Objective To evaluate the importance of clinical screening and follow up by direct colonoscopy for colorectal cancer at an early and curable stage. Methods There were 2 196 elderly people aged between 60 to 89 years. The clinical screening by direct colonoscopy was performed according to the protocol. 1 740 of 2 196(79.2%) patients were followed up every year. Results Fifty two elderly persons were found to be colorectal cancer patients by colonoscopy, with the detectable rate being 2.4%. Nineteen were diagnosed early stage colorectal cancer, accounting for 36.5% of the detected colorectal cancer. Nine among the followed up cases were detected early colorectal cancer, accounting for 45 0% of the detected colorectal cancer. The resectable rate and the 5 year survival rate was 97 7% and 80 9% for colorectal cancer, respectively. 98 9% of the cecum intubation cases was successful. The incidence of complication for colonoscopy was 0 05%. Conclusions By clincal colonscopy screening and follow up study for colorectal cancer and precancerous changes in the elderly, the patients with adenomatoid polyps were early diagnosed and treated, so it raised the detectable rate of early colorectal cancer and the level of grade prevention of colorectal cancer.

Objective To investigate the short-term prognosis of acute severe stroke patients treated with early partly of enteral nutrition followed by parenteral nutrition,only early enteral nutrition or only conventional family feeding.Methods According to stratified random method,97 severe acute stroke patients were divided into three groups,including early partly enteral nutrition and parenteral nutrition therapy group (study group,33 cases),only early enteral nutrition group (32 cases),and only conventional family feeding group (32 cases).The nutritional status,mortality,and incidence of infection were observed in the three groups at 21 days; NIH Stroke Scale (NIHSS) and Barthel Index at 21 days were compared among the three groups,and Modificied Rankin Scale (mRS) were compared at 90 days.Results At 21 days,the nutritional parameters including triceps skinfold thickness,mid-arm muscular circumference,hemoglobin,serum albumin,serum prealbumin and triglycerides in the study group were better than that in the other two groups.The incidence of malnutrition(10.0％ (3/30),37.5％ (9/24),12/19) and infection (18.2％ (6/33),40.6％ (13/32),56.3％ (18/32)) among the three groups were significantly different (x2 =15.2417,P =0.0005 ; x2 =10.1030,P =0.0064).The mortality (9.1％ (3/33),25.0％ (8/32),40.6％(13/32); x2 =8.6777,P =0.0131) and the NIHSS score (11.51 ±2.68,13.22 ±2.71,14.48 ± 2.55 ;F =7.86,P =0.0008) in the intervention group were lower than that in the other two groups.However,the Barthel Index had no significant difference among the three groups.At 90 days,the mRS grade 0 to l and the mRS grade 2 to 3 had no significant difference among the three groups; However,the mRS grade 4 to 5 among the three groups were statistical difference.Conclusion The early partly enteral nutrition combined with the stage of parenteral nutrition therapy can improve the short-term prognosis of severe acute stroke,though it cannot improve the Barthel Index on the 21th day.

Objective To establish diagnostic standards of colorectal tubular adenocarcinoma with confocal laser endomicroscopy(CLE), and to evaluate its diagnostic value in vivo.Methods The confocal images of 12 cases, which were pathologically confirmed colorectal tubular adenocarcinoma(4 well differentiated, 4 moderately differentiated and 4 poorly differentiated), were collected and analyzed to establish diagnostic standards of the disease with CLE.Then 49 lesions were prospectively evaluated based on CLE standards,which were compared to histopathology results.Results The sensitivity, specificity, accuracy, positive predictive value(PV +)and negative predictive value(PV -)of CLE in diagnosing tubular adenocarcinoma were 94.7%, 90.9%, 93.9%, 100% and 76.9%, respectively.The corresponding data of well differentiated adenocarcinoma were 100%, 83.3%, 88.9%, 85.7% and 87.0%, those of moderately differentiated adenocarcinoma were 86.7%, 90.5%, 86.1%, 86.7% and 90.5%, and those of poorly differentiated adenocarcinoma were 77.8%, 92.6%, 88.9%, 100% and 86.2%.Conclusion CLE is able to diagnose and grade colorectal tubular adenocarcinoma.

Objective: To observe the effect of Tuina (Chinese therapeutic massage) on creatine kinase (CK), mitochondrial Ca2+ concentration, and ultrastructure of skeletal muscle in delayed onset muscle soreness (DOMS) model rats.Methods: A total of 130 healthy male Sprague-Dawley rats were randomly divided into a blank group, an exercise control group, a pre-exercise Tuina group, and a post-exercise Tuina group. According to the time points for sample collection, the exercise control group was divided into a 0 h exercise control group, a 24 h exercise control group, a 48 h exercise control group, and a 72 h exercise control group; the pre-exercise Tuina group was further divided into a 0 h pre-exercise Tuina group, a 24 h pre-exercise Tuina group, a 48 h pre-exercise Tuina group, and a 72 h pre-exercise Tuina group; and the post-exercise Tuina group was divided into a 0 h post-exercise Tuina group, a 24 h post-exercise Tuina group, a 48 h post-exercise Tuina group, and a 72 h post-exercise Tuina group. Rats in all groups except for the blank group received DOMS modeling. Professionals performed Nie-Pinching manipulation and finger Nian-Twisting manipulation on the lower limbs of the rats. The samples were collected at 0 h, 24 h, 48 h, or 72 h after exhaustive exercise for each pre-exercise Tuina group. The samples were collected at 0 h, 24 h, 48 h, or 72 h after Tuina for each post-exercise Tuina group. The changes in serum CK, skeletal muscle mitochondrial Ca2+ concentration, and Ca2+-adenosine triphosphatase (ATPase) were determined. The ultrastructure changes of skeletal muscles in each group were observed by a transmission electron microscope. Results: The electron microscope showed that compared with the exercise control group, the skeletal muscle structures of the pre-exercise Tuina group and the post-exercise Tuina group were significantly improved, and the overall performance of skeletal muscle in the pre-exercise Tuina group was more similar to that of the blank group. The level of serum CK in the pre-exercise Tuina group and the post-exercise Tuina group was significantly lower than that in the exercise control group (P<0.01). The Ca2+ concentration of skeletal muscle in the 24 h, 48 h, and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point (P<0.01). The Ca2+-ATPase concentration of skeletal muscle in the 24 h and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point (P<0.05).Conclusion: Tuina effectively prevents muscle damage caused by heavy exercise and long-term exercise, which may be related to the increase of skeletal muscle Ca2+-ATPase activity and mitochondrial Ca2+ transport.

OBJECTIVETo evaluate the safety and effectiveness of direct gastroscopy for detecting gastric cancer.

METHODSClinical screening by direct gastroscopy was performed for gastric cancer (GC) from September 1985 to July 1998. 3048 elderly people were screened. Their age ranged from 60 to 93 years, and 2034 of the 3084 were followed up.

RESULTSNinety-two patients with gastric cancer were discovered by gastroscopy, representing 3.02% of the screened population. The rate of early gastric cancer (EGC) was 63.04% (58/92) of all gastric cancers detected. The rate was up to 79.59% (39/49) on follow-up, and was 74.14% (43/51) in asymptomatic patients with gastric cancer. The excision rate was 88.89% for patients with gastric cancer, and 100% for patients with early gastric cancer. The 5-year survival rate was 91.89% for patients with gastric cancer, and 96.30% for patients with early gastric cancer.

CONCLUSIONClinical screening and follow-up by direct gastroscopy in persons over 60 years of age are a safe and effective method for raising the 5-year survival and detection rate of gastric cancer, especially early gastric cancer.

Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastroscopy ; Humans ; Male ; Middle Aged ; Prognosis ; Stomach Neoplasms ; diagnosis ; mortality ; Survival Rate

Objective:To study the high risk factors of hypothermia in premature infants with gestational age ≤34 weeks, and to analyze the incidence of hypothermia before and after the implementation of the quality improvement program of hypothermia in hospital and its influence on various systemic complications, aiming to improve the early identification of hypothermia and to reveal the important clinical significance of temperature management in time.Methods:Clinical data of preterm infants born in Maternal and Child Health Hospital of Hubei Province from May 2017 to December 2018, with gestational age ≤34 weeks, and admitted within 1 hour after birth were collected.According to the admission temperature, the infants were divided into normal temperature group (36.5-37.5 ℃), mild hypothermia group (36.0-36.4 ℃), moderate hypothermia gsroup (32.0-35.9 ℃), and severe hypothermia group (<32.0 ℃). The high risk factors of hypothermia in premature infants were analyzed.The incidence and degree of hypothermia and the effects on the systemic complications before and after the implementation of the hypothermia quality improvement program were compared.Results:A total of 306 premature infants were enrolled in the study, including 63(20.6%)cases in the normal temperature group, 115(37.6%) cases in the mild hypothermia group, and 128(41.8%) cases in the moderate hypothermia group, without severe hypothermia.Infants with birth asphyxia were at higher risk for hypothermia( OR=0.195, 95% CI 0.046-0.833, P=0.027); the lower the Apgar score at 1 min( r=0.123, P=0.032)and 5 min after birth( r=0.136, P=0.017), the higher the risk of admission hypothermia.After the quality improvement project, the incidence of admission hypothermia decreased from 82.3% to 73.8%( χ2=32.67, P<0.001), and the use of pulmonary surfactant in infants with respiratory distress syndrome was significantly reduced(70.0% vs. 32.0%, χ2=40.11, P<0.001), and the incidence of hypotension within 72 hours after birth decreased(11.8% vs. 4.9%, χ2=3.87, P<0.049). Conclusion:Birth asphyxia is a risk factor for admission hypothermia in premature infants, and Apgar score is associated with admission hypothermia in premature infants.Temperature management of preterm infants can significantly reduce the incidence of hypothermia and hypotension, and reduce the use of pulmonary surfactant in respiratory distress syndrome infants.

Objective:To explore the application value of right modified myocardial work index (Mod-RMPI) in assessing fetal right ventricular function in assisted reproductive technology (ART).Methods:Sixty-four fetuses conceived by assisted reproduction (ART group) and 80 fetuses with spontaneously conceived (SC) pregnancies (control group) from November 2021 to February 2022 underwent echocardiography in the Third Affiliated Hospital of Zhengzhou University were enrolled, gestational ranges from 20 to 28 weeks. The differences of Mod-RMPI, tricuspid valve E/A ratio (TV-E/A) were compared between the ART group and the control group; The correlation between maternal age, body mass index (BMI), pregnancy, and delivery and Mod-RMPI in the ART group was analyzed by applying multiple linear regression analysis; The receiver operating characteristic (ROC) curves were used to test the predictive efficacy of Mod-RMPI for adverse pregnancy outcomes.Results:①Compared with the control group, Mod-RMPI, isovolumetric relaxation time(IRT), isovolumetric contraction time(ICT) and BMI were increased in ART group with statistically significant difference, ventricular ejection time (ET) were decreased, the difference was (all P<0.05). But there were no significant differences in total spent time (TST) and TV-E/A compared with the control group ( P>0.05). ②There were no correlations between maternal age, BMI, gravidity, and times of bearing birth and Mod-RMPI ( P>0.05). ③The ROC curve analysis showed the area under the curve of Mod-RMPI for predicting adverse pregnancy outcome was 0.748, the optimal cut-off value was 0.465, the sensitivity was 0.778, and the specificity was 0.608. Conclusions:ART can affect fetal right ventricular function.Mod-RMPI has good consistency and repeatability, and has certain value in predicting adverse pregnancy outcome.

【Objective】 To explore the effects of breastfeeding on the immune response of CD4⁺T lymphocytes in infants in non-inflammatory state, and to analyze the immunomodulatory significance of the whole composition of breast milk. 【Methods】 A retrospective cohort study was conducted. From January to September 2022, six-month-old infants who took physical examination in the Child Healthcare Department of Changzhou Children′s Hospital Affiliated to Nantong University, were selected based on inclusion criteria, and were divided into breastfeeding group (n=33) and formula feeding group (n=27) based on their feeding patterns. Flow cytometry was used to detect the percentage of CD4⁺ T cells, including helper T cell (Th) 1, Th2, Th17, regulatory T cell (Treg), and the levels of related cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, IL-17 in peripheral blood. The differences in these indicators between the two groups were compared. 【Results】 Compared with the formula feeding group, the breastfeeding group showed significantly higher percentages of Th1(t=3.038), Treg (t=2.088). The ratio of Th1 to Th2(Z=2.756), IL-10(Z=2.297) and IFN-γ (Z=2.076) in the peripheral blood of the breastfeeding group were also significantly higher. Conversely, the breastfeeding group had significantly lower percentage of Th17(Z=2.704) and IL-17A (t=2.187) (P<0.05). There was no significant difference the percentage of Th2, as well as in the levels of IL-2, IL-4, IL-6 and TNF-α between the two groups (P>0.05). 【Conclusions】 Breastfeeding has a regulatory effect on the immune response of infant CD4⁺ T lymphocytes. It promotes the development of Th1/Th2 towards Th1 and the immunomodulatory effect of Treg. Moreover, it inhibits the Th17 type immune response. These findings suggest that the complete composition of breast milk contributes to the development and maturation of infant immune system, enhancing immune defense and immune tolerance.

Objective To explore the role of clinical pharmacists involved in the case of a patient with acute myeloid leukemia whose QTc interval prolongation was induced by gilteritinib, and to provide reference for drug treatment and monitoring of those patients. Methods The abnormal electrocardiogram （ECG） of a patient with acute myeloid leukemia was found in time by clinical pharmacists, who participated in clinical diagnosis and treatment by analyzing the patient’s underlying diseases, diagnosis and treatment process, therapeutic drugs and their potential interactions. Results Clinical pharmacists suspected that the prolonged QTc interval was likely to be an adverse reaction caused by gilteritinib, and recommended immediate discontinuation of the drug and re-examination of the electrocardiogram.The physician took the suggestion to stop the suspected drug therapy with gilteritinib promptly, and ECG was rechecked 3 d later, and the QTc value returned to the normal range. Conclusion Clinical pharmacists participating in clinical diagnosis and treatment could provide better pharmaceutical care for patients.

This article provides an interpretive review of the "2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation", which was updated and published by the American College of Cardiology (ACC), the American Heart Association (AHA), the American College of Chest Physicians (ACCP), and the Heart Rhythm Society (HRS) based on the latest clinical evidence. It delves into the classification and management strategies for atrial fibrillation (AF), grounded in the most current evidence-based medical research. The guideline offers significant updates in various aspects such as the definition and staging of AF, clinical evaluation and treatment, modification of risk factors, prevention of thromboembolism, and management of specific populations. Notably, the introduction of a new staging model for AF and corresponding management strategies stands out, underscoring the importance of prevention and early intervention. This article focuses on the three pillars of integrated AF management—stroke risk assessment, modification of risk factors, and management of specific patient groups, in addition to rate and rhythm control, analyzes their substantial significance in clinical practice and guides clinicians in providing more precise treatment.