly hypertensive patients who had smoking or drinking habits, social activity, hobby, or physical exercise than in healthy controls, (P＜0.05 for all).Scores of depression were also higher in elderly hypertensive patients who had family support, barely enough or adequate family expenses or family support than in healthy controls, regardless of living conditions (P＜0.05 for all).Multiple stepwise regression analysis showed that risk factors for depression in elderly hypertensive patients were family support, age, medical insurance coverage, family expenses, living conditions, hobbies, and gender, while risk factors for depression in healthy elderly residents were family support, interests, medical insurance coverage, and age.Conclusions The incidence of depression is higher in elderly hypertensive patients than in health elderly people in communityin Fuzhou.Family support, hobbies, medical insurance coverage and age are the common risk factors for depression in both elderly hypertensive patients and healthy residents.Family expenses, living conditions and gender are important risk factors for depression in elderly hypertensive patients.

Objective To investigate the quality of life (QOL) in elderly patients with chronic diseases living at home and its influencing factors.Methods 1856 elderly patients with chronic diseases living at home were selected by random cluster sampling from two communities.All patients were investigated by SF-36 questionnaire and self-made questionnaire.Results The average QOL scores were (63.8±15.1) in elderly patients with chronic diseases living at home.Scores of SF-36's eight dimensions were respectively (67.8± 22.6) in physiological function,(47.3± 39.4) in role physical,(90.2±14.3) in bodily pain,(52.3±11.9) in general health,(64.1 ± 17.1) in vitality,(74.0 ± 20.9) in social function,(49.7 ± 39.5) in emotional function,(65.0 ± 16.9) in mental health.Scores of SF-36 in each dimension were lower in patients aged 75 years and above than in patients aged 60-74 years (all P＜0.05).Scores of SF-36's dimensions including physical function,bodily pain,vitality,social function and mental health in patients aged 75 years and above were lower in males than females (all P＜0.05).Multiple stepwise regression analysis showed that the major influencing factors for the QOL in elderly patients with chronic diseases living at home were movement,hobbies,age,caregivcr,family support,number of chronic diseases,education status,and alcohol consumption (all P＜0.05).Conclusions The major influencing factors for quality of life in elderly patients with chronic diseases living at home are included demographic,behavior and family factors,etc.Comprehensive community interventions should be taken to improve the quality of life in this elderly population.

Lymphoma is a malignancy of mature lymphocytes. Signalling through the B cell receptor ( BCR ) is central to the development and maintenance of B cells. In light of the numer-ous proliferative and survival pathways activated downstream of the BCR, it comes as no surprise that malignant B cells would co-opt this receptor to promote their own growth and survival. Compounds that inhibit various components of this pathway, in-cluding spleen tyrosine kinase(Syk), Bruton’s tyrosine kinase (Btk), and phosphoinositol-3 kinase(PI3K), have been devel-oped. In this paper,the B-cell receptor signaling and its targeted inhibitors of lymphoid malignancies are reviewed.

Objective To find out the health status and community health care requirement of the elderly in urban Fuzhou and to provide suggestions on how to develop and consummate the community health care for elderly. Methods With the method of stratified random sampling, 3285 elderly people aged 60 years and over were surveyed by a questionnaire. Results The average quality of life of elderly people in urban Fuzhou was above the moderate level. But education level of the elderly was low. And the prevalence rate of chronic diseases was high. There were 2134 elderly people (65.0%) who had more than one chronic disease. The older the people, the higher proportion the coincidence of multiple diseases (P＜0.01). The first five chronic diseases in the elderly were hypertension, diabetes, coronary heart disease, arthropathy and stroke. The incidence rate of depression was high up to 60%. The requirement rate of community health care was 75.2%, and the older the people, the more items they needed(P＜0.05). The requirement of community health care at the first 5 rank position were regular physical examination, health education, regular home visiting, health direction and diet direction. Conclusions Elderly people have many health problems and requirements of community health care.We should provide more and more community health care, in order to improve the quality of life of elderly people.

ObjectiveTo investigate the status of depression and its relationship with quality of life in Fuzhou city community Methods With stratified random sampling method,3285 elderly people (age≥ 60 years) in 12 communities of Fuzhou city were investigated by SF-36 health survey questionnaire and Geriatric Depression Scale (GDS)Results The number of the elderly with depression was 1981 ( 60.3％).The incidence of depression in the female elderly was statistically higher than male(x2 =7.561,P＜0.01).The incidence of depression increased with age(P＜0.01),and declined with higher education ( P ＜ 0.01 ) and income ( P ＜ 0.05).The higher incidence of depression appeared in the elderly with no spouse,paying for medical expenses themselves,living alone(all P＜0.01).The scores of physiological functions (PF),physiological role (RP),body pain (BP),general health (GH),vigor (VT),social function (SF),emotional role (RE),mental health (MH) and quality of life in the elderly without depression (78.0± 19.2,62.7 ± 39.7,94.1 ± 12.3,57.9± 12.0,74.3 ± 14.9,83.0 ± 20.1,64.3 ± 39.1,73.8 ± 14.8,and 73.5 ± 13.6,respectively) were higher than in the elderly with depression (65.9±22.6,45.3±37.8,89.5±15.2,50.8±11.4,59.8 ± 15.9,70.5± 20.9,44.7 ± 37.8,60.6 ± 15.6 and 60.9 ± 14.0,respectively) (P＜0.01 ).All scores had significant differences among different levels of depression (P＜ 0.01 )and the dimension scores decreasedwithserious depression.Depression was negatively correlated with various dimensions of quality of life and total score(P＜0.01).ConclusionsThe incidence of depression of the elderly in Fuzhou city is high.There are negative correlations of depression with quality of life scores and total score of various dimensions.The community nursing service should emphasize on the elderly who are female,advanced age,no spouse,poor-education,low-income,no medical insurance and live alone,then take appropriate measures to reduce depression and improve quality of life of the elderly.

Objective To study the risk factors of lymph node metastasis in the central neck compartment of thyroid carcinoma,and to explore the reasonable range of lymph node dissection in central neck dissection for clinically node-negative papillary thyroid microcarcinoma patients.Methods From Dec.2015 to Dec.2016,a total of 200 patients with CN0 papillary thyroid carcinoma were randomly divided into two groups according to the registration number:unilateral central neck dissection group and bilateral central neck dissection group in Department of Thyroid Surgery,Fujian Medical University Union Hospital.The risk factors of lymph node metastasis and value of bilateral central neck dissection were analyzed.Results The risk factors of lymph node metastasis in the central papillary thyroid carcinoma were ≥0.7 cm in diameter and older than 45 years in age and gender in male.Further analysis found that contralateral central lymph node metastasis occurred in patients with tumor diameter ≥0.5 cm.The positive rate was 22％.The number of lymph nodes detected in the unilateral and bilateral central areas was 9.53±6.04 and 12.19±7.18,P=0.035,respectively.The positive numbers of lymph nodes were 1.17±1.47 and 2.11±2.75,P=0,022 respectively.Conclusion In patients with tumor diameter ≥0.5 cm,bilateral central neck dissection is conducive to improving the thoroughness of tumor dissection and does not increase the risk of complications.

Objective To explore the expression and significance of neutrophil gelatinase-associated lipocalin (NGAL) in lupus nephritis (LN) in mice. Methods Female MRL/lpr lupus mice (n=36) were randomly divided into the experimental group and intervention group, and female Kunming mice (n =18) served as controls. Each mice in the intervention group received intraperitoneal injection of 20 μg anti-mice interleukin (IL)-17 antibody. The serum concentrations of NGAL, IL-17,matrix metalloproteinase(MMP)-9 and tissue inhibitor of metalloproteinase (TIMP)-1 were measured by enzyme-linked immunosorbent assay (ELISA). And the protein expressions of NGAL, IL-17, MMP-9 and TIMP-1 in renal tissue were detected by immunohistochemisty. One-factor analysis of variance (ANOVA) or nonparametric rank sum test was used for the comparisons between the three groups. Associations between these factors were analyzed by Pearson′s test. Results The levels of serum NGAL, IL-17, MMP-9 and TIMP-1 in the experimental group were obviously increased as compared to those in the control group and intervention group [NGAL: (30.31±1.22) ng/ml vs (11.36±0.14) ng/ml, (20.09±0.35) ng/ml, F=986.524, P<0.001]. The protein expression of NGAL, IL-17, MMP-9 and TIMP-1 in the renal tubular epithelial cells in the experimental group was increased as compared to the control group and intervention group[NGAL:(11.27±0.58) vs(0.45±0.19),(9.22±0.67), H=15.158, P =0.001]. In the experimental group, a positive correlation was found between the level of serum NGAL
and the serum levels of IL-17, MMP-9 and MMP-9/TIMP-1(r=0.899, 0.789, 0.925, P<0.01). The protein expression of NGAL in renal tissue was positively correlated with IL-17, MMP-9 and MMP-9/TIMP-1 levels (r=0.929, 0.899, 0.723, P<0.01). Conclusion The level of NGAL in the serum and renal tissue is signifi-cantly increased in the MRL/lpr lupus mice. And it is closely correlated with the levels of IL-17 and MMP-9. Our results suggest the potential role of NGAL in the inflammation of lupus nephritis.

[ ABSTRACT] AIM:To investigate the role of the Notch pathway in Toll-like receptor 4 ( TLR4 )-mediated in-flammatory response in renal ischemia reperfusion injury ( IRI) in rats.METHODS: A total of 75 male sprague-Dawley rats were randomly divided into sham operation group , IRI group and DAPT treatment group .Blood samples and the kid-neys were obtained at 6 h, 12 h, 24 h, 48 h and 72 h after reperfusion .The concentrations of blood urea nitrogen ( BUN) and serum creatinine (Scr) were measured.The serum levels of tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) were detected by ELISA, and the expression of Notch1, TLR4 and NF-κB p65 in the renal tissues was assessed by im-munohistochemistry and Western blot .RESULTS: The serum levels of BUN, Scr, TNF-αand IL-6 in IRI group were markedly increased as compared with sham group (P<0.05).The protein levels of Notch1, TLR4 and NF-κB p65 in re-nal tubular epithelial cells in IRI group was significantly enhanced as compared with sham group ( P<0.05 ) .In DAPT group, the serum levels of BUN, Scr, TNF-αand IL-6 were significantly reduced compared with IRI group (P<0.05), and the protein levels of Notch1, TLR4 and NF-κB p65 were apparently less than those in IRI group (P<0.05).CON-CLUSION:Significant changes of renal function , a rise of serum inflammatory factor including TNF-αand IL-6 and en-hanced expression of Notch 1, TLR4 and NF-κB p65 in the renal tissue occurred in the rats with IRI .γ-Secretase inhibitor DAPT attenuates TLR4-mediated inflammatory response in the renal IRI through the inhibition of Notch 1 and down-regula-tion of NF-κB.