Gastric cancer is one of the most common malignant tumors of digestive tract, and surgical excision is the only way to extend the lifetime of patients with gastric cancer. Malnutrition is a common complication after such surgery, which affects patients' rehabilitation greatly. Nutritional support is, therefore, crucial to patients with gastric cancer after surgery. Early oral feeding, as the most preferred way of nutritional support after surgery, can not only improve patients' nutritional state, but also keep intestinal mucosa intact and accelerate the recovery of their gastrointestinal function. Hence, this paper summarizes the characteristics and demands of nutrient metabolism, the time, type and feasibility of early oral feeding, the effect on gastrointestinal function as well as the effect on postoperative complications in patients with gastric cancer after surgical excision.

Objective To explore the impact of health management programs on hypertension related to their cost of the hypertensive,so as to provide evidence for related policy-making.Methods Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps.Information regarding hypertensive patients were collected through a questionnaire.Two-part model was used to analyze the influence from health management scheme.Results This study included 1 1 294 participants who were 35 years old or beyond,with 4 904 (43.42％) males and 6 390 (56.58％) females.The median cost from the outpatient was 100 (30-200) Yuan,and the cost of patients under management program were significantly lower than those without (P＜0.05).Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P＞0.05).Regarding the calculation on the outpatient cost,results showed that the patients under the management program were more likely to practice ‘outpatient-medical-behavior’ (OR=2.50,95％CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients.Hypertensive patients from the urban areas were more likely to adopt ‘medical behavior’ (OR=1.31,95％CI:1.18-1.45) which was 1.69 times of the costs from the rural patients.Results of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10,95％CI:1.01-1.20) and was 1.19 times the costs of the rural patients.Conclusion Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.

Objective To explore the ATPase activity and apoptotic-associated protein expression of chronic pressure ulcers patients with type 2 diabetes.Methods A total of 43 type 2 diabetes patients with pressure sores were chosen,among whom there were 21 cases with 111 pressure sores and 22 cases with Ⅳ pressure sores,the patients who may use ATPase in the last one month (digitalis,calcium antagonists,etc.).Another Other 20 healthy volunteers were chosen as control group.ATPase activity and apoptotic associated protein expression were detected.Results Compared with the control group,the ATPase activity in the stage Ⅲ pressure sore group was decreased,Bcl-2 expression was decreased,and the expression of Bax was increased;compared with the stage Ⅲ pressure ulcer group,the ATPase activity in the stage Ⅳ pressure sore group was more significantly reduced,Bcl-2 was significantly decreased and Bax expression was significant increased.Conclusion Type 2 diabetic chronic pressure ulcers might be relevant to the decreased ATPase activity and up regulated apostosis.

Objective To explore the ATPase activity and apoptotic-associated protein expression of chronic pressure ulcers patients with type 2 diabetes.Methods A total of 43 type 2 diabetes patients with pressure sores were chosen,among whom there were 21 cases with 111 pressure sores and 22 cases with Ⅳ pressure sores,the patients who may use ATPase in the last one month (digitalis,calcium antagonists,etc.).Another Other 20 healthy volunteers were chosen as control group.ATPase activity and apoptotic associated protein expression were detected.Results Compared with the control group,the ATPase activity in the stage Ⅲ pressure sore group was decreased,Bcl-2 expression was decreased,and the expression of Bax was increased;compared with the stage Ⅲ pressure ulcer group,the ATPase activity in the stage Ⅳ pressure sore group was more significantly reduced,Bcl-2 was significantly decreased and Bax expression was significant increased.Conclusion Type 2 diabetic chronic pressure ulcers might be relevant to the decreased ATPase activity and up regulated apostosis.

Objective: To investigate the prevalence of hypercholesterolemia among Chinese adults in different geographic areas, and to analyze the related factors. Methods: China Chronic and Non-Communicable Disease and Risk Factor Surveillance was conducted in 2013, based on 298 counties/districts in 31 provinces of Chinese mainland. The adults aged 18 years old were randomly selected using multi-stage stratified clustering sampling method. Information on chronic disease and risk factors was collected using face-to-face questionnaire interview and physical measurement. Blood samples were collected by local staffs. Serum total cholesterol (TC) was determined using standard method in a central laboratory. After excluding 565 participants missing key variables and 1 558 participants with abnormal TC values, a total of 174 976 participants were included. Weighted prevalence of hypercholesterolemia was calculated. Hypercholesterolemia related individual or geographic determinants were defined using multilevel logistic regression. Results: The prevalence of hypercholesterolemia in Chinese adults age 18 years old and above was 6.9% (95%CI: 6.4%-7.3%), ranged from 3.0% (95%CI: 2.5%-3.4%) in the northwest of China to 14.2% (95%CI: 12.9%-15.5%) in the south (χ²=183.42, P<0.001). The prevalence of hypercholesterolemia was higher in 6 provinces including Tianjin, Liaoning, Fujian, Guangdong, Guangxi, and Hainan (≥9.0%), but lower in 7 provinces including Shanxi, Shannxi, Gansu, Qinghai, Ningxia, Xinjiang, and Tibet (<3.9%). There was a 1.27 fold variation in hypercholesterolemia prevalence by provincial level, and 72.5% of the geographical variation in hypercholesterolemia prevalence was account for by area-level determinants. With multilevel logistic analysis, the individual risk factors associated with hypercholesterolemia included aging, higher education level or annual household income per capita, regular drinking, too much red meal intake, inactivity, overweight or obesity. For geographic factors, residents living at south China, counties/districts with higher urbanization rates, higher education level or lower standardized death rates were more likely to have hypercholesterolemia (all P<0.05). Conclusion The prevalence of hypercholesterolemia was high in Chinese adults, it was different between regions and related with characteristics of population, individual behaviors and geographical regions.

Objective: To investigate the geographical variation of prediabetes in adults in different regions of China, and to analyze the related factors of prediabetes. Methods: Data was obtained from China Chronic Disease and Related Risk Factor Surveillance in 2013. The surveillance adopted multiple-stage stratified cluster random sampling method, which sampled 177 099 residents aged above 18 years old among 298 surveillance points in 31 provinces of Chinese Mainland. Questionnaire interview was used to obtain demographic variables, personal living style, and socio-economical information. Physical examination was conducted and fasting venous blood sample and (oral glucose tolerance test-2 hours, OGTT-2 h) venous blood sample were obtained from the participants. A total of 171 567 residents aged 18 and above were included in the analysis. The prevalence of prediabetes was analyzed by provinces and by China's geographical regions, after complex weighting. Multilevel logistic models were established to explore the related factors of prediabetes on the area level and individual level. Results: The prevalence of prediabetes among residents aged 18 and above was 16.6% (95%CI: 15.6%-17.6%) in China. The prevalence of prediabetes was the highest (18.3%) in the south China and lowest (13.1%) in the northwest area. The difference of the prevalence in different areas were not statistically significant (P=0.510). If categorized the prevalence of prediabetes into 5 groups by quintile, Hainan, Jilin, Shandong, Anhui, Hunan and Chongqing were in the highest group of prevalence of prediabetes (18.6%-22.7%), and Tibet, Qinghai, Gansu, Ningxia, Guizhou, and Jiangxi were in the lowest group (7.6%-12.6%). The variance of prevalence of prediabetes on the county level (MOR: 1.60 (95%CI:1.53-1.67)) was more diverse than the province level (MOR: 1.21(95%CI:1.08-1.29)) and higher than the street level (1.23 (95%CI:1.14-1.30)). Several factors increased risk of pre-diabetes, including smoking, hazardous drinking and harmful drinking, drinking in the past 30 days, overweight, obesity, central obesity, sugary drink intake, hypertension, high total cholesterol, high triglycerides, high blood low-density lipoprotein cholesterol, low blood high-density lipoprotein cholesterol (all P<0.05). After adjusted the above variables, 92.5% of variance of prediabetes prevalence conld be explained on the provincial level. Conclusion The geographical distribution of prediabetes in adults in China differed by geographic areas, and it significantly varied on the county level. The related variables included demographic variables, personal behavior, and geographic related variables.

Objective: To evaluate the provincial representativeness of China Non-communicable and Chronic Disease Risk Factor Surveillance System, 2013. Methods: The Sixth National Population Census data which was collected by National Bureau of Statistics of People's Republic of China was used to calculate proportion of population who aged 65 and above, mortality rate, the proportion of non-agriculture population, the illiteracy rate and urbanization rate in order to evaluate the surveillance system in each province. The Mann-Whitney U test was used to determine the statistically differences between the surveillance system and corresponding general population. Results: Among the 298 disease surveillance points (DSPs) in China Non-communicable and Chronic Disease Risk Factor Surveillance System, there were 111, 85, and 102 DSPs located in the east, middle, and west area of China, which covering 13.90%, 11.48%, and 12.28% of the total population, respectively. The surveillance system covered 169 million of the population of China, accounting for 12.70% of Chinese population. The number of DSPs by provinces ranges from 6 (Hainan, Qinghai, and Ningxia) to 14 (Shandong, Guangdong and Henan). It indicated that mortality rate (DSP: 0.238%; Province: 0.482%) and the illiteracy rate (DSP: 15.54%; Province: 26.22%) among DSPs in Tibet were significantly lower than the provincial level, on the other hand, the proportion of non-agriculture population among DSPs (40.6%) was significantly higher than the provincial level (18.8%). The urbanization rate among Jiangxi DSPs (43.4%) was significantly lower than the provincial level (59.9%). The proportion of non-agriculture population among Shandong DSPs (32.8%) was significantly higher than the provincial level (24.2%), however, the illiteracy rate among Shandong DSPs (3.86%) was significantly lower than the provincial level (5.25%). Other than the provinces mentioned above, there was no statistical differences (P>0.05) among proportions of population who aged 65 and above, mortality rates, the proportions of non-agriculture population, the illiteracy rates and urbanization rate between provincial surveillance system and corresponding area. Conclusion Other than 3 provinces, in general, China Non-communicable and Chronic Disease Risk Factor Surveillance System had provincial representativeness.

Objective To investigate the prevalence and co-prevalence of tobacco use,excessive alcohol use,insufficient intake of vegetable and fruit,physical inactivity,and overweight or obesity in floating population and influencing factors in China,2012.Methods Data from the 2012 China Chronic Disease Risk Factor Survey in Floating Population in China were used.In this survey,48 704 people aged 18-59 years in floating population were selected through stratified multistage clustering sampling in 170 counties and districts from 31 province (autonomous regions and municipalities) and Xinjiang Production and Construction Corps.The gender specific prevalence and co-prevalence of five risk factors were estimated,and the rank sum test was used for result comparison.Results Among the people surveyed,27.4％ had one risk factor,37.1％ had two risk factors,28.5％ had ≥3 risk factors.The prevalence or co-prevalence of risk factors were positively correlated with age (P＜0.05),income level (P＜0.05) and migration time (P＜0.05),and negatively correlated with educational level (P＜0.05).People who were males,in Han ethnic group,engaged in construction and from other provinces were more likely to have more risk factors (P＜0.05).Conclusion The prevalence and co-prevalence of tobacco use,excessive alcohol use,insufficient intake of vegetable and fruit,physical inactivity and overweight or obesity were high in floating population in China,suggesting that it is necessary to strengthen the comprehensive behavior intervention in floating population.

Objective To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors.Methods The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project.The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project.By face-to-face questionnaire survey and health examination,the information of the subjects' demographic characteristics,risk factors,complications,involvement in community-based management of hypertension,anti-hypertension treatment,blood pressure,body height,waistline and body weight were collected.In this study,Rao-Scott x2 test was used to compare the variations among sub-groups.Taylor series linearization method was used to estimate the prevalence rate.The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension.Results A total of 5 120 subjects were recruited in the analysis.The proportion of those receiving management for more than two years was 36.57％,and it was higher in urban area (44.56％) than in nural area (31.79％,P＜0.05);In the past 12 months,6.17％ and 14.46％ of the patients received no blood pressure measurement and drug therapy advice respectively,but there were no significant differences between urban group and rural group (P＞0.05);In the past 12 months,the proportions of the patients receiving diet and physical activity advice were 84.25％ and 84.90％ respectively,and the proportions were higher in urban group than in rural group (P＜0.05);In the past 12 months,the proportions of the subjects receiving tobacco and alcohol use advice were 78.41％ and 77.80％ respectively,and the proportions were higher in rural group than in urban group (P＜0.05).In urban area,the subjects receiving standardized management had lower SBP (142.79 ± 17.39) mmHg,lower DBP (84.26 ± 9.49) mmHg and higher blood pressure control rate (49.77％) than those receiving no standardized management (P＜0.05);while in rural area,no difference was found in BP control between the patients receiving and receiving no standardized management (P＞0.05).In urban area,the influencing factors for BP control among the subjects receiving community based management were educational level,annual income,body weight,hypertension management mode,times of receiving BP measurement,times of receiving antihypertensive medicine advice and receiving physical activity advice;while in rural area,the influencing factors for BP control among the subjects receiving community based management were annual income,body weight,family history of hypertension,antihypertensive medicine awareness,times of receiving antihypertensive medicine advice and receiving diet advice.Conclusion The effects of community-based standardized management of hypertension were better in urban area than in rural area,and the quality of the services of community-based hypertension management was lower in rural area than in urban area.

Objective To investigate the community-based management of diabetes patients aged ≥35 years in China.Methods The subjects from 2013-2014 Chronic Non-communicable Disease and Risk Factor Surveillance in China were used in this study,those who were aged ≥35 years and diagnosed by doctors in hospitals at community level or above were selected through clustering sampling.Questionnaire was used to collect the data of subjects' general information,health status,the treatment and the control of blood glucose.Blood samples were taken from the subjects to detect the fasting blood glucose level and blood glucose level at 2 hours after oral administration of glucosum anhydricum.The subjects were weighted according to complex sampling scheme to calculated the different rates and 95％CI.The Rao-scott x2 test was performed to test the differences in rates between the subgroups.Results The survey indicated that among the 10 056 diabetes patients aged ≥35 years and diagnosed with diabetes,4 609 received management service in communities.After being weighted,the management rate of diabetes patients was 45.0％ (95％ CI:40.8％-49.2％).Females (46.9％,95％CI:42.8％-51.0％) had higher management rate than males (43.0％,95％CI:38.1％-47.9％).The management rate was higher in rural area (50.4％,95％CI:46.3％-54.5％) than in urban area (41.6％,95％CI:35.5％-47.6％).There was a significant age specific difference in the proportion of patients receiving management services (x2=21.0,P＜0.01),the rate of management was highest in the patients aged ≥65 years (49.2％,95％CI:43.6％-54.7％),but lowest in the patients aged 35-44 years (35.2％,95％CI:27.9％-42.4％).The overall standardized management rate of diabetes patients in communities was 16.7％ (95％ CI:13.7％-19.7％).The proportion of urban patients receiving standardized management service (19.7％,95％CI:15.3％-24.1％) was higher than that of rural patients (12.8％,95％ CI:9.8％-15.8％).The overall treatment rate of diabetes patients in communities was 95.8％ (95％CI:94.8％-96.9％).The treatment rate was higher in females (97.0％,95％CI:96.0％-98.0％) than that in males (94.5％,95％CI:92.7％-96.4％).The control rate of blood glucose in diabetes patients receiving management in communities was 34.6％ (95％CI:31.5％-37.6％),and the highest blood glucose control rate was in the patients aged ≥65 years (38.2％,95％ CI:33.4％-43.0％),while the lowest blood glucose control rate was in the patients aged 45-54 years (34.4％,95％CI:26.7％-42.0％).Conclusions Both the standardized management rate and blood glucose control rate were low in the diabetes patients aged ≥35 years in China.It is necessary to strengthen the allocation of medical resources in communities and standardized diabetes management.