Objective To explore and evaluate the micro-elimination mode of hepatitis C virus(HCV)in patients in a general hospital in Jiangxi Province,and provide reference for formulating provincial strategies to eliminate the public health hazards of HCV.Methods Relevant data of hospitalized patients who received HCV screening at the hospital from January 2021 to December 2022 were collected.Data from 2021 were set as the baseline and data from 2022 as the HCV micro-elimination mode operating data.Indexes such as gender,age,department,anti-HCV posi-tive rate,HCV-RNA positive rate,etc.were analyzed.The operational effect was analyzed based on specialty de-partment visiting rate,treatment rate,and loss-to-follow-up(LTFU)rate.The development of the mode was quan-titatively evaluated by superiority weakness opportunity threats-analytic hierarchy process(SWOT-AHP)method.Results A total of 397 744 hospitalized patients underwent anti-HCV screening from 2021 to 2022,with a male to female ratio of 1.34∶1 and an average age of 54 years old.The main departments for patients receiving screening were infectious diseases/gastroenterology departments.HCV gene subtypes in specimens from 62 patients was mainly subtype 1b(43 specimens),followed by subtype 6(9 specimens).The first HCV early warning rate after mode operation was 81.20％,the anti-HCV detection rate after warning was 93.15％,and the anti-HCV detection rate after subsequent pop-up window early warning was 100％.Compared with 2021,the treatment rate of HCV hospi-talized patients in 2022 has increased,with statistically significant difference(P＜0.05).However,there were no statistically significant differences in patients'specialty department visiting rate and LTFU rate(both P＞0.05).Barycentric coordinates calculation P(X,Y)=(0.018 2,0.006 9)located in the first quadrant.Conclusion The HCV micro-elimination mode for patients in a general hospital in Jiangxi Province is feasible and effective.Further mode optimization should focus on strengths/opportunities(SO)strategy,to rely on internal advantages and utilize external opportunities.

OBJECTIVE: To investigate the clinical efficacy of unicompartmental knee arthroplasty (UKA) in the treatment of knee osteoarthritis in patients over 75 years old. METHODS: The clinical efficacy of primary fixed platform UKA in patients with osteoarthritis, was retrospectively analyzed from October 2014 to November 2020. Age, body mass index (BMI), range of motion (ROM), preoperative joint function score, the quality of life score and other preoperative indicators were measured by propensity score matching (PSM). The patients were divided into elderly group (≥75 years old) and control group (<75 years old). Oxford knee score(OKS), Western Ontario McMaster Universities osteoarthritis index(WOMAC), Short Form-12 including physical component summary (PCS), mental component summary(MCS), minimal clinically important difference(MCID ) and clinical complications were evaluated preoperatively and postoperatively. RESULTS: A total of 514 patients were analyzed, 428 patients fulfilled the inclusion criteria. A propensity-score matching study was conducted to eliminate confounding factors. After 1∶2 propensity match, there were 84 patients in elderly group (≥75 years), age ranged from 75 to 88 years old, with an average of (78.79±3.08) years old, and 168 patients in control group (<75 years), age ranged from 47 to 74 years old, with an average of (64.10±5.96)years old. The follow-up duration of two groups ranged from 12 to 84 months with an average of (29.35±16.52) months in elderly group, and 12 to 85 months with an average of (31.83±17.34) months in control group. There was only significant difference in age between the elderly and control groups preoperatively (P<0.01). Postoperatively, the elderly group showed significantly higher WOMAC (P<0.01) and lower SF-12 PCS scores (P<0.01) as compared to the control group. There was no significant difference between the elderly group and the control group in knee range of motion, OKS and the proportion of each scoring system reaching the minimum clinical difference value (P>0.05). In the aspect of preperative complications, the elderly group exhibited more surgical site complications and postoperative delirium compared to control group(P<0.05). The differences in other indicators including deep vein thrombosis, acute urinary retention, cardiovascular events, cerebrovascular events and radiolucent lines around prothesis were not statistically significant(P>0.05). CONCLUSION UKA in the treatment of elderly patients over 75 years old with knee osteoarthritis was safe and feasible, and could obtain satisfactory short-term efficacy.
Humans ; Aged ; Aged, 80 and over ; Middle Aged ; Osteoarthritis, Knee/surgery* ; Knee Prosthesis ; Retrospective Studies ; Propensity Score ; Quality of Life ; Knee Joint/surgery* ; Arthroplasty, Replacement, Knee/methods* ; Treatment Outcome

Objective: To compare and analyze the clinical efficacy of pancreaticoduodenectomy for distal bile duct cancer and pancreatic head cancer. Methods: Clinical data of 1 005 patients who underwent pancreaticoduodenectomy and postoperative pathological examination confirmed the diagnosis of distal bile duct cancer and pancreatic head cancer at the Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were analyzed retrospectively. There were 112 cases in the distal bile duct cancer group, 71 males and 41 females,with age (M(IQR)) of 65(15) years(range: 40 to 87 years); 893 cases in the pancreatic head cancer group, 534 males and 359 females,with age of 64(13)years(range: 16 to 91 years). The differences between clinicopathological characteristics and postoperative overall survival of the two groups were analyzed by χ² test, Fisher's exact probability method, rank sum test or log-rank test, respectively. The difference in postoperative overall survival between the two groups was compared using Kaplan-Meier method after propensity score matching (1∶1). Results: Compared with the pancreatic head cancer group,the distal bile duct cancer group had shorter operative time (240.0(134.0) minutes vs. 261.0(97.0) minutes, Z=2.712, P=0.007),less proportion of combined venous resection (4.5% (5/112) vs. 19.4% (173/893), χ²=15.177,P<0.01),smaller tumor diameter (2.0(1.0) cm vs. 3.0(1.5) cm,Z=10.567,P<0.01),higher well/moderate differentiation ratio (51.4% (56/112) vs. 38.0% (337/893), χ²=7.328, P=0.007),fewer positive lymph nodes (0(1) vs. 1(3), Z=5.824, P<0.01),and higher R0 resection rate (77.7% (87/112) vs. 38.3%(342/893), χ²=64.399, P<0.01),but with a higher incidence of overall postoperative complications (50.0% (56/112) vs. 36.3% (324/892), χ²=7.913,P=0.005),postoperative pancreatic fistula (28.6% (32/112) vs. 13.9% (124/893), χ²=16.318,P<0.01),and postoperative abdominal infection (21.4% (24/112) vs. 8.6% (77/892), χ²=18.001,P<0.01). After propensity score matching, there was no statistical difference in postoperative overall survival time between patients in the distal bile duct cancer group and the pancreatic head cancer group (50.6 months vs. 35.1 months,Z=1.640,P=0.201),and multifactorial analysis showed that tumor site was not an independent risk factor affecting the prognosis of patients in both groups after matching (HR=0.73,95%CI:0.43 to 1.23,P=0.238). Conclusions: Patients with distal bile duct cancer are more likely to benefit from early diagnosis and surgical treatment than patients with pancreatic head cancer,but with a relative higher postoperative complication rates. The different tumor origin site is not an independent risk factor for prognosis of patients with distal bile duct cancer and pancreatic head cancer after propensity score matching.
Bile Ducts ; Female ; Humans ; Male ; Pancreas ; Pancreatic Neoplasms/surgery* ; Pancreaticoduodenectomy ; Retrospective Studies ; Treatment Outcome

More and more studies have found that red blood cell distribution width (RDW) can be used for acute pancreatitis (AP) classification, dynamic monitoring and evaluation of disease severity, mortality, prognosis and complication. Some inflammatory markers, such as procalcitonin (PCT), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and pancreatitis scoring system are also associated with severity of AP, and can further improve the evaluation of AP severity when combined with RDW. This article reviewed the RDW and classification of AP, the dynamic changes of RDW and AP, RDW combined with inflammatory indices for prediction of severity of AP, and RDW combined with pancreatitis scoring system for prediction of severity of AP, so as to improve the understanding of predictive value of RDW in assessing the severity of AP.

Background/Aims: Gastroparesis is commonly seen in patients with diabetes and functional dyspepsia with no satisfactory therapies. Dysautonomia is one of the main reasons for the imbalanced motility. We hypothesized that spinal cord stimulation (SCS) is a viable therapy for gastroparesis via the autonomic modulation to improve gastric motility. The aim is to find an optimal method of SCS for treating gastroparesis. Methods: Eight healthy-female dogs were implanted with a gastric cannula, a duodenal cannula, 2 multi-electrode spinal leads, and an implantable pulse generator. Gastric motility index (MI) was used to determine the best stimulation location/parameters of SCS. Optimized SCS was used to improve glucagon-induced gastroparesis. Results: With fixed parameters, SCS at Thoracic 10 (T10) was found most effective for increasing gastric MI (37.8%, P = 0.013). SCS was optimized with different parameters (pulse width: 0.05-0.6 msec, frequency: 5-500 Hz, motor threshold: 30-90%) on T10. Our findings revealed that 0.5 msec, 20 Hz with 90% motor threshold at T10 were the best parameters in increasing MI. Glucagon significantly delayed gastric emptying, and this inhibitory effect was partially blocked by SCS. Gastric emptying at 120 minutes was 25.6% in the control session and 15.7% in glucagon session (P = 0.007 vs control), while it was 22.9% with SCS session (P = 0.041 vs glucagon). SCS with the optimal parameters was found to maximally enhance vagal activity and inhibit sympathetic activity assessed by the spectral analysis of heart rate variability. Conclusions SCS with optimized stimulation location and parameters improves gastric motility in healthy-dogs and accelerates gastric emptying impaired by glucagon via enhancing vagal activity.

Myocardial fibrosis (MF) is an important pathological change involved in the progress from myocardial infarction (MI) to heart failure(HF). Metabolic disorder of arachidonic acid (AA) in cardiomyocytes plays an important role in process of MF. Fufang Danshen tablets is a traditional Chinese medicine (TCM), which showed significant effect on coronary heart diseases and anti-MF. However, the underlying mechanism of anti-MF remains unclear. In this study, HF animal model of myocardial infarction was established by ligation of left anterior descending coronary artery. The heart function of rats in each group was evaluated by echocardiography and hemodynamic measurement. Histological examination, TUNEL and Western blot were used to detect the levels of MF and proteins related to AA metabolism. As a result, MI significantly decreased the levels of ejection fraction (EF), ejection fraction (FS) and left ventricular systolic pressure (LVSP), and these decreases were significantly improved by the treatment of Fufang Danshen tablets. Besides, Fufang Danshen tablets treatment down-regulated the levels of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) in serum. HE, Masson and TUNEL staining results showed that Fufang Danshen tablets treatment could inhibit the inflammatory cells infiltration and attenuate the fibrosis and apoptosis to exert cardioprotective effect. Western blot indicated that Fufang Danshen tablets treatment down-regulated the expressions of AT₁, MMP2, MM9, while up-regulated the expression of AT₂ to inhibit MF. Further mechanism study indicated that Fufang Danshen tablets inhibited MF by down-regulated the expressions of AA metabolism, such as PLA2, P450, COX2 and 5-LOX. In summary, Fufang Danshen tablets can effectively inhibit MF in the ischemic area after MI in rats. The mechanism is related to the regulation of AT₁-mediated PLA2-COX2 metabolic pathway.

Background: Right upper lobectomy (RUL) for lung cancer with different dissecting orders involves the most vari-able anatomical structures, but no studies have analyzed its effects on postoperative recovery. This study compared the conventional surgical approach, VAB (dissecting pulmonary vessels first, followed by the bronchus), and the alter-native surgical approach, aBVA (dissecting the posterior ascending arterial branch first, followed by the bronchus and vessels) on improving surgical feasibility and postoperative recovery for lung cancer patients. Methods: According to the surgical approach, consecutive lung cancer patients undergoing RUL were grouped into aBVA and VAB cohorts. Their clinical, pathologic, and perioperative characteristics were collected to compare periop-erative outcomes. Results: Three hundred one patients were selected (109 in the aBVA cohort and 192 in the VAB cohort). The mean operation time was shorter in the aBVA cohort than in the VAB cohort (164 vs. 221 min, P < 0.001), and less blood loss occurred in the aBVA cohort (92 vs. 141 mL, P < 0.001). The rate of conversion to thoracotomy was lower in the aBVA cohort than in the VAB cohort (0% vs. 11.5%, P < 0.001). The mean duration of postoperative chest drainage was shorter in the aBVA cohort than in the VAB cohort (3.6 vs. 4.5 days, P = 0.001). The rates of postoperative complica-tions were comparable (P = 0.629). The median overall survival was not arrived in both cohorts (P > 0.05). The median disease-free survival was comparable for all patients in the two cohorts (not arrived vs. 41.97 months) and for patients with disease recurrences (13.25 vs. 9.44 months) (both P > 0.05). The recurrence models in two cohorts were also comparable for patients with local recurrences (6.4% vs. 7.8%), distant metastases (10.1% vs. 8.3%), and both (1.8% vs. 1.6%) (all P > 0.05). Conclusions: Dissecting the right upper bronchus before turning over the lobe repeatedly and dissecting veins via the aBVA approach during RUL would promote surgical feasibility and achieve comparable postoperative recovery for lung cancer patients.

This study is to establish an HPLC-DAD-ELSD method for simultaneous determination of 5 flavones and saponins in Rhizoma Anemarrhenae including neo-mangiferin, mangiferin, timosaponin B II, timosaponin B III and timosaponin A III. Samples were analyzed on a Merck Purospher STAR column(4.6 mm x 250 mm, 5 μm). The mobile phase consisted of acetonitrile( A) and 0. 1% formic acid (B) with gradient elution at a flow rate of 1.0 mL · min(-1). The column temperature was set at 40 °C. The DAD detector wavelength was set at 254 nm. The ELSD conditions were as follows: the nebulizing gas flow rate was 2.0 L · min(-1) and temperature of drift tube was 105 °C. The volume was 10 μL. The five compounds were well separated with good linear correlations. The mean recoveries were between 102.0%-104.0%. This method was quick and reliable which provides a foundation for quality control of R. Anemarrhenae.
Anemarrhena ; chemistry ; Chromatography, High Pressure Liquid ; instrumentation ; methods ; Drugs, Chinese Herbal ; analysis ; Flavones ; analysis ; Rhizome ; chemistry ; Saponins ; analysis

BACKGROUND:Studies have shown that cytokine inhibitor pirfenidone can inhibit biological activity of fibroblasts by regulating a variety of cytokines. It has made good progress in the research and application of anti-fibrosis of internal organs, but the effect and mechanism for hypertrophic scars and skin fibroblasts are unclear. OBJECTIVE:To investigate the effect of pirfenidone on human hypertrophic scar fibroblasts. METHODS:Human hypertrophic scar fibroblasts were cultured using tissue culture method. Passages 3-6 cel s grew wel in the logarithmic growth phase were col ected. Cel s were divided into the control group (0 g/L pirfenidone), 0.15, 0.3 and 1 g/L pirfenidone groups according to different mass concentrations. Cel s were intervened for 12, 36 and 48 hours. RESULTS AND CONCLUSION:MTT, reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay results demonstrated that compared with the control group, cel proliferation, transforming growth factorβ1 mRNA expression, types I and III col agen secretion were decreased in the 0.15, 0.3 and 1 g/L pirfenidone groups (P<0.05), and the decrease was most significant in the 1 g/L pirfenidone group (P<0.05). At 24, 48 and 72 hours after intervention, significant differences in inhibitory rate of cel proliferation and the secretion of types I and III col agen were detected among 0.15, 0.3 and 1 g/L pirfenidone groups (P<0.05). Results confirmed that pirfenidone apparently inhibited the secretion of col agen of hypertrophic scar fibroblasts cultured in vitro, transforming growth factorβ1 expression and cel proliferation and viability.

Objective To explore the prognostic factors of community -acquired pneumonia (CAP)among children. Methods A total of 783 children with CAP admitted to hospital from 2009 to 2012 were selected.Related information including baseline data was extracted from the hospital health records and analyzed by univariate and multiple logistic regression analysis.Results The logistic regression analysis showed that obnubilation (OR =5.866,95%CI =2.020 -17.033),dysphoria (OR =1.420,95%CI =1.038 -1.942),multi -infection(OR =1.376,95%CI =0.993 -1.907) and polypnea(OR =1.026,95%CI =1.004 -1.049)were the independent risk factors that influenced the prognosis of patients with community -acquired pneumonia.Conclusion More attentions should be paid to CAP children with the symptoms of obnubilation,dysphoria,multi -infection and polypnea.