Objectives:To analyze and compare the disease burden of ischemic stroke due to tobacco exposure (including active and passive smoking) and its changing trends in China from 1990 to 2019,and to provide a reference for precise prevention and control of ischemic stroke. Methods:Based on the Global Burden of Disease Study 2019 database,we analyzed the burden of ischemic stroke disease attributable to tobacco exposure and its trends in different age and sex populations in China from 1990 to 2019,and compared the epidemiological differences in the burden of ischemic stroke disease attributable to active versus passive smoking. Results:Between 1990 and 2019,the disease burden of ischemic stroke attributable to tobacco exposure showed a decreasing trend in China and globally,but the decrease was relatively small in China.In 2019,the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life-year rate (ASDR) of ischemic stroke attributable to tobacco exposure in China were 10.64/100000 and 239.39/100000,both higher than the global average levels (5.85/100000 and 140.23/100000 respectively).The actual mortality and disability-adjusted life year (DALY) rates for ischemic stroke due to tobacco exposure in 2019 increased by 103.79％ and 90.48％,respectively,compared with 1990.There was a sex difference in the disease burden of ischemic stroke due to active and passive smoking,with the number of deaths,mortality,DALY,and DALY rates for ischemic stroke due to active smoking being significantly higher in men than in women.Conversely,the burden of ischemic stroke due to passive smoking was higher in women.At the age level,ischemic stroke attributable to both active and passive smoking presented the highest number of deaths,mortality,and DALY rates among those ≥70 years of age.Whereas DALY for ischemic stroke attributable to active smoking was mainly concentrated in those aged 50-69 years,DALY for ischemic stroke attributable to passive smoking was mainly concentrated in those aged ≥70 years. Conclusions:The disease burden of ischemic stroke attributable to tobacco exposure is higher in China than the global average level.The burden of ischemic stroke disease attributable to active and passive smoking varies significantly by sex and age,and more targeted tobacco control policies should be developed in China.

Objective To investigate the expression of programmed death ligand 1(PD-L1) in primary tumor cells(TCs) and tumor-infiltrating immune cells(TICs) in patients with liver metastases from colorectal cancer(CRC) and determine its predictive value for recurrence after microwave ablation(MWA) of liver metastases. Methods The paraffin-embedded specimens of 28 patients with CRC liver metastasis were collected retrospectively. The expression of PD-L1 in the primary lesions was detected by immunohistochemistry, and the relationship between PD-L1 and clinical features was analyzed. Recurrence-free survival(RFS) was analyzed by Kaplan-Meier method and Log rank test. Cox proportional hazards regression model was used to analyze the factors influencing recurrence. Results The positive rates of PD-L1 in TCs and TICs in primary CRC were 14.3%(4/28) and 46.4%(13/28), respectively. PD-L1 expression in primary TICs of CRC patients with liver metastases was significantly correlated with the largest hepatic tumor diameter (P < 0.05). PD-L1 expression in primary TICs of CRC patients with liver metastasis was correlated with poor RFS after MWA (P < 0.05). PD-L1 expression in primary TICs and the largest hepatic tumor diameter > 3 cm in CRC patients with liver metastases were the risk factors for recurrence after MWA (P < 0.05). Conclusion PD-L1 expression in primary TICs of CRC patients with liver metastasis may increase the risk of recurrence after MWA for liver metastasis.

High mobility group protein B1 (HMGB1) is a kind of nuclear protein widely existing in cells, which is released or secreted from cells by stress in the body and plays a key role in the survival or death pathways of cells. HMGB1 has a huge biological function and is the main regulator of major diseases such as inflammatory diseases and tumors. HMGB1 is closely related to the proliferation, differentiation, migration, apoptosis and drug resistance of tumor cells. With the continuous deepening of research on HMGB1, it is found that HMGB1 plays an important role in the occurrence, development, metastasis and drug resistance of breast cancer. Combined with the research status of HMGB1, the expression of HMGB1 in breast cancer is discussed to provide a new therapeutic scheme for clinical treatment.

Objective: To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction (AEG). Methods: Indication of Cheng's Giraffe esophagogastric reconstruction: (1) Siewert II AEG or Siewert III AEG with diameter < 4 cm; (2) preoperative staging as cT1-2N0M0. A descriptive case series study was carried out. Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed, including 14 cases in IA stage, 11 cases in IIA stage and 8 cases in IIB stage. Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows: Firstly, 12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach. Secondly, the gastric fundus and His angle were formed. Finally, the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm. The reflux disease questionare (RDQ) scores, radionuclide gastric emptying scintigraphy, and 24-hour multichannel intraluminal (MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux. Result: All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction, including 13 cases by open surgery and 21 cases by laparoscopic surgery. The operation time was (144.6±39.8) minutes, the blood loss during operation was (35.4±17.2) ml. No laparoscopic case was converted to open surgery and no postoperative complication was observed. The postoperative hospital stay was (8.4±2.5) days. The postoperative RDQ score was 4.4±3.1 one month after operation, and 3.3±2.5 six months after operation. Gastric-half emptying time was (67.0±21.5) minutes, and the residual ratio was (52.2±7.7)% in 1 hour, (36.4±3.1)% in 2 hours and (28.8±3.6)% in 3 hours at postoperative 1-month. The 24-hour MII-pH monitoring at postoperative 2-month revealed the frequency of acid reflux was (12.6±7.9) times, frequency of non-acid reflux was (19.6±9.7) times, DeMeester score was 5.8±2.9. Conclusion Cheng's Giraffe esophagogastric reconstruction is safe and feasible in the treatment of Siewert type II AEG, and has good dynamic and anti-reflux effects.

Objective: To investigate the associations between behavioral risk factors and overweight or obesity among schoolage children and adolescents in Shanghai, and to provide a reference for making targeted prervention and control measures for overweight and obesity. Methods: A total of 11 913 children and adolescents aged 9-18 years old were selected according to 2014 Shanghai Physical Fitness and Health Surveillance. Questionnaire survey and physical examination including height, weight and other physical index were performed. Logistic regression was used to analyze the association between overweight or obesity and sleep time, diet, physical exercise and sedentary behavior Results: The prevalence of overweight or obesity was higher among boys who slept longer than or equal to 10 hours(36.7%), compared with those with less than 8 hours of sleep(31.3%)(P<0.01). The rates of overweight or obesity in girls was higher among breakfast skippers(36.4%) than breakfast nonskippers(17.6%)(P<0.05). The prevalence of overweight or obesity was higher among pupils who did not like physical education(38.2%) than those who preferred(30.8%)(P<0.01). The prevalence of overweight or obesity among junior middle school students playing video games and computer over 2 hours(28.1%) was higher than those playing less than 1 hours(23.0%)(P<0.05). Unwilling to participate in longdistance running exercise, watching TV more than 1h per day were risk factors for overweight or obesity(OR=1.16, 95%CI:1.05-1.27; OR=1.22, 95%CI:1.05-1.43, respectively).Girls who were breakfast nonskippers had a lower risk of overweight or obesity (OR=0.33, 95%CI:0.16-0.67). Students in urban areas who watch TV more than 1h per day was risk factor for overweight or obesity(OR=1.36, 95%CI:1.07-1.74). Students in rural areas who slept longer than 10 hours had an increased risk of being overweight or obese (OR=2.0, 95%CI:1.23-3.25). Pupils who played video games and computers for more than 2 hours had an increased risk of being overweight or obese(OR=1.45, 95%CI:1.01-2.08). Conclusion In 2014, overweight or obesity among Shanghai’s primary and middle school students was highly interconnected with bad dietary behavior, static life style, and the distribution of factors shows obvious population characteristics.

Objective To discuss the correlation between MTHFR gene polymorphism and unexplained recurrent spontaneous abortion.Methods A case control study was used in this study,140 patients with unexplained recurrent spontaneous abortion(UR-SA) (abortion group)and 143 cases of normal women(control group)were recruited.Genomic DNA was obtained and extracted from the oral mucosa cells.Fluorescence quantitative PCR was used to examine the MTHFR gene polymorphisms,and Taqman-MGB technology was conducted to analysis the relationship between single nucleotide polymorphism and disease.Results There was statistically significant difference in the frequencies of C677T genotype and alleles between the two groups(P＜0.05).However,no significant difference in the frequencies of A1298C genotype and alleles between the two groups(P＞0.05).Conclusion MTHFR gene C677T polymorphism might be one of the genetic risk factors of URSA.

Objective To investigate the influence of the genotype distribution of methylenetetrahydrofolate reductase (MTHFR) C677T,A1298C and methionine synthase reductase (MTRR) A66G in threatened abortion of Chinese Han gestationalage women in Sanya city,which involved in the folic acid biosynthetic pathway among.Methods One hundred and thirty-nine samples of case group and the same number of control group were recruited from Sanya region in Hainan Province.Genomic DNA was extracted from the mucosal epithelium of the subjects.The gene polyrnorphisms of MTHFR and MTRR were detected by Fluorescence quantitative PCR technology.The distribution frequencies of both case group and control group.were analyzed and compared,to investigate the effect of the gene polymorphisms on threatened abortion.Results Both the case group and the control group complied with Hardy-Weinberg law.The genotype frequency of MTHFR C677T,MTHFR A1298C and MTRR A66G were not significantly different.Conclusion This study suggests that the gene polymorphism which involved in folic metabolism was not significantly different from the group of threatened abortion and the control group,and whether the metabolism related genes are the risk factors of threatened abortion need to be further discussed.

Objective To investigate the effects of Bucinnazine Hydrochloride on the pain behavior and the expression of caveolin-1 (Cav-1) in the anterior cingulate cortex of neuropathic pain mice.Methods 64 adult male Kunming mice (20-25g) were divided randomly into 4 groups with 16 in each group:Sham+BH(Bucinnazine Hydrochloride) group,Sham+NS (Normal Saline) group,CCI+ BH group and CCI+ NS group.The corresponding drugs were administered by intraperitoneal injectionfrom the forth day after CCI once a day for three days.Paw thermal withdrawal latency was measured by Hargreaves methods.Mechanicalwithdrawal threshold was assayed by electronic dolorimeter.c-Fos protein in anterior cingulate cortex was detected by immunohistochemistry staining and the expression of t-Cav-1,p-Cav-1was detected by Western blot.Results Bucinnazine Hydrochloride administered by intraperitoneal injection(0.1 mg/10 g,mice) alleviated thermal hyperalgesia and mechanical allodynia of CCI mice.Compared with the forth day (4.92±0.41) s of CCI+BH group,paw withdrawal latency on the fifth day(5.92±0.61) s was increased(P＜0.05),and on the sixth day(7.93±0.91) s and seventh day (9.12±0.69)s were increased more(P＜0.01,P＜0.01).The paw withdrawal mechanical threshold on the sixth and seventh day of CCI+BH group mice((2.54 ±0.41)g,(3.68±0.61)g) were increased significantly (P＜0.01,P＜0.01)compared with the forth day(1.55± 0.31)g.Immunohistochenistry results showed that the expression of c-Fos decreased after treated with Bucinnazine Hydrochloride in the anterior cingulate cortex of CCI mice(P＜0.001).Western Blotting showed that the expression of t-Cav-1 (1.97±0.31) and p-Cav-1 (0.11 ±0.09) in the anterior cingulate cortex of CCI +BH group mice decreased compared with that of in CCI+NS group mice(t-Cav-1:2.87±0.15,p-Cav-1:0.48± 0.09) (P＜0.01,P＜0.01).Conclusion Bucinnazine Hydrochloride can alleviate both thermal hyperalgesia and mechanical allodynia of neuropathic pain of mice,and reduce the expression of c-Fos,t-Cav-1,p-Cav-1 in the anterior cingulate cortex of neuropathic pain mice.

Objective To compare the clinical outcome of internal fixation(IF)and total hip arthroplasty (THA)for the elderly patients with displaced femoral neck fracture. Methods A total of 128 patients with dis-placed femoral neck fracture admitted from January 2010 to December 2012 were selected and divided into IF group(61 cases)and THA group(67 cases). The operation and hospitalization index were compared between the 2 groups. All patients underwent follow-ups after operation. The functional recovery scale for hip fracture (FRS) and EQ-5D index were applied to evaluate the clinical outcomes periodically. Results Compared to THA group, the intraoperative trauma ,operation time and bed days were less in IF group(P<0.05),however the incidence of complication in IF group was higher than that in THA group. All the patients were followed up more than 3 years and mortality rate between the 2 groups showed no significant difference(P>0.05). Follow-ups at all time points revealed hip function in THE group is better than that in IF group(P<0.05),while no significant difference was found in terms of life quality(P > 0.05). Within 3 years,the costs related to fracture were 41772 yuan for IF group and 61174 yuan for THA group respectively. Conclusion Both internal fixation and total hip arthroplasty can provide satisfactory outcome for elderly patients with displaced femoral neck fracture. Compared with IF ,THA causes bigger trauma and costs more ,but ends up with lower complication incidences ,and improve hip function in a shorter period.

According to the trend of the development of the quality education, it is necessary to re-form the traditional homework assignments in medical microbiology for improving the innovation ability of students. This program attempts to reform the homework on clinical medicine undergraduates. First, the teacher must master diversified knowledge, and then the student design and finish the homework combine with personal characteristic from the training requirements of experimental confirmation, theoretical cognition and social survey. The questionnaire shows the personalized homework can help students to master the pro-fessional knowledge, stimulate study interest and improve the comprehensive quality.