Objective:To discuss the possibility of modifying nonfunctional distractors to improve the quality of multiple-choice questions in medical examination through analyzing the changes in the difficulty and discrimination of items and the selection rate of modified distractors.Methods:Thirty-two multiple-choice questions involving nonfunctional distractors from a medical examination were studied. According to the item-writing guidelines, experts modified nonfunctional distractors based on actual measurements. We analyzed the changes in the difficulty and discrimination of items and the selection rate of modified distractors before and after item modification using the paired Wilcoxon test, and investigated the correlation of item difficulty and discrimination before and after item modification by Spearman's rank correlation analysis.Results:Six questions were modified due to technical factors, and 26 questions were modified due to weak interference in knowledge content. Before and after nonfunctional distractor modification, the difficulty values of the questions were 0.676 (0.558, 0.893) and 0.637 (0.531, 0.839), respectively; the discrimination values (point-biserial correlation) were 0.261 (0.150, 0.316) and 0.262 (0.138, 0.358), respectively; and the discrimination index values were 0.215 (0.113, 0.352) and 0.259 (0.138, 0.346), respectively. There were significant differences in the difficulty and discrimination index of items before and after modification. The difficulty and discrimination of items before and after modification were both significantly correlated. The selection rates of modified distractors were 0.009 (0.003, 0.015) and 0.044 (0.021, 0.092) before and after modification, respectively, which were significantly different.Conclusions:Nonfunctional distractors in this study were mainly caused by reasons in the contents of the test questions, less in technical defects. Through the analysis and modification of nonfunctional distractors, the selection rate of nonfunctional distractors can be effectively increased, and item difficulty and discrimination can be improved.

In recent years,steady progress has been made in the epidemiology,pathogenesis,and therapeutic targets of nonalcoholic steatohepatitis(NASH),while there has been slow progress in the field of therapeutic drug development.This article reviews the advances in lifestyle intervention,surgical methods,gut microbiota,and drugs in the treatment of NASH,especially the role of insulin sensitizers,antioxidants,cholesterol-lowering drugs,thyroid hormone mimetics,incretins,and cytokines in the treatment of NASH,in order to provide more methods and options for the treatment of NASH in the future.

Objective To explore the characteristics of opportunistic infections(OIs)in HIV-infected indi-viduals with suboptimal immune reconstitution after ART treatment so as to provide a reference for preventing and managing HIV infections.Methods The clinical data including opportunistic infections specifically were acquired from 112 HIV-infected individuals with suboptimal immune reconstitution from the outpatient department of Wuming Hospital,Guangxi Medical University.The impact of baseline CD4+T lymphocyte counts on the incidence,type,and mixed infection rates of the opportunistic infections were analyzed.Results The opportunistic infection rate among the 112 HIV-infected individuals with suboptimal immune reconstitution was 42.86%,among which fungal infections were the most commonly seen.The opportunistic infection rate of the patients with a baseline of CD4+T lymphocyte counts≤50/μL was significantly higher than that of the patients with a baseline of CD4+T lymphocyte counts>50/μL,and there was no significant difference in the type of opportunistic infections as well as the rate of mixed infections.Conclusion HIV-infected people with suboptimal immune reconstitution in Guangxi are susceptible to HIV OIs.Among them,the group with a baseline CD4+ T lymphocyte counts≤50/μL has a higher rate of OIs,mainly fungal infections.

Objective:To investigate the effect of SCN1A gene polymorphism (SCN1A-rs3812718) on the alterations of spontaneous brain activity using amplitude of low-frequency fluctuations (ALFF) of MR in patients with temporal lobe epilepsy (TLE).Methods:A total of 37 TLE patients (TLE group) admitted to the Epilepsy Center of the 900th Hospital of Joint Logistic Team from March 2018 to August 2019 were retrospectively analyzed, and another 28 healthy volunteers matched for gender, age, and years of education with the TLE group were selected as the healthy control group (HC group). Sixty-five subjects were divided into four groups by genotype and diagnosis: 34 cases in AA/AG-TLE subgroup, 3 cases in GG-TLE subgroup, 20 cases in AA/AG-HC subgroup and 8 cases in GG-HC subgroup. All subjects underwent sagittal 3D-T 1WI and resting-state functional MRI using a Siemens 3.0 T Trio Tim MR scanner. Then ALFF values of the four groups were calculated using DPABI by the MATLAB 2010 platform. The ALFF values between two groups were compared by independent samples t-test. The ALFF values of different genotypes at rs3812718 locus in TLE and HC group were analyzed by multivariate analysis of variance to find out the corresponding brain regions with interaction, and then post hoc simple effect analysis was performed. Results:The ALFF values in TLE group significantly increased in left marginal lobe, left parahippocampal gyrus, left fusiform gyrus, left hippocampus, right insular lobe and right inferior temporal gyrus (Alphasim corrected P<0.001) and decreased in the left superior frontal gyrus, left middle frontal gyrus, left inferior frontal gyrus, right middle frontal gyrus, right precuneus, left precuneus, bilateral cingulate gyrus and right angular gyrus (Alphasim correction P<0.05) compared with HC group. Subjects carrying the non-risk G allele had higher ALFF values in the right inferior temporal gyrus, right fusiform gyrus, and right cerebellum than subjects carrying the risk A allele ( t=3.30, Alphasim corrected P=0.002). There was a significant interaction effect on posterior cerebellar lobe, left anterior cerebellar lobe, left inferior temporal gyrus, left superior parietal lobule and right precuneus of TLE patients with SCN1A-rs3812718 genotype. Post-hoc simple effect analysis showed that ALFF significantly increased in the left posterior cerebellar lobe, left anterior cerebellar lobe, left inferior temporal gyrus and left fusiform gyrus in GG-TLE subgroup ( t=5.97, P<0.001), but significantly decreased in the right superior parietal lobule, right precuneus, right posterior cerebellar lobe in AA/AG-TLE subgroup compared to the HC group. Compared with GG-TLE subgroup, ALFF in left posterior cerebellar lobe, left fusiform gyrus and left inferior temporal gyrus decreased in AA/AG-TLE subgroup. Conclusion:SCN1A gene polymorphism in the rs3812718 locus affects spontaneous neural activity in resting state, which may be one of the pathophysiological mechanisms of TLE.

Objective:To investigate the medicinal retention of different concentrations of melatonin in the bone tissue of type 2 diabetic osteoporosis (T2DOP) rats and explore to efficacy of improvement of the bone microstructure of T2DOP rats.Methods:A total of 95 SD rats were selected, 60 of which had intraperitoneal in jection of high-fat diet combined with low-dose streptozotocin establishing a T2DOP rat model. Two months later, 45 rats' model was determined to be successful by detecting blood glucose and insulin sensitivity index. 30 successful modelling and 30 normal SD rats were randomly selected for melatonin distribution experiment, and were divided into four groups according to the injected melatonin concentration, including modeling rat high concentration group (50 mg/kg), modeling rat low concentration group (10 mg/kg), normal rat high concentration group (50 mg/kg) and normal rat low concentration (10 mg/kg), and there were15 rats in each group. Each group was divided into 5 sub-groups according to the time point of sampling (5, 15, 30, 60, 120 min), 3 animals per group. The bone tissue of each group was pretreated, and then the melatonin drug distribution in the bone tissue was detected by high performance liquid chromatography (HPLC). Another 15 rats were successfully modeled, and were divided into T2DOP group, high melatonin group (50 mg/kg) and low melatonin group (10 mg/kg), 5 rats in each group. 5 normal SD rats were taken as controls (control group), and Micro-CT was used to detect changes in bone microstructure after 8 weeks of treatment with melatonin.Results:The results of the drug distribution experiment showed that after melatonin was injected intraperitoneally, there were drugs remaining in the bone tissues of the rats in each group. The drug concentration reached the highest after 30 min of administration, and significantly decreased after 120 min. Compared with the normal rat low concentration group, there was no significant difference in the drug concentration between the two groups at 5 time points. However, the drug concentration at the four time points of 5, 15, 30, and 60 min in the modeling rat high concentration group were 7.613±2.568 ng/ml, 13.983±2.262 ng/ml, 18.816±1.291 ng/ml, 6.172±1.962 ng/ml, 1.112±0.566 ng/ml, which were significantly different compared with normal rat high group. Micro-CT results showed that after 8 weeks of melatonin treatment, the bone density of the high concentration group was (205.72±28.41 g/cm 3) significantly lower than that in the low concentration group (223.63±35.41 g/cm 3), but both groups were significantly higher than the normal rat group (158.31±31.86 g/cm 3). Conclusion:Exogenous melatonin is distributed in bone tissue, and the drug absorption rate of T2DOP rats is higher. Meanwhile, there is no difference in the distribution of melatonin in bone tissue with different concentrations, and these two concentrations of melatonincan canimprove the bone microstructure of T2DOP rats.

Objective To investigate the therapeutic effect of anteromedial ankle approach for talus fracture.Methods From January 2012 to October 2018,the data of 28 cases of talus fracture treated by anteromedial ankle approach were retrospectively analyzed,including 26 males and 2 females,aged 24-61 years with an average of 38.6 years.All 25 cases of closed injuries and 3 cases of open injuries were fresh injuries.There were 16 cases of traffic injuries,8 falling injuries,2 heavy object injuries and 2 sprains.Among the 28 patients,17 were talus neck fractures,and according to Hawkins talus neck fracture classification,there were 1 case of type Ⅰ,12 type Ⅱ,and 4 type Ⅲ.There were 11 cases of talus fracture,which were classified according to Sneppen talus fracture types:2 cases of type Ⅰ,8 cases of type Ⅱ and 1 case of type Ⅴ.Among them,2 cases of talus neck fracture complicated with T12 vertebral body fractures and 2 cases complicated with calcaneal fractures.The time from injury to operation for 3 patients with open fracture was 3-6 hours.25 cases of closed fracture injuries took 2-10 hours to operate,with an average time of 5.6 hours.All patients were fixed with cannulated screws through the anteromedial ankle approach.The weight-bearing time and strength of lower limbs were determined according to fracture healing after surgery.The ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Score.Results All 28 patients were followed up for 23 to 82 months,with an average of 37.5 months.All fractures healed.The healing time of talus neck fracture was 3.5-8 months,with an average of 5 months.The healing time of talus fracture was 3-7 months,averaging 4.5 months.At the latest follow-up,AOFAS score ranged from 68 to 100,with an average of 82.5 points,including excellent in 15 cases,good in 8 cases,fair in 4 cases and poor in 1 case,with the excellent and good rate of 82.1％ (23/28).There were no signs of fracture displacement,malunion,loosening and prolapse of internal fixation,fracture and ischemic necrosis of talus after operation.Traumatic arthritis occurred in 9 patients,with an incidence rate of 32.1％ (9/28).Tibial joint was involved in 5 cases,talus joint in 3 cases,tibialis in 1 case and talus joint in 1 case.Among them,traumatic arthritis occurred in 2 cases of open injury.Nine patients (32.1％) suffered from traumatic arthritis 6-10 months after operation,with an average of 8 months.According to conservative treatments such as weight control,ankle immobilization,physiotherapy,anti-inflammatory and analgesic,nutrition of articular cartilage drugs,joint traction and plasty were given.The patients' conditions improved to different degrees and could tolerate walking and normal life and work.Conclusion The anteromedial ankle approach has the advantages of minimal vessel injuries,clear exposure for direct reduction,low rate of necrosis of talus and satisfactory curative effect.

OBJECTIVETo evaluate the current feeding status of infants and young children under 2 years old in rural areas of Hubei province.

METHODSThe study was conducted by cluster random sampling from September 2009 to march 2010. The data on breastfeeding and complementary food supplement of the 1 197 infants and young children aged 0-23 months in 8 counties of Hubei province were collected through questionnaires. The feeding status was analyzed according to the WHO 2008 edition of Indicators for assessing infant and young child feeding practices.

RESULTSA total of 1 197 children aged 0-23 months were investigated. The rate of ever breastfeeding of children aged 0-23 months reached up to 93.9% (1 124/1 197), while the percentage of early initiation of breastfeeding was only 22.0% (263/1 197). The rates of exclusive breastfeeding under 6 months, continued breastfeeding for 1 year, and continued breastfeeding for 2 years were 72.1% (277/384), 17.0% (26/153) and 4.9% (7/144), respectively. The median time of giving complementary food was the 6th month and the weaning time was the 9th month. The rate of complementary food supplemented from 6th-8th month in time was 61.8% (444/718) . The rates of minimum dietary diversity, minimum meal frequency, minimum acceptable diet, and consumption of iron-rich or iron-fortified foods among children aged 6-23 months were 61.7% (502/813), 81.5% (663/813), 54.4% (442/813) and 50.1% (407/813), respectively.

CONCLUSIONLate initiation of breastfeeding, non-continued breastfeeding, giving complementary food too early or too late, inadequate category and frequency of complementary food, and the low rate of consumption of iron-rich or iron-fortified foods were the main issues to be concerned on infant feeding in rural areas of Hubei province.

Breast Feeding ; statistics & numerical data ; Child, Preschool ; China ; Diet Surveys ; statistics & numerical data ; Feeding Behavior ; Humans ; Infant ; Infant Food ; statistics & numerical data ; Rural Population ; Surveys and Questionnaires ; Weaning

Objective To investigate the effect of Th1/Th2 cytokines and immune state on the occurrence and familial aggregation of hepatocellular carcinoma(HCC).Methods Ninety-five members whose families have had two or even more HCC patients(high-occurrence families) were selected as the case group,by matching with the same nationality,gender,residential area,age±5 years old,95 members whose families had no any cancer were selected as the control.The level of peripheral blood Th1 type cytokines such as interferon-γ(IFN-γ),interleukin-2(IL-2) and Th2 type cytokines such as interleukin-4(IL-4),interleukin-10 (IL-10) were detected by enzyme linked immunosorbent assay(ELISA).Results There was a Th1/Th2 serum cytokine imbalance profile in members of HCC high-occurrence family.The levels of IFN-γ and IL-2 were significantly lower in members of HCC high-occurrence family than that of the controls.The levels of IL-4 and IL-10 were higher in members of HCC high-occurrence family than that of the controls.Conclusion There was a poor cellular immune state in members of HCC in the high-occurrence families.Th1 type cytokines was inhibited,and Th2 type cytokines was enhanced,so more susceptible to HBV chronic infection.It might be the mechanism of HCC occurrence and familial aggregation.

Objective To evaluate the midterm results of the revision total hip replacement with a fluted and tapered modular stem. Methods Nineteen patients (21 hips) underwent revision total hip arthroplasty from May 2000 to August 2005 were reviewed. There were 13 females and 6 males, with an average age of 67 years. Pre-revision diagnosis included aseptic loosening of the cups and stems associated with femoral defects (Paprosky classification) type Ⅱ 4 hips (19%), type Ⅲa 14 hips (67%), and type Ⅲb 3 hips (14%). The adopted acetabular component was SPH (Lima-Lto, Italy), and femoral component was a fluted and tapered modular stem (Lima-Lto, Italy). Clinical and radiographic evaluations were performed postoperatively. Results The mean follow-up was 7 years (range, 5-10). The Harris hip score improved from 46.2±15.2 preoperatively to 90.3±5.3 postoperatively, and maintain 92.2±3.5 at the latest follow-up. The X-ray films showed bone ingrowths fixation in 20 hips (95%) and fibrous stable fixation in 1 hip (5%). The average stem subsidence was 2.4 mm (range, 0-10 mm). There were no re-revisions of the femoral stem for any reason. Conclusion The midterm results of revision total hip replacement with a fluted and tapered modular stem in Paprosky type Ⅱ, Ⅲ a, Ⅲ b femoral defect associated aseptic loosening of the femoral stem was encouraging.

ObjectiveTo summarize the clinical result of the proximal femoral shaft splitting at sagittal view in primary total hip arthroplasty (THA) in treatment of ultimate hip disease combined with femoral metaphyseal stenosis deformity.MethodsA retrospective study was done on 18 patients with proximal femoral deformity (22 hips including 14 patients with unilateral hips and 4 with bilateral hips)treated from January 2000 to December 2009.There were three males and 15 females, at age range of 41-75 years (average 54 years).According to Berry classification system, all patients were indentified as metaphyseal segment abnormality and deformity, including developmental type disease (congenital hip dysplasia) in 17 patients and old tuberculosis of the hip in one.The congenital hip dysplasia was diagnosed as type Ⅳ by using the Crowe classification system.All the patients were treated with the proximal femoral shaft splitting, subtrochanteric shortening with overlapping femoral resection and V-shaped derotational osteotomy.In the meantime, standard biological fixation of the femoral stem prosthesis was performed.ResultsThere found no dislocation, infection, lower extremity nerve stretch injury or uncontrolled proximal femur fractures.X-ray showed that all acetabular cups were placed at the anatomical position and that the initial femoral stem prosthesis fixation was rated as good.All osteotomy areas were healed within 3-6 months.Limb length discrepancy was restored to average 3 cm after surgery.The patients were followed up for 1-10 years (average six years), which showed that the average Harris hip score was improved from preoperative 30 to postoperative 93, with no aseptic loosening or osteolysis or radiolucent line around the femoral component, no prosthesis sinking or varus displacement, or no patients needing revision of the femoral component.ConclusionsThe proximal femoral shaft splitting at sagittal view and standard biological fixation of the femoral stem prosthesis can attain satisfactory result for patients with ultimate hip disease combined with femoral metaphyseal stenosis deformity.