Objective: To compare the application effect of the colonoscopy, fecal immunochemical test (FIT) and novel risk-adapted screening approach in colorectal cancer screening in Xuzhou population. Methods: From May 2018 to April 2019, 4 280 subjects aged 50-74 were recruited from Gulou district, Yunlong district and Quanshan district of Xuzhou. They were randomly assigned to the colonoscopy group (n=863), FIT group (n=1 723) and novel risk-adapted screening approach group (n=1 694) according to the ratio of 1∶2∶2. For the novel risk-adapted screening approach group, after the risk assessment, high-risk subjects were invited to undergo colonoscopy and low-risk subjects were invited to undergo FIT examination. All FIT positive subjects were invited to undergo colonoscopy. Colonoscopy participation rate [(the number of colonoscopies completed/the number of colonoscopies invited to participate)×100%], detection rate of colorectal lesions [(the number of diagnosed patients/the number of colonoscopies completed)×100%], colonoscopy resource load (the number of colonoscopies completed/the number of diagnosed advanced tumors) and FIT resource load in each group were calculated and compared. Results: The age of all subjects was (61±6) years old, including 1 816 males (42.43%). There was no statistically significant difference in the socio-demographic characteristics of the subjects in different screening groups. The colonoscopy participation rate was 22.60% (195/863) in the colonoscopy group, 57.04% (77/135) in the FIT group, and 33.94% (149/439) in the novel risk-adapted screening approach group, respectively. The colonoscopy participation rate was higher in the FIT group than in the colonoscopy group and the novel risk-adapted screening approach group (P<0.001). The colonoscopy participation rate of novel risk-adapted screening group was significantly higher than the colonoscopy group (P<0.001). The detection rates of advanced tumors were 6.67% (13/195), 9.09% (7/77) and 8.72% (13/149), respectively, and the difference was not statistically significant (P>0.05). The colonoscopy resource load (95%CI) was 15 (13-17) in the colonoscopy group, 11 (9-14) in the FIT group and 11 (10-13) in the novel risk-adapted screening approach group, respectively. Among them, the colonoscopy resource load of high-risk individuals in the novel risk-adapted screening approach group was 12 (9-15). FIT resource loads (95%CI) were 207 (196-218) and 88 (83-94) in the FIT group and the novel risk-adapted screening approach group. Conclusion: The combined application of risk-adapted screening approach and FIT may have a good application effect in colorectal cancer screening.
Aged ; Colonoscopy ; Colorectal Neoplasms/pathology* ; Early Detection of Cancer ; Feces ; Female ; Humans ; Male ; Mass Screening ; Middle Aged ; Occult Blood

In the research and development of new drugs, it is very important to investigate the in vitro metabolism of candidate drugs. Traditional models such as liver microsomes have many limitations, while the in vitro model of recombinant human drug metabolizing enzymes is considered as an important and useful approach because of its convenient access, stable activity and low cost. In this study, six major human UDP-glucuronosyltransferases (UGTs) genes (UGT1A1, 1A3, 1A4, 1A6, 1A9 and 2B7) were cloned from human liver cDNA and heterologously expressed in Saccharomyces cerevisiae and baculovirus-infected insect cell. UGT1A1, 1A3, 1A6 and 1A9 were successfully expressed in yeast and showed glucuronidation activity against a variety of different structural types of substrates, but their activities were low. All six UGTs were successfully expressed and exhibited significantly improved glucuronidation activity when Trichopolusia ni cells BTI-TN5B1-4 (High Five) were used as the host. The recombinant human UGTs expressed in insect cells can catalyze the glucuronidation of their specific substrates, and the glucuronidation products were synthesized at milligram-scale with yields of 13%-66% for the first time, of which the structures were identified via MS, ¹H NMR, and ¹³C NMR spectroscopic analysis. Above all, the recombinant human UGTs yeast and insect cell expression systems constructed in this study can be used for in vitro metabolism evaluation in the early stage of new drugs research and development, and also provide a new tool for the synthesis of glucuronide metabolites.

Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.
Cardiac Surgical Procedures/adverse effects* ; Dissent and Disputes ; Forensic Medicine ; Forensic Pathology ; Humans ; Retrospective Studies

Objective To explore the spatio-temporal characteristics of Oncomelania hupensis snails along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal, so as to provide scientific evidence for the dynamic assessment of the risk of snail spread in this region. Methods O. hupensis snail status was collected in the plain regions with waterway networks in the study area from 2012 to 2017. The spatio-temporal variations of snail distribution were investigated along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal using buffer zone analysis, spatial autocorrelation, hotspot analysis and standard deviational ellipse with the geographical information system (GIS) tools. Results The number of snail habitats showed a tendency towards a rise in the study area from 2012 to 2017, and snail habitats were predominantly distributed in the 1 000 m long buffer zone of the Danyang-Jintan-Liyang Canal, notably along the Jiuqu River at the junction between the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal. The distribution of snail habitats appeared spatial autocorrelations in 2014, 2016 and 2017, and the hotspot areas were mainly identified at the junction between the Danyang-Jintan-Liyang Canal and the Beijing-Hangzhou Grand Canal. In addition, the overall distribution of snail habitats was located in the northeastern-southwestern part of the study aera, and gradually shifted to the southern and northern parts with the time. Conclusions The spatial distribution of O. hupensis snails is complex along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal, and there is a risk of snail spread from the upper reaches to the lower reaches, where snail control needs to be intensified.

【Objective】 To explore the correlation between the falling height and the fracture degree of skull and extremity bones. 【Methods】 A total of 66 cases of high falls with no-obstacles and hard contact surface that occurred in Yuexiu District of Guangzhou from June 2014 to May 2018 were collected, in which only fractures of skull and(or) extremity bones were observed. Of these cases, 1 to 3 points were assigned to linear fractures, comminuted fractures, and open fractures respectively in reference to "Human Injury Degree Appraisal Standard" , and each site of fractures could receive a unique maximal abbreviated injury scale(MAIS) value from Abbreviated Injury Scale(AIS) 2005. The sum of unique MAIS to different fracture sites indicated the total severity of those fractures(FT). Multiple linear regression analysis was performed on the falling height(Y) and FT of skull and extremity bones, age and gender. 【Results】 Age was an influential factor in the classification and quantification of fracture degree. There was a strong positive correlation between skull FT or extremity bones FT(r1 = 0.698 or r2 = 0.780) and Y, ? ? (m) = 6.660 + 2.843 × skull FT + 2.664 × extremity bones FT-0.099 × Age, R² = 0.871, SE = ±4.577 m. 【Conclusion】 Our results suggest that the total severity of skull fracturesand extremity bones fractures are two important indicators for the prediction of falling height. The mathematical model for prediction of falling height may be practical and applicable in related studies for the reason that it is confirmed in the earlier literatures.

Objective To explore the significance of modified pediatric early warning score (MPEWS) in emergency early warning triage and classification. Method Selecting ill children who came to emergency department from February of 2017 to January of 2018 as objects of study, and triage nurses of emergency department gave MPEWS to the sick children under the demand of the filed data collection. Furthermore, according to the five levels of disease severity classification, doctors gave the disease assessment and classification to the sick children, finding the relevance between the MPEWS and the severity of the disease.Result Consequently, there is a relevance between the MPEWS scores and the severity of the disease indeed (rs=-0.630, P ＜ 0.001). The data show that the higher of the scores, the lower disease level, and the higher severity of the disease. ROC areas under the curve of the subjects is 0.996, and the confidence interval is 0.993-0.999 (P ＜0.05). That indicates that MPEWS exists statistical significance of emergency children judgement. The optimal number is 4.5, the sensitivity is 96％, and the specificity is 99.9％.Conclusions MPEWS is valuable in emergency early warning triage, children emergency severity assessment and identifying critical ill children in time.

Objective: To investigate the current status of antithrombotic strategy for elderly patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) after stent implantation in Beijing area and to study the safety and efficacy of different therapeutic strategy. Methods: A total of 467 relevant patients were enrolled by re-travelling electronic medical records from 12 hospitals in Beijing area. The patients' mean age was (78.70±3.32) years and they were divided into 2 groups by antithrombotic therapy condition: Triple therapy group, n=17 (3.64％), Double therapy group, n=450 (96.36％). The incidence of major adverse cardiac and cerebral events (MACCE) including all-caused death, non-fatal myocardial infarction, stent thrombosis, target vessel revascularization (TVR), stoke and bleeding was compared between Triple therapy group and Double therapy group.Results: The medication in Double therapy group included aspirin+ticagrelor, aspirin+clopidogrel, clopidogrel+warfarin and cilostazol+clopidogrel; in Triple therapy group was aspirin+clopidogrel+warfarin. Patient with HAS-BLED score≥3 was defined as high risk of bleeding and they were all treated by double therapy; HAS-BLED<3 was defined as low risk of bleeding, only 5.03％ patients were treated by triple therapy. 3 patients in Triple therapy group and 33 in Double therapy group suffered from gastrointestinal bleeding, P=0.338; 6 patients in Triple therapy group and 128 in Double therapy group had MACCE, P=0.589; 3 and 80 patients died in Triple therapy group and Double therapy group, P=0.766. Conclusion: Triple therapy was rarely used in elderly AF and ACS patients after stent implantation, double therapy was the main strategy; the incidence of MACCE and mortality were similar between triple and double therapies; patients with triple therapy had the higher incidence of gastrointestinal bleeding.

Objective To investigate the efficacy and safety of modified electroconvuisive therapy combined with paroxetine in the treatment of depression patients with attempted suicide andprovide the basis for clinical treatment.Methods A total of 128 cases of depression patients with attempted suicide were divided into treatment group ( n =64 ) and control group ( n =64 ).Patients in treatment group were treated with modified electroconvuisive therapy combined with paroxetine , 3 times per week , 12 times totally , and patients in control group were treated with paroxetine, 30-40 mg· d-1 , once a day for 4 weeks.Before and after treatment, Hamilton depression(HAMD) scale, Beck score, and adverse reactions of the two groups were observed , the efficacy and safety of two groups were evaluated.Results After treatment 1 week, the HAMD and Beck score of the patients in treatment group were ( 19.65 ±7.43 ) and (9.19 ±3.47 ), respectively, significantly better than those of control group (24.62 ±4.57 ),(12.43 ±5.28 ).In the following 2 -4 weeks after treatment, the HAMD and Beck score of treatment group were also better than control group.The effective rate in treatment group (96.9%)was higher than that in control group (90.6%,P<0.05).The complete recovery rate in treatment group is 62.5%, which was higher than 34.4%in control group ( P<0.05 ).The incidence rate of adverse reactions in treatment group and control group were 6.25%, 9.38%, respectively , the difference had no statistical significance ( P >0.05 ).Conclusion Modified electroconvuisive therapy combined with paroxetine in the treatment of depression patients with attempted suicide is superior to the single effect of paroxetine, and does not increase the risk of adverse reactions.

Objective To investigate the diagnostic value of three-vessel and tracheal (3VT) view in fetal aortic arch anomalies .Methods Ultrasound findings of 17 fetuses with aortic arch anomalies diagnosed in Pe-king Union Medical College Hospital between May 2010 and May 2014 were reviewed and compared with the find-ings of postnatal ultrasonography and pathological examinations to analyze the ultrasound features of aortic arch anomalies of different types , focusing on the importance of 3VT view.Results In all 17 cases the 3VT view was abnormal .3 cases were aortic coarctation , mainly manifested as reduced diameter of the aortic arch;7 cases were interrupted aortic arch , in which there was discontinuity between the thinning aortic arch and the descending aor -ta;5 cases were right aortic arch ( RAA) with aberrant left subclavian artery , with a‘U’ -shaped vascular loop around the trachea;and 2 cases were RAA with mirror-image branching , with the aortic arch situated to the right of the trachea and not forming a V-or U-shaped confluence with the ductus .Conclusions The 3VT view is a very sensitive view to effectively diagnose fetal aortic arch anomalies .Meticulous ultrasound examination focusing on this view during second trimester may disclose the presence of such anomalies and help provide the appropriate genetic counselling .

Objective To evaluate the status of dental caries of deciduous teeth with International Caries Detection and Assessment System (ICDAS ) among preschool children in Lin 'an city.Methods A total of 491 children from 5 kindergartens aged 2.5 to 4.5 years were enrolled using the cluster random sampling method and were examined with the modified criteria of ICDAS.Results The caries rate of deciduous teeth was 66.80% among the tested children.The mean DMFT score was 3.98 and the mean DMFS score was 5.77.The prevalence rate was of no significant difference between genders (P >0.05).Early enamel caries rate was 24.44%,while the caries were found most frequently on the occlusal and proximal surface (32.90%)and least frequently on the tongue palatal surfaces (7.62%).Conclusion The prevalence rate of deciduous dental caries among preschool children is relatively high in Lin'an city.ICDAS might be used to early prevention and diagnose of dental caries.