ObjectiveTo summarize the clinical significance of ultrasonic screening of fetal structural anomalies at 11-13+6 weeks.Methods We conducted a retrospective study of 4853 cases of nuchal translucency screening at 11-13+6 weeks in Maternal and Child Health Hospital of Bao?an of Shenzhen City from September 2011 to May 2014. The screening ultrasound planes included the median sagittal plane, neck sagittal section, cerebral transverse section, cardiac four-chamber view, three-vessel-trachea view, abdominal transverse section, bladder section, upper limb section and lower limb section of the fetuses. All the cases then underwent the ultrasonic structural screening in the second trimester (20-24 weeks) and the third (28-32 weeks) trimester and were followed up until 6 weeks after birth or the biopsy after abortion.Results Eighty-ifve fetal structural anomalies were detected among the 4853 pregnant women at 11-13+6 weeks of gestation with the detection rate of 1.75% (85/4853), including central nervous system abnormalities (28 cases), anterior abdominal wall anomalies (9 cases), cardiac anomalies (6 cases), urinary system malformation (3 cases), skeletal system malformation (2 cases), multilocular cystic tumor and dropsy embryo (35 cases), and abnormal twins (2 cases). Among above abnormal fetuses, 6 cases showed normal structure in the screening after 14 weeks and were born without malformations, while the rest 79 cases were taken artiifcial abortion (73 cases in the ifrst trimester and 6 cases in the second trimester). Only 9 cases were taken chorionic puncture or amniocentesis, including normal karyotypes (3 cases), 47, XN, +18 (3 cases) and 45, X (3 cases). The False negative rate in the ifrst trimester was 23% (25/110). Supplementary detection of fetal structural abnormalities in the second and third trimester were found in 22 cases (20%, 22/110). Two cases of VSD and 1 case of microtia were identiifed after birth.ConclusionsThe fetal malformation can be detected in the earlier gestation with the ultrasonic screening at 11-13+6 weeks, which provide the earlier termination to the abnormal fetus. It has important clinical signiifcance in effectively reducing fetal births with structural abnormalities.

Abstract?AIM: To compare the changes in epithelial thickness profile following TransPRK and Epi-LASIK for myopia.? METHODS: In this prospective non -randomized controlled study, 76 right eyes of 76 myopic patients with the spherical equivalent refraction -1.25 to -6.00D were included under the informed consent. The eyes were divided into TransPRK group for 43 eyes and Epi-LASIK group for 33 eyes. Epithelial thickness was measured using spectral-domain optical coherence tomography at different corneal zones ( central, 2mm; paracentral, 2-5mm;and mid-peripheral, 5-6mm) preoperatively and at 1, 3, and 6mo postoperatively. The results were compared between the two groups.?RESULTS: The epithelium were thicker at 3 and 6mo after surgery compared to preoperative measurements in the two groups (all P<0.05).In TransPRK group, the epithelial thickness at 3 and 6mo demonstrated a negative meniscus-like lenticular pattern with lesser thickening centrally and progressively great thickening centrifugally (F3mo =-2.687,P=0.027;F6mo =-2.908,P=0.000).No statistically significant change was detected among the three zones in Epi-LASIK group (F=1.365, P=0.237). The epithelial thickness was thicker in the TransPRK group compared to the Epi-LASIK group mid-peripherally ( P<0.05) .? CONCLUSION: Significant epithelial thickening was observed after TransPRK and Epi-LASIK.It was showed a lenticular change with more thickening mid-peripherally after TransPRK than Epi -LASIK. Wound healing and inflammation may account for differences in the effect on epithelial thickness change by both surgeries.

Objective To retrospectively analyze the effect of corticosteroids therapy for inflammatory bowel disease (IBD) at 1-month and 1-year. Methods Those who was diagnosed as Crohn's disease (CD, n=55) or ulcerative colitis (UC, n= 154) from 1998 to 2006 were investigated. The effect of corticosteroids was evaluated after one month and 1-year. The prognostic factors were calculated using Logistic regression analysis. Results The patients who received eortieosteroids therapy were 21 (38.2%) with CD and 20 (13.0%) with UC (2 cases withdrawn). In one month followe-up, the complete and partial remissions were found in 15 (71.4%) and 3 (14.3%) patients with CD, respectively, while there were 15 (83.3%) and 3 (16.7%) in patients UC, respectively. Only 3 (14.3%) patients with CD was no response. In one year follow up, 11 out of 21 (52.4%) patients with CD had prolonged response to corticosteroids, 6 (28.6%) were corticosteroid dependence, and 4 (19%) required surgery; whereas 11 out of 18 (61.1%) patients with UC had prolonged response, 3 (16.7%) were corticosteroid dependence, and 4 (22.2%) required surgery. Logistic regression analysis showed that serum albumin level was associated with efficacy of corticosteroids after one year (P= 0.027, OR: 1.320,95% CI: 1.032~1. 690). Conclusion The IBD patients who has response to initiating corticosteroids therapy will get shor-term remission. Its prognosis is related with serum albumin level.

Animals ; Hepatocyte Growth Factor ; metabolism ; Humans ; Proto-Oncogene Proteins c-met ; Serine Endopeptidases

Objective: To study the influence of preoperative transcatheter arterial chemoembolization (TACE) by selection on survival rate of resectable hepatocellular carcinoma (HCC) patients. Methods: Jan. 1996 to Jan. 1997, TACE was performed before surgery in 62 of 126 patients undergoing resection and the other 64 patients without TACE from. Results were retrospectively analyzed with regard to the changes of pathological examination after operation, recurrence rate and survival rate 1, 2, 3 years after operation. Results: Pathological examination showed that there were 13 total necrosis in TACE group, but no one in contrast group. There were no significant difference of recurrence rate 1, 3 years after operation between 2 groups. Recurrence rate 2 years after operation was 29.8% in TACE group, but 58.3% in contrast group. There were significant difference of recurrence rate 2 years after operation between 2 groups (P<0.05). Survival rate 3 years after operation was 54.4% in TACE group, but 33.3% in contrast group. Survival rate of TACE group was higher than that of contrast group (P<0.05). There were not significant difference of recurrence rate 1, 2 years after operation between 2 groups. Conclusion: Proper preoperative TACE for resectable HCC can improve the outcome of the operation to some extent.

BACKGROUNDIn recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services.

METHODSThis study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination.

RESULTSWe found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups.

CONCLUSIONSWe argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures.

Aged ; Diabetes Mellitus, Type 2 ; economics ; Female ; Health Expenditures ; standards ; Humans ; Insurance, Health, Reimbursement ; Male ; Middle Aged ; Outpatients

OBJECTIVETo explore Chinese medical syndrome distribution features of Japanese encephalitis (JE), and to analyze its correlation between syndromes and features of etiologies and pathogeneses.

METHODSRecruited were 277 patients with confirmative diagnosis of JE from Wuhan Medical Treatment Center, Children's Hospital Affiliated to Chongqing Medical University, Fifth People's Hospital of Guiyang City, Hangzhou Sixth People's Hospital, and Chengdu Hospital of Infectious Diseases between July to September 2012. Chinese medical syndrome distribution features were summarized from their general materials and detailed records of clinical data, including medical history, symptoms and signs, tongue fur, and pulse figures.The frequency of symptoms and signs was calculated according to mild, ordinary, severe, extreme severe degrees. The distribution of Chinese medical syndromes was summarized. And its correlation between syndromes and features of etiologies and pathogeneses were analyzed.

RESULTSAfter clustering analysis, Chinese medical syndromes of JE could be categorized as four groups: toxicity accumulation in Fei and Wei syndrome (TAFWS), brain collateral impaired by poison syndrome (BCIPS), depression of toxicity in the pericardium syndrome (DTPS), exhaustion of yin and yang syndrome (EYYS). BCIPS and DTPS were dominated, accounting for 74.0% (205 cases). The main causes covered evil of summer heat [accounting for 92.42% (256/277 cases)], heat [accounting for 87.73% (243/277 cases)], and toxin [accounting for 99.64% (276/277 cases)].

CONCLUSIONSThe four Chinese medical syndrome types of JE met Chinese medical clinical features of encephalitis. It is induced by infestation of dampness-heat, resulting in toxicity accumulation in Fei and Wei, brain collateral impaired by poison, depression of toxicity in the pericardium. Yin fluid and blood is exhausted as time goes by. Qi and yin are impaired to form intermingled deficiency and excess, and finally causing exhaustion of yin and yang.

Adolescent ; Child ; Child, Preschool ; Encephalitis, Japanese ; diagnosis ; pathology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Medicine, Chinese Traditional ; methods ; Yang Deficiency ; diagnosis ; Yin Deficiency ; diagnosis

OBJECTIVETo describe the incidence and mortality rates of esophageal cancer from 1974-2002 in Cixian county of Hebei province. Basic information on comparative geographical, epidemiological, and clinical research was collected.

METHODSIn early 1970s, cancer registry system in Cixian was established, collecting information on all the esophageal cancer cases in Cixian. Data was checked manually, then computerized, coded and analyzed using the software--SPSS 11.5.

RESULTSFrom 1974 to 2002, there were 18 471 esophageal cancer cases in Cixian, with 11 068 males and 7403 females, respectively. The age standardized incidence rate (ASR) for males was 208.77 per 100,000, while 120.47 per 100,000 for females. The trend of incidence rate of esophageal cancer had decreased during the 29 years from 1974 to 2002 (trend chi(2) = 19.94, P < 0.001). From 25 years of age onward, the incidence rates of the lower age groups declined with the increase of age. As for geographic distribution, the incidence rate in mountainous areas and hilly areas showed a significant declining trend in mountainous areas, chi(2) = 195.00, P < 0.001; hilly areas, chi(2) = 46.08, P < 0.001. The esophageal cancer incidence in plain areas remained steady, but had a slight increase in recent years. From 1969 to 2002, there were 18,736 cases died of esophageal cancer with 11 598 males and 7138 females. The ASR for male was 127.17 per 100,000 and 101.57 per 100,000 for female. Compared with the year 1969, the mortality rate of esophageal cancer in 2002 had a 37.96% decline. The proportion of esophageal cancer among malignant tumors in different decades decreased significantly.

CONCLUSIONThe trend of the incidence rate of esophageal cancer had been decreasing for the last 29 years. The incidence rate in mountainous areas and hilly areas showed a declining trend while in the plain areas it remained steady but having slight increase in the recent years. The mortality rate of esophageal cancer had a significant decrease from 1969 to 2002.

Adult ; Age Factors ; China ; epidemiology ; Esophageal Neoplasms ; epidemiology ; mortality ; Female ; Humans ; Incidence ; Male ; Registries ; Software

OBJECTIVETo investigate the distribution and expression of corticotropin releasing factor (CRF) in spinal cord, hypothalamus and third ventricle of cerebrum, of the hypersensitive viscera rats, and to research on the mechanism of CRF in the hypersensitive vicera signal conduction pathway in IBS (irritable bowel syndrome) and to investigate possible active mechanisms of tongxie prescription on IBS.

METHODForty SD rats were divided randomly into three groups. The rats of model No. 1 were sensitized by injecting egg albumin into abdominal cavity. The rats of model No. 2 were sensitised by conditional stimulus and unconditional stimulus. The two model groups were both divided randomly into two groups. The five groups were given intragastric administration with Tongxie prescription or normal saline for four weeks. Then quantitative analysis of CRF in the lumbosacral spinal cord and brain of rats were achieved by immunohistochemical method and computerized image system.

RESULTThe sensitivity of the groups being treated with tongxie prescription were much lower than the model groups (P < 0.01). The immunohistochemical method showed that CRF was expressed in the lumbar intumescentia of spinal cord, hypothalamus and the diaphragmatic surface of third ventricle of cerebrum. The CRF positive index of the model groups was higher than that of the blank group (P < 0.01). The CRF positive index of the healing groups was lower than that of the model groups (P < 0.01). The CRF positive index of the healing groups was higher than that of the blank group (P < 0.01).

CONCLUSIONThe two model rats evoked by two different stimulation both appeared visceral hypersensitivity state. CRF is related to stress. The increase of CRF expression in the lumbar intumescentia of spinal cord, hypothalamus and the diaphragmatic surface of third ventricle of cerebrum showed that CRF is critical to the introduce of stimulus signal of vicera. Tongxie prescription can significantly decrease CRF expression. This is one mechanism to decrease sensitivity of hypersensitive viscera rats.

Animals ; Brain ; drug effects ; metabolism ; Cerebral Ventricles ; drug effects ; metabolism ; Corticotropin-Releasing Hormone ; genetics ; metabolism ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; Gene Expression ; drug effects ; Humans ; Irritable Bowel Syndrome ; drug therapy ; genetics ; metabolism ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; drug effects ; Spinal Cord ; drug effects ; metabolism

OBJECTIVETo investigate the role of activated hepatocyte growth factor (HGF) in apoptosis of hepatic stellate cells (HSCs) and in modulating the Rho signaling pathway.

METHODSHSCs were divided into the following groups: blank control, consisting of HSCs without treatment; two treatment controls, consisting of HSCs exposed to exogenous HGF at 50 ng/ml and HSCs exposed to exogenous HGF activator (HGFA) at 70 ng/ml; three experimental groups, consisting of HSCs exposed to both exogenous HGF and HGFA, HSCs pre-incubated with the HGF inhibitor c-met at 500 ng/ml for 6 hours and then exposed to exogenous HGF and HGFA, and HSCs pre-incubated with the Rho pathway inhibitor Y-27632 at 10 ng/ml and then exposed to exogenous HGF and HGFA. Activation status of the cultured HSCs was determined by change in expression of alpha-smooth muscle actin (SMA). The optimal intervention concentration of Y-27632 was determined by MTT assay. The apoptotic status of HSCs was determined by flow cytometry. Expression of the HGF-alpha chain was detected by immunofluorescence. The expression of RhoA was evaluated by PCR (for mRNA) and by immunohistochemical staining and Western blot analysis (for protein).

RESULTSExposure to 10 mumol/L Y-27632 led to obvious growth inhibition of HGF + HGFA-induced HSCs, compared with the other concentrations tested (P less than 0.05). HGF + HGFA induced the expression of the HGF-alpha chain in a time-dependent manner (P less than 0.01); however, the increases in expression of HGF-alpha chain induced by HGF alone and HGFA alone were not significantly different from the level in the blank controls (P more than 0.05). Exposure to HGF alone and HGFA alone led to a time-dependent increase in apoptosis (24 h, 48 h, 72 h) but exposure to HGF + HGFA led to the highest levels of apoptosis (P less than 0.05). Exposure to HGF + HGFA led to a time-dependent decrease in RhoA mRNA and protein expression (P less than 0.01).

CONCLUSIONActivation of hepatocyte growth factor promotes apoptosis of hepatic stellate cells by suppressing RhoA expression and down-regulating the Rho signaling pathway.