Objective:To explore the incidence of chronic obstructive pulmonary disease (COPD) in a cohort aged 40 years and above in Songjiang District, Shanghai, and to analyze the association of Mediterranean diet pattern and dietary approaches in stopping hypertension pattern (DASH) with the risk of developing COPD.Methods:Based on a natural population cohort in Songjiang District, Shanghai, 27 474 adults aged 40 years and above who did not have COPD at baseline were enrolled in the study. The Cox proportional risk regression model was used to analyze the association of baseline Mediterranean diet pattern score and DASH score with the risk of COPD, and the hazard ratio ( HR) of the risk and its 95% CI were calculated. Restricted cubic spline was used to analyze the nonlinear association between the two diet scores and the risk of COPD. Stratified analyses were performed according to gender, age, smoking status, etcetera. Sensitivity analyses were conducted by censoring cases diagnosed within one year after the baseline survey or people with a history of malignant tumor disease. Results:As of June 30, 2023, after a median follow-up time of 6.21 years, there were 1 089 (4.0%) new COPD cases with an incidence density of 64.00 per 10 000 person-years. After adjusting for relevant confounders, in the Mediterranean tertile subgroups under diet pattern score, the risk of developing COPD could be reduced by approximately 14% in the intermediate scoring group ( HR=0.86, 95% CI: 0.75-0.99) and 15% in the highest scoring group ( HR=0.85, 95% CI: 0.72-0.99) compared to the lowest scoring group. The association remained after censoring cases diagnosed within one year of the baseline survey ( HR=0.82, 95% CI: 0.70-0.95; HR=0.82, 95% CI: 0.68-0.97) or censoring people with a history of malignant tumor disease ( HR=0.84, 95% CI: 0.73-0.97; HR=0.84, 95% CI: 0.71-0.99). No statistical association was found between the DASH score and the risk of COPD. Conclusions:The Mediterranean diet pattern was associated with a lower risk of COPD. Increasing the intake of vegetables, fruits, legumes, and whole grains and decreasing the intake of red meat and others can reduce the risk of COPD. No association was found between the DASH dietary pattern and the risk of COPD in this community population.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.

Objective: To analyze and compare therapy responses, outcomes, and incidence of severe hematologic adverse events of flumatinib and imatinib in patients newly diagnosed with chronic phase chronic myeloid leukemia (CML) . Methods: Data of patients with chronic phase CML diagnosed between January 2006 and November 2022 from 76 centers, aged ≥18 years, and received initial flumatinib or imatinib therapy within 6 months after diagnosis in China were retrospectively interrogated. Propensity score matching (PSM) analysis was performed to reduce the bias of the initial TKI selection, and the therapy responses and outcomes of patients receiving initial flumatinib or imatinib therapy were compared. Results: A total of 4 833 adult patients with CML receiving initial imatinib (n=4 380) or flumatinib (n=453) therapy were included in the study. In the imatinib cohort, the median follow-up time was 54 [interquartile range (IQR), 31-85] months, and the 7-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.2%, 88.4%, 78.3%, and 63.0%, respectively. The 7-year FFS, PFS, and OS rates were 71.8%, 93.0%, and 96.9%, respectively. With the median follow-up of 18 (IQR, 13-25) months in the flumatinib cohort, the 2-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.4%, 86.5%, 58.4%, and 46.6%, respectively. The 2-year FFS, PFS, and OS rates were 80.1%, 95.0%, and 99.5%, respectively. The PSM analysis indicated that patients receiving initial flumatinib therapy had significantly higher cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) and higher probabilities of FFS than those receiving the initial imatinib therapy (all P<0.001), whereas the PFS (P=0.230) and OS (P=0.268) were comparable between the two cohorts. The incidence of severe hematologic adverse events (grade≥Ⅲ) was comparable in the two cohorts. Conclusion: Patients receiving initial flumatinib therapy had higher cumulative incidences of therapy responses and higher probability of FFS than those receiving initial imatinib therapy, whereas the incidence of severe hematologic adverse events was comparable between the two cohorts.
Adult ; Humans ; Adolescent ; Imatinib Mesylate/adverse effects* ; Incidence ; Antineoplastic Agents/adverse effects* ; Retrospective Studies ; Pyrimidines/adverse effects* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy* ; Treatment Outcome ; Benzamides/adverse effects* ; Leukemia, Myeloid, Chronic-Phase/drug therapy* ; Aminopyridines/therapeutic use* ; Protein Kinase Inhibitors/therapeutic use*

Objective:To observe the improving effect of Danggui Shaoyaosan on diminished ovarian reserve （DOR） in rats triggered by Tripterygia wilfordii polyglycoside tablet combined with stress， and to explore the role of transforming growth factor-β₁ （TGF-β₁）/Smads signaling pathway in such improvement. Method:Forty-eight female SD rats with normal sexual cycle were selected and randomly divided into a normal group （n=8） and a modeling group （n=40）， and the ones in the modeling group were given Tripterygium wilfordii polyglycoside tablets （50 mg·kg^-1） combined with random stress for 15 d. After successful modeling， the rats were randomized into the model group， low-， medium-， and high-dose （3.96， 7.92， 15.84 g·kg^-1） Danggui Shaoyaosan groups， and estradiol valerate group （0.09 mg·kg^-1）， with eight in each group. Under the premise of stress exposure， they were separately gavaged with the normal saline， low-， medium- and high-dose Danggui Shaoyaosan， and estradiol valerate for 15 successive days. The estrous cycle of rats in each group was observed daily. After intervention， the rats were sacrificed and the ovarian visceral index was calculated. The pathological changes in ovarian tissues were observed by hematoxylin eosin （HE） staining. The protein expression levels of TGF-β₁ and TGF-β₁ receptor （TGF-β₁R） in the ovarian tissues of rats were measured by immunohistochemistry （IHC）， and the mRNA expression levels of Smad2， Smad3， and Smad7 in the ovarian tissues by real-time polymerase chain reaction （Real-time PCR）. Result:Compared with the normal group， the model group exhibited disordered estrus cycle （P<0.05）， reduced visceral index （P<0.01）， and down-regulated TGF-β₁ and TGF-β₁R protein and Smad2 and Smad3 mRNA expression in the ovarian tissues （P<0.01）， and up-regulated Smad7 mRNA expression （P<0.01）. Compared with the model group， Danggui Shaoyaosan at the low， medium， and high doses and estradiol valerate improved the estrus cycle of rats to varying degrees （P<0.05） and increased the visceral index， with better effects observed in the medium-group and high-dose Danggui Shaoyaosan groups （P<0.05，P<0.01）. Besides， the protein expression levels of TGF-β₁ and TGF-β₁R and the mRNA expression levels of Smad2 and Smad3 in the ovarian tissues were elevated to varying degrees （P<0.01）， and the Smad7 mRNA expression declined （P<0.01）. The improvements in TGF-β₁ and TGF-β₁R protein expression of the medium-dose Danggui Shaoyaosan group and estradiol valerate group were more obvious. Conclusion:Danggui Shaoyaosan significantly improves ovarian reserve in DOR rats， which is closely related to the regulation of TGF-β₁/Smads signaling pathway.

Objective:To explore the influence of new labor standards on the indications in the birth process and the prognosis of mothers and infants.Methods:186 cases treated in our hospital from January,2015 to January,2016 were divided into the observation group (85 cases) and the control group (101 cases),the observation group received new labor standards,the control group adopt Friedman labor standards.The clinical indications,pregnant complications,pregnant outcome,neonatal-perinatal outcome were compared between two groups.Results:The cesarean delivery rate,number of using oxytocin,forceps delivery rate of observation group were significantly lower than those of the control group(P＜0.05);the duration time of both first and second stage of labor were obviously longer than those of the control group (P＜0.05);the duration time of active phase,bleeding volume in birth process in both groups showed no statistical difference (P＞0.05);there was no adverse maternal and infant events in both groups;the incidence rate of pregnancy complications,fetal distress in uterus,asphyxia neonatorum and neonatal body weight were of no statistical difference (P＞0.05).Conclusion:The new labor standards prolong the duration time of birth and give women fully trial opportunities,could effectively reduce the rate of cesarean section,reduce the over intervention production.

To investigate the difference of liver injury in rats gavaged with crude and processed Polygoni Multiflori Radix. The 75% ethanol extract of crude and processed Polygoni Multiflori Radix (50 g · kg(-1) crude medicine weight/body weight) were continuous oral administered to rats for 6 weeks. Serum biochemical indicators were dynamically detected, the change of liver histopathology was assessed 6 weeks later. Principal component analysis (PCA) was adopted to screen sensitive indicator of the liver damage induced by polygoni multiflori radix. Biochemical tests showed that the crude Polygoni Multiflori Radix group had significant increase of serum ALT, AST, ALP, DBIL and TBIL (P < 0.01 or P < 0.05) and significant decreases of serum IBIL and TBA (P < 0.01 or P < 0.05), while the processed Polygoni Multiflori Radix group showed no obvious changes, compared to the untreated normal group. Histopathologic analysis revealed that crude Polygoni Multiflori Radix group exhibited significant inflammatory cells infiltration in portal area around the blood vessels, tissue destruction and local necrosis of liver cells. There were not obvious pathological changes in processed Polygoni Multiflori Radix group. The results demonstrated that the injury effect of processed Polygoni Multiflori Radix on liver injury of rats was significantly lower than that of unprocessed, and that processing can effectively reduce the hepatotoxicity of Polygoni Multiflori Radix. Traditional transaminase liver function indicators were not sensitive for crude Polygoni Multiflori Radix induced liver damage. The serum content of DBIL and TBIL can reflect the liver damage induced by crude Polygoni Multiflori Radix early and can be sensitive indicators for clinical monitoring the usage of it.
Animals ; Chemical and Drug Induced Liver Injury ; etiology ; Chemistry, Pharmaceutical ; methods ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; toxicity ; Female ; Liver ; drug effects ; injuries ; Male ; Plant Roots ; chemistry ; toxicity ; Polygonum ; chemistry ; toxicity ; Rats

Objective To observe the improvement of universal and specifical quality of life score caused by morning exercises and related nursing intervention of post-menopausal women with coronary heart disease.Methods Thirty-five post-menopausal female patients with coronary heart disease (CHD) from a community of Shenyang south lake street were involved in the study.They participated in the morning exercises consisting of a constant speed walking on level road in the morning,with the speed of 50 ～ 80 m/min,once a day,lasting 30 ～ 50 min each time,3 ～ 5 times a week,with 12 weeks as one course of treatment,and received related nursing intervention referring to community nursing model during morning exercises.Thirty-two postmenopausal women with CHD who was not participated in the morning exercises were as control group.They were respectively received the assessment of health questionnaire (SF-36),Seattle angina symptoms questionnaire (SAQ) and post-menopausal women common physical and mental symptoms self rating scale (Kupperman self-rating scale) quality of life in 3 days and 12 weeks.Results No significant difference was found in the first SF-36 scale assessment (P ＞ 0.05),while,12 weeks later,each dimension point of the morning exercises group was significantly higher than those of the first assessment as well as the control group.The SAQ score (87.02 ± 16.4) in morning exercises group was significantly higher than first assessment (64.59 ± 10.87),as well as the data 12 weeks later in control group (68.24 ± 9.98),the differences was statistically significant (t =2.483,2.290;P ＜ 0.01).In the first assessment of Kupperman self-rating scale,each clause score and final score of the two groups was no significant difference (P ＞ 0.05).While after 12 weeks,most clause scores and final score (24.62 ± 4.10) of the morning exercises group were significantly lower than the first assessment(31.24 ± 5.89) and the control group (29.95 ± 5.76),the differences was statistically significant(t =2.454,2.218 ;P ＜ 0.01).Conclusions Morning exercises and related nursing intervention can definitely improve the scores of universal and specific quality of life of the post-menopausal women with coronary heart disease.

OBJECTIVETo evaluate the effect of promoting male circumcision among the general population in the high HIV prevalence areas of Guangxi Province.

METHODSWe interviewed 590 male residents from Hezhou and Qinzhou areas of Guangxi Province and conducted intervention using male circumcision promotion materials and various methods. If the subjects were willing and had no contraindication, they were referred to the appointed hospitals to receive circumcision. We conducted follow-up visits at 6 and 9 months after intervention for the changes in the subjects' knowledge, attitude and practice related to male circumcision.

RESULTSThe male circumcision knowledge, willingness and operation rate were significantly improved after intervention (P < 0.05), but with no significant difference between the two follow-up visits (P > 0.05). The number of those who knew that phimosis and redundant prepuce were the reasons for circumcision increased from 66.1% at baseline to 81.9% and 79.8% at the two follow-up visits; those who knew that circumcision could prevent AIDS and sexually transmitted diseases increased from 28.0% to 77.4% and 78.6%; those who knew that surgical complications could be pain, bleeding and infection increased from 29.5%, 19.3% and 39.3% to 72.5%, 58.2% and 59.4% at the first follow-up and 75.0%, 57.0% and 63.0% at the second; those who were willing to receive circumcision increased from 35.3% at baseline to 59.6% and 61.3% at the two follow-up visits; and the rate of surgery increased from zero to 12.7% and 16.1%.

CONCLUSIONThe promotion of male circumcision among the general population in the high HIV prevalence areas of Guangxi Province significantly improved their knowledge, attitude and practice related to AIDS prevention. And the promotion activities should focus on the publicity of AIDS knowledge, risks of phimosis and redundant prepuce, and safety of circumcision.

Acquired Immunodeficiency Syndrome ; prevention & control ; Adult ; China ; Circumcision, Male ; psychology ; Health Education ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Phimosis ; surgery ; Prevalence ; Surveys and Questionnaires

Objective To investigate the relationship of iatrogenic anemia and diagnosis blood loss for patients in RICU,and the change of the anemia before and after the optimized phlebotomy.Methods A prospective study was performed including 69 patients in RICU who met the inclusion criteria during January 2011 to May 2012.The patients adopted from January 2011 to July 2011 were assigned into control group (n =37) and from August 2011 to May 2012 were assigned into observation group (n =32).The control group received the conventional phlebotomy,while the observation group received optimized blood collection method aimed at reducing the blood loss volume respectively.Results In the control group the number of patients with anemia at the 7th day was more than that of the 1st day (23 vs 6 ; x2 =16.388,P =0.000) ; there was difference in Hbd1,Hbd3,Hbd7 (P ＜ 0.05) ; the mean daily phlebotomy volume of the first three days was greater than that of the last four days (P ＝ 0.000) ; Hbc1-3 and Hbc1-7 wcre related with BLd1-3,Hbc4-7 was related with BLd4-7 (P ＜0.05) ; BLd1-3,BLd4-7,BLd1-7 were related with APACHE Ⅱ score positively (P ＜ 0.05).In observation group there was no difference in the proportion of patients with anemia between the 7th day and the 1st day (19 vs 14 ;x2 =1.564,P =0.211); Hbd1,Hbd3 and Hbd7 were no difference (P ＞0.05); the average daily blood loss volume of the first three days was greater than that of last four days (P ＜ 0.05) ; Hbc1-3,Hbc4-7,Hbc1-7 were not related with BLd1-3,BLd4-7 and BLd1-7 (P ＞ 0.05).BLd1-3,BLd4-7 and BLd1-7 were unrelated with APACHE Ⅱ scores (P ＞ 0.05).BLd1-3,BLd4-7,BLd1-7,Hbc1-3,Hbc1-7 in the control group were greater than those of the observation group (P ＜ 0.05) ; there was no difference in Hbc4-7 between the two groups (P ＞ 0.05).Conclusions Diagnostic blood loss can cause the iatrogenic anemia of patients in RICU,and optimizing the blood collection method and enhancing blood conservation can reduce the incidence of iatrogenic anemia.

Objective To investigate the characteristics of MRSA colonization and their influence to the prognosis of patients in respiratory intensive care unit (RICU),so as to provide the basis for the caring of the RICU patients.Methods A prospective study included 246 cases of patients admitted to RICU in our hospital during Jan 2010 to Neb 2011.Swab specimens from nares,pharynx,axillae,groin,chest and hands of the patients were collected and cultured at the first day in RICU,and then repeated every 3 days.The patients were divided into MRSA colonization group (n =30) and MRSA non-colonization group (n =216) according to MRSA culture results.Results The MRSA colonization rate was 12.19％ in RICU patients,including 16 cases of hospital-acquired colonization.No significant difference was found in the gender,the APACHE Ⅱ score and APACHE Ⅲ between MRSA colonization group and the MRSA non-colonization group (P ＞ 0.05).The mean age in MRSA colonization group was significantly greater than that of the MRSA non-colonization group [(81.13 ± 6.86) vs (74.78 ± 11.89) ; t =2.955,P =0.003)] ; The number of hospitalization and the mortality in one year of the MRSA colonization group was significantly more than those of MRSA non-colonization group [(1.83 ±1.216) vs (1.06 ±0.257),40.0％ vs 16.7％ ;t =2.998,x2 =9.132;P＜0.01)].MRSA was mainly colonized in nares.Conclusions MRSA colonization has an important impact on the prognosis of RICU patients.More than 50％ of MRSA colonization cases are hospital-associated,suggesting that we should strengthen the bedside care,prevention of cross infection.