Objective:To explore the correlation between TCM Syndromes of small pulmonary nodules (SPN) and the features of CT imaging and tumor markers in the chest.Methods:With retrospective study, the clinical data of 420 patients with small pulmonary nodules who were included from June 2016 to May 2018 from the East China Hospital Affiliated to Fudan University and Shanghai TCM Integrated Hospital were analized. The correlation between TCM syndromes and clinical high-risk indicators was analyzed by frequency analysis and Pearson correlation analysis.Results:The TCM syndromes were mainly lung qi and spleen qi deficiency syndrome (28.8%), followed by qi and yin deficiency syndrome (27.6%), lung yin deficiency syndrome (22.9%), qi deficiency and blood stasis syndrome (12.4%) and liver depression and spleen deficiency syndrome (8.3%). Compared with the patients with qi deficiency and blood stasis, the patients with liver depression and spleen deficiency had carcino embryonic antigen (CEA) level decreased significantly ( P<0.01); compared with the patients with qi and yin deficiency, CYFRA21-1 level in the patients with lung yin deficiency increased significantly ( P<0.001) and CYFRA21-1 level decreased in the patients with qi deficiency and blood stasis ( P=0.014); compared with the patients with lung yin deficiency, the level of neuron-specific- enolase (NSE) in the patients with lung qi and spleen qi deficiency. The level of NSE decreased ( P=0.044), and the level of NSE increased significantly in patients with liver depression and spleen deficiency ( P=0.005); there was no significant difference in the level of SCC between different syndromes ( F=0.825, P=0.551). The syndrome of deficiency of lung yin was moderately correlated with chronic bronchitis, smooth margin and burr ( r=0.613, -0.628, 0.755). The syndrome of qi and yin deficiency was lowly correlation to the solidity ( r=-0.421). The syndrome of lung qi and spleen qi deficiency was moderately correlation with the solidity ( r=0.540), and were low correlation with the chronic bronchitis history, ground glass, round, quasi round, and smooth edge ( r value was 0.303, -0.495, 0.376, -0.337, 0.319 respectively); liver depression and spleen deficiency syndrome were correlated with smoking history, chronic bronchitis history, left lower lobe of lung, isolated focus, multiple focus, quasi circle, NSE ( r value was -0.099, -0.150, 0.120, 0.113, -0.113, -0.107, 0.133 respectively); qi deficiency and blood stasis syndrome was moderately correlated with lobular shape ( r=0.682), and slightly correlated with irregular edge ( r=0.470). Conclusions:There is a certain correlation between TCM syndrome differentiation and clinical indexes in patients with pulmonary nodules. The level of tumor markers was different in different syndrome types. Among them, the lung yin deficiency syndrome and qi deficiency and blood stasis syndrome are at high risk of developing malignant tumors, but the lung qi and spleen qi deficiency syndrome, qi and yin deficiency syndrome and liver depression and spleen deficiency syndrome are at low risk of developing malignant tumors.

Objective: To study the MRI manifestations of foot injuries in amateur marathoners and the diagnostic value of MRI for foot injuries. Methods: Forty-eight amateur marathoners were prospectively recruited from October 2018 to March 2019. Participants were grouped according to the FASS criteria. All participants underwent bilateral foot MRI examinations. The MRI features of foot in amateur marathoners with and without foot pain were analyzed.The association with gender, age, time to participate in marathon, amount of running per week, number of times to complete the whole marathon and the symptoms of foot pain was studied. Results: There were 28 sides in FASS in grade 0, including 8 males and 20 females, 8 hydrocele of the first metatarsophalangeal joint, 6 edema of bone marrow, 4 edema of soft tissue, 4 hydrocele of tendon sheath, and 6 without abnormal manifestations of MRI. There were 68 sides in FASS grade 1, including 42 males and 26 females, 38 Achilles tendinitis, 14 plantar fasciitis, 12 Achilles tendon bursitis and 4 posterior ankle impingement syndrome. The incidence of foot pain in amateur marathoners was related to gender (OR=1.060, P=0.043), unrelated to age (OR=0.248, P=0.078), number of marathons completed (OR=1.006, P=0.956), time to participate in marathon (OR=1.008, P=0.944), amount of running per week (OR=0.971, P=0.407). Conclusion Among amateur marathon runners, the foot pain is mainly caused by Achilles tendon and plantar fascia, while those without foot pain are mainly characterized by joint effusion, tendon sheath effusion and bone marrow edema. Gender is the only factor affecting the incidence of foot pain in amateur marathoners. MRI examination is an effective method to determine foot injury and has important clinical application value in the diagnosis and treatment of foot injury.

Objective To study the MRI manifestations of foot injuries in amateur marathoners and the diagnostic value of MRI for foot injuries. Methods Forty?eight amateur marathoners were prospectively recruited from October 2018 to March 2019. Participants were grouped according to the FASS criteria. All participants underwent bilateral foot MRI examinations. The MRI features of foot in amateur marathoners with and without foot pain were analyzed.The association with gender, age, time to participate in marathon, amount of running per week, number of times to complete the whole marathon and the symptoms of foot pain was studied. Results There were 28 sides in FASS in grade 0, including 8 males and 20 females, 8 hydrocele of the first metatarsophalangeal joint, 6 edema of bone marrow, 4 edema of soft tissue, 4 hydrocele of tendon sheath, and 6 without abnormal manifestations of MRI. There were 68 sides in FASS grade 1, including 42 males and 26 females, 38 Achilles tendinitis, 14 plantar fasciitis, 12 Achilles tendon bursitis and 4 posterior ankle impingement syndrome. The incidence of foot pain in amateur marathoners was related to gender(OR=1.060, P=0.043), unrelated to age(OR=0.248, P=0.078), number of marathons completed(OR=1.006, P=0.956), time to participate in marathon(OR=1.008,P=0.944), amount of running per week (OR=0.971,P=0.407). Conclusion Among amateur marathon runners, the foot pain is mainly caused by Achilles tendon and plantar fascia, while those without foot pain are mainly characterized by joint effusion, tendon sheath effusion and bone marrow edema. Gender is the only factor affecting the incidence of foot pain in amateur marathoners. MRI examination is an effective method to determine foot injury and has important clinical application value in the diagnosis and treatment of foot injury.

Objective:To explore clinical significance of sinus heart rate turbulence (HRT) phenomenon in aged pa‐tients with stable angina pectoris (SAP) .Methods :A total of 120 aged SAP patients ,who received 24h DCG in our hospital from Jan 2013 to Oct 2015 ,were selected as SAP group .Meanwhile ,another 144 aged patients ,who re‐ceived 24h DCG examination simultaneously and coronary angiography results were normal ,were regarded as nor‐mal control group .According to coronary lesion severity ,SAP group was further divided into single vessel coronary disease group (single vessel group ,n=35) ,double‐vessel coronary disease group (double‐vessel group ,n=48) and multi‐vessel coronary disease group (multi‐vessel group ,n=37) .The 24h DCG ,HRT indexes ,including turbulence onset (TO) and turbulence slope (TS) ,were measured and compared among all groups .Results:Compared with normal control group ,there was significant rise in TO [(0.77 ± 0.37)% vs .(1.26 ± 0.92)% ] and significant reduc‐tion in TS [(5.45 ± 4.02) ms/RR interval vs .(1.53 ± 0.70) ms/RR interval] ,P<0.01 both ;significant rise in ab‐normal rates of TO (19.44% vs .42.50% ) ,TS (15.97% vs .31.67% ) and TO + TS (11.11% vs .30.83% ) in SAP group ,P<0.01 all .Compared with single vessel group ,there was significant rise in TO [(0.66 ± 0.22)% vs .(1.28 ± 1.11)% vs .(1.46 ± 1.20)% ] and significant reduction in TS [ (2.04 ± 0.82) ms/RR interval vs .(1.66 ± 0.38) ms/RR interval vs .(1.29 ± 0.58) ms/RR interval] in double‐vessel group and multi‐vessel group ,and TO of multi‐vessel group was significantly higher than that of double‐vessel group ,TS of multi‐vessel group was significantly low‐er than that of double‐vessel group , P<0.01 all .Conclusion:Sinus heart rate turbulence can be used as risk predic‐tor for aged patients with stable angina pectoris ,which can provide basis for clinical effective treatment and progno‐sis assessment .

Objective : To investigate the short-term efficacy of implant in the treatment of patients with dentition defect caused by chronic periodontitis. Methods : 53 patients with mild to moderate chronic periodontitis treated in our hospital from June 2014 to May 2015 were selected as observation group, and 53 patients without periodontal diseases in the same period were selected as control group. The plaque index (PLI), sulcus bleeding index (SBI), periodontal probing depth (PD) and gingival papilla index (PIS) were measured at six months and one year after operation, respectively. Interleukin-6 (IL-6), interleukin-8 (IL-8), high sensitive C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) were detected at six months and one year after operation, respectively. At the last follow-up, the survival rate of two groups were calculated. Results : One year after operation, 5 of the 64 implants in the observation group failed compared with 2 of the 71 implants in the control group. There was no statistical difference in the implant survival rate between the two groups (92.19% vs 97.18%, P=0.191). There was no significant difference in SBI (t=0.936, P=0.351)、 PLI (t=0.457, P=0.649)、PIS (t=1.132, P=0.217)、PD (t=0.957, P=0.341) between the two groups at six months after operation. One year after operation, the periodontal index of the observation group was higher than that of the control group SBI (t=5.297, P=0.000)、 PLI (t=2.341, P=0.021)、 PIS (t=8.218, P=0.000) and PD (t=6.492, P=0.000). The levels of IL-6 (t=6.463, P=0.000)、 IL-8 (t=7.202, P=0.000)、 hs-CRP (t=4.237, P=0.000) and TNF-α (t=6.194, P=0.000) in the observation group were higher than those in the control group at six months after operation. One year after operation, the level of inflammatory factors in the observation group was higher than that in the control group IL-6 (t=12.835, P=0.000)、 IL-8 (t=13.207, P=0.000)、 hs-CRP (t=11.319, P=0.000) and TNF-α (t=8.117, P=0.000). Conclusion Implant as the treatment of patients with dentition defect caused by chronic periodontitis obtained satisfied short-term effect, but its long-term efficacy remains to be further verified.

Objective To evaluate the therapeutic effect of nurse-led clinics ( NLCs) in patients with type 2 diabetes mellitus ( T2DM) . Methods We searched randomized controlled trials ( RCTs) related to the therapeutic effect of patients with T2DM in PubMed, EMBASE, CENTRAL, Web of science, CBM, CNKI, VIP, and Wanfang databases from the beginning to June 2016. The methodological quality assessment was used to assess the included studies according to “bias risk assessment” recommended by Cochrane Handbook 5. 1. 0 software, and the data were extracted and analyzed by using the RevMan 5.1 software. Results Totally 15 RCTs with 2 204 patients were included in this study. The Meta-analysis showed that:compared with the control group, NLC intervention can further decrease the HbA1c level of patients with T2DM [ MD=-1.11, 95%CI(-1.47,-0.75), P<0.001];improve patients′adherence to medication [RR=1.28, 95%CI(1.20,1.35)], diet control [RR=1.68, 95%CI(1.52,1.86)], exercise reinforcement [RR=1.32, 95%CI(1.22,1.43)], and regular blood glucose monitoring [ RR=1. 68, 95%CI ( 1. 30, 2. 17 ) ]; and improve patients′ quality of life. Meta-regression analysis showed that the effect of NLC were positively related to the baseline level of HbA1c ( r=-0.33, P<0.05). Conclusions The application of NLC can improve the therapeutic effect of patients with T2DM, and improve their treatment compliance and quality of life.

BACKGROUNDIn March 2013, human cases of infection with a novel A (H7N9) influenza virus emerged in China. The epidemic spread quickly and as of 6 May 2013, there were 129 confirmed cases. The purpose of this study was to analyze the epidemiology of the confirmed cases, determine the impacts of bird migration and temperature changes on the H7N9 epidemic, predict the future trends of the epidemic, explore the response patterns of the government and propose preventive suggestions.

METHODSThe geographic, temporal and population distribution of all cases reported up to 6 May 2013 were described from available records. Risk assessment standard was established by analysing the temperature and relative humidity records during the period of extensive outbreak in three epidemic regions in eastern China, including Shanghai, Zhejiang and Jiangsu provinces. Risk assessment maps were created by combining the bird migration routes in eastern China with the monthly average temperatures from May 1993 to December 2012 nationwide.

RESULTSAmong the confirmed cases, there were more men than women, and 50.4% were elderly adults (age >61 years). The major demographic groups were retirees and farmers. The temperature on the days of disease onset was concentrated in the range of 9°C-19°C; we defined 9°C-19°C as the high-risk temperature range, 0°C-9°C or 19°C-25°C as medium risk and <0°C or >25°C as low risk. The relative humidity on the days of disease onset ranged widely from 25% to 99%, but did not correlate with the incidence of infection. Based on the temperature analysis and the eastern bird migration routes, we predicted that after May, the high-risk region would move to the northeast and inland, while after September, it would move back to north China.

CONCLUSIONSTemperature and bird migration strongly influence the spread of the H7N9 virus. In order to control the H7N9 epidemic effectively, Chinese authorities should strengthen the surveillance of migrating birds, increase poultry and environmental sampling, improve live poultry selling and husbandry patterns and move from a "passive response pattern" to an "active response pattern" in focused preventive measures.

Animals ; Birds ; China ; epidemiology ; Influenza A Virus, H7N9 Subtype ; pathogenicity ; Influenza in Birds ; epidemiology ; Temperature