Objective To investigate the current situation and risk factors of falls in the rural community elderly aged 65 years and above in Chongqing City, and to provide references for developing preventive measures. Methods The multistage cluster random sampling method was used to select several rural communities in Chongqing City from September to December, 2019, and then the elderly aged 65 years and above who lived in the communities for one year were chosen to serve as the surveyed subjects. A self designed questionnaire (sociodemographic factors, exercise status, illness and medication status and fall to related information) was used to collect the data regarding falls occurring in the last year. The chi-square test and multi factor multi-variant logistic regression analysis were utilized to analyze the data, the used software was SPSS 25.0. Results A total of 801 rural community elderly people in Chongqing City were surveyed．The average age was (71.64±5.85) years old. 7.12% of elderly need cane or walker. 6.87% of them self-reported their health was poor. 42.57% of elderly seldom have the habit of exercise. The prevalence of heart disease, diabetes, osteoporosis, arthritis, cataract, deafness self-reported was 8.99%、8.11%、17.48%、25.97%、13.73% and 6.24% respectively. Totally 104 elderly people experienced 128 falls in the past 12 months, and the incidence rates of falls and falling times were 12.84% and 15.98% respectively．The multi-variant logistic regression analysis showed that poor heath status self-reported（OR=4.04，95% , CI：1.71-9.52）, diabetes （OR=2.68，95% CI： 1.41-5.12）, osteoporosis （OR=1.91 , 95% CI：1.16-3.15）, arthritis （OR=2.60 , 95% CI：1.65-4.11） and non self-care（OR=2.44，95% CI：1.16-5.16） were the risk factors for falls in the rural community elderly. Conclusions The incidence rate of falls in the rural community elderly aged 65 years and above in Chongqing City was low．It is necessary to formulate comprehensive intervention measures for the risk factors of fall so as to reduce the incidence rate of falls in the elderly.

Objective: To investigate surgical strategies and the corresponding benefits for patients with perihilar cholangiocarcinoma(pCCA). Methods: A total of 81 patients with pCCA who underwent radical excision in the Department of Biliary and Pancreatic Surgery of Sun Yat-Sen Memorial Hospital between January 2014 and December 2021 were retrospectively collected.The cohort consisted of 50 male and 31 female patients,with an age of (62.5±11.5)years(range:26 to 83 years).Seventy-five cases were diagnosed with jaundice,60 of whom received preoperative biliary drainage,while 20 patients received portal vein embolization.Their serum bilirubin level within one week before the operation(M(IQR)) was 44.3 (41.9) μmol/L(range:8.0 to 344.2 μmol/L).Preoperative imaging examinations were performed to evaluate the Bismuth-Corlette type of pCCA,showing 3,6,21,27,and 24 cases of Bismuth-Corlette type Ⅰ,Ⅱ,Ⅲa,Ⅲb,and Ⅳ,respectively.The primary outcome was overall survival (OS),and the secondary outcomes were relapse-free survival (RFS),90-day postoperative morbidity and 90-day postoperative mortality.OS and RFS were estimated using the Kaplan-Meier method and compared by the Log-rank test.Significant prognostic factors were determined using univariate and multivariable Cox proportional hazard regression analyses. Results: In the cohort of 81 pCCA patients,67 cases(82.7%) underwent major hepatectomy while 3 cases received major hepatectomy combined with pancreaticoduodenectomy.Thirty-four patients underwent hepatectomy combined with vascular resection and reconstruction(18 cases of portal vein resection and reconstruction alone;9 cases of hepatic artery resection and reconstruction alone;7 cases of combination of portal vein and hepatic artery resection and reconstruction).Margin negative(R0 excision) were achieved in 53.1%(43/81) of these patients.The operation duration was (627±136)minutes(range:565 to 940 minutes),and the intraoperative blood loss was 400(455)ml(range:200 to 2 800 ml).The 90-day postoperative mortality was 3.7%(3/81).Grade 3-4 postoperative morbidity was 23.4% (19/81) according to the Clavien-Dindo classification of surgical complications.Up to the last follow-up at September 2022,the follow-up time was 34.0(24.2)months (range:0.4 to 103.6 months).Three patients who died within 90 days after surgery were excluded from the survival analysis.The median OS was 36.10 months (95%CI:18.23 to 42.97 months) and the 1-,3-and 5-year OS rates were 85.3%,46.8% and 27.3%,respectively.The median OS of 41 patients with negative margins was 47.83 months(95%CI:36.90 to 58.80 months) and that of 37 patients with positive margins was 20.47 months(95%CI:10.52 to 30.58 months).The median RFS of 70 patients with R0 and R1 resection was 24.50 months(95%CI:12.15 to 31.85 months)and the 1-,3-and 5-year RFS rates were 65.2%,45.7% and 29.9%,respectively.The median RFS of 41 patients with R0 resection was 38.57 months(95%CI:21.50 to 55.63 months) and that of 29 patients with R1 resection was 10.83 months(95%CI:2.82 to 19.86 months). Conclusions: The primary therapy for pCCA is radical surgical resection.A precise preoperative evaluation and sufficient preparation can reduce postoperative morbidity.Surgical treatment can achieve a better survival outcome by increasing the radical resection rate.

Objective: To investigate the characteristics and comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome. Methods: A retrospective observational study was conducted. From May 2012 to December 2021, the data of 19 patients with iatrogenic Cushing's syndrome discharged from the Department of Burns and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University were collected, including 8 males and 11 females, aged 28-71 (56±11) years, with 12 cases of infected acute wounds and 7 cases of infected chronic wounds. The lesions were located in the limbs, perianal, and sacrococcygeal regions, with original infection ranging from 9 cm×5 cm to 85 cm×45 cm. After admission, the patients were performed with multidisciplinary assisted diagnosis and treatment, and the wounds were treated with debridement and vacuum sealing drainage, according to the size, severity of infection, suture tension, and bone and tendon tissue exposure of wounds, direct suture or autologous skin and/or artificial dermis and/or autologous tissue flap transplantation was selected for wound repair. The levels of cortisol and adrenocorticotropic hormone (ACTH) of patients at 8:00, 16:00, and 24:00 within 24 h after admission were counted. After admission, the number of operations, wound repair methods, and wound and skin/flap donor site healing of patients were recorded. During follow-up, the wounds were observed for recurrent infection. Results: The cortisol levels of 16 patients at 8:00, 16:00, and 24:00 within 24 h after admission were (130±54), (80±16), and (109±39) nmol/L, respectively, and ACTH levels were (7.2±2.8), (4.1±1.8), and (6.0±3.0) pg/mL, respectively; and the other 3 patients had no such statistical results. After admission, the number of surgical operation for patients was 3.4±0.9. The following methods were used for wound repair, including direct suturing in 4 cases and autologous skin and/or artificial dermis grafting in 9 cases, of which 2 cases underwent stage Ⅱ autologous skin grafting after artificial dermis grafting in stage Ⅰ, and 6 cases had pedicled retrograde island flap+autologous skin grafting. The wound healing was observed, showing that all directly sutured wounds healed well; the wounds in 6 cases of autologous skin and/or artificial dermis grafting healed well, and the wounds in 3 cases also healed well after the secondary skin grafting; the flaps in 4 cases survived well with the wounds in 2 cases with distal perforators flap arteries circumfluence obstacle of posterior leg healed after stage Ⅱ debridement and autologous skin grafting. The healing status of skin/flap donor sites was followed showing that the donor sites of medium-thickness skin grafts in the thigh of 4 cases were well healed after transplanted with autologous split-thickness grafts from scalp; the donor sites of medium-thickness skin grafts in 3 cases did not undergo split-thickness skin grafting, of which 2 cases had poor healing but healed well after secondary skin grafting 2 weeks after surgery; the donor sites of split-thickness skin grafts in the head of 2 patients healed well; and all donor sites of flaps healed well after autologous skin grafting. During follow-up of more than half a year, 3 gout patients were hospitalized again for surgical treatment due to gout stone rupture, 4 patients were hospitalized again for surgical treatment due to infection, and no recurrent infection was found in the rest of patients. Conclusions: The infected wounds in patients with iatrogenic Cushing's syndrome have poor ability to regenerate and are prone to repeated infection. Local wound treatment together with multidisciplinary comprehensive treatment should be performed to control infection and close wounds in a timely manner, so as to maximize the benefits of patients.
Adrenocorticotropic Hormone ; China ; Cushing Syndrome/surgery* ; Female ; Gout ; Humans ; Hydrocortisone ; Iatrogenic Disease ; Male ; Skin, Artificial ; Wound Infection

Objective To evaluate the impact of comprehensive intervention mode on osteoporosis related knowledge and behavior among city residents aged over 40-year-old and to provide reference for osteoporosis prevention and treatment. Methods Health education including self-management of osteoporosis was conducted among Chongqing city residents aged over 40-year-old for 4 consecutive months.All the subjects were asked to fill out the questionnaire during face-to-face interview before and after the intervention.The changes in knowledge and daily life style were tested by Chi-square test. Results The residents surveyed were 2 028 before the intervention and 1 986 after the intervention.After the intervention, the proportion of awareness was significantly higher (P < 0.01) than that before the intervention in the following: features of osteoporosis(33.23% vs 18.49%), sensitive population of osteoporosis(10.52% vs 3.75%), balanced diet to prevent osteoporosis (23.82% vs 11.09%), bone health supplements (51.06% vs 32.84%), recommended daily calcium intake for postmenopausal women and older people (34.89% vs 13.91%).After the intervention, the proportions of residents who never drink milk and its products, and never eat beans and their products were decreased significantly (13.49% vs 23.09%, and 4.94% vs 7.00%, P < 0.01).The proportion of residents who take average more than 30 minutes daily outdoor activity under sunlight was increased significantly after the intervention (64.25% vs 59.27%, P < 0.01).The proportion of residents preferring salty food was decreased significantly after the intervention (8.26% vs 14.89%, P < 0.01). Conclusion The comprehensive intervention mode of health education in combination with traditional and new media as well as health self-management is a cost-effective prevention measure for osteoporosis, which can improve the osteoporosis cognitive level of middle-aged and senile people and the development of good behavior.

Objective To investigate the effect of CYP46A1 on the pathogenesis of Alzheimer's disease.Methods Recombinant lentiviral vectors which including anthropogenic CYP46A1 were injected into bilateral hippocampus of 3-monthold male 5XFAD transgenic mice,while empty vectors were injected into the corresponding position of the control group.After two months,the ability of learning and memory were tested by Morris water maze and T maze experiments,and amyloid plaque and inflammatory infiltration in the brain were detected by immunohistochemical staining and ELISA respectively.Results Compared with the control group,CYP46A1 virus injection significantly increased the CYP46A1 mRNA and protein expression in hippocampus.In addition,CYP46A1 overexpression significantly decreased the latency to find the platform in Morris water maze test and increased the correct rate to choose in T maze test.Aβ immunohistochemical staining and plaques area statistics demonstrated that the amyloid plaque area of hippocampus in CYP46A1 overexpression mice was significantly reduced,and there was a significantly decrease of hippocampal astrocytes expression by means of GFAP staining.Furthermore,hippocampal CYP46A1 overexpression significantly decreased the expression level of Aβ40,Aβ42,IL-1β and TNF-α,while compare with the control group.Conclusion CYP46A1 overexpression in hippocampus can promote the cognitive impairment,as well as ameliorate the brain inflammatory infiltration in 5XFAD transgenic mice,suggesting that CYP46A1 has anti-Alzheimer's disease like effects.

Objective To evaluate the effect and its factors of the postgraduates’ autonomy learning in medical English, and to suggest improving methods. Methods The postgraduates enrolled in Kunming Medical University in 2016 were divided into two groups. Those for professional degree education learnt Medical English by the approach of autonomy learning, while those for academic degree education were taught in traditional method. At the end of the semester,an examination was applied to measure and compare the learning effects in both groups, and questionnaires were conducted to investigate their attitudes and satisfaction. The results were evaluated by quantitative analysis and qualitative analysis.Results The postgraduates for professional degree education got lower examination scores than the postgraduates for academic degree education. Time management appeared to be the main problem. Conclusion Although the postgraduates highly regard the necessity of medical English learning and have great sense of learning responsibility, process supervision from the administration is suggested to assist their time management so that better learning effects can be achieved.

BACKGROUND: How to promote the early vascularization of large tissue-engineered bone has become the hotspot of current research. Cell co-culture and the addition of bioactive factors to promote angiogenesis are very good methods to promote early vascularization. OBJECTIVE: To explore the ability of angiogenesis by co-transplantation of bone marrow mesenchymal stem cells (BMSCs) and human umbilical vein endothelial cells(HUVECs)which were transfected with vascular endothelial growth factor 165(VEGF165)gene in vivo,to move forward a single step to offer theoretical basis and experimental basis to build vascularized tissue-engineered bone which can be used to repair large segmental bone defects. METHODS: We built an ischemic skin flap with 4 cm×1.5 cm in the back of Sprague-Dawley rats, and then BMSCs+VEGF165-transfected HUVECs (group A), VEGF165-transfected HUVECs (group B), BMSCs+non-transfected HUVECs (group C), non-transfected HUVECs (group D), DMEM (group E) were respectively transplanted. ELISA method was used to detect peripheral blood VEGF level. Histologically, survival and microvessel density of the flap were observed. RESULTS AND CONCLUSION: (1) The flap survival quality of group A was better than that in the other groups. VEGF exhibited high expression continuously high expression at 2, 4, 7, 14 days after transplantation, and reached the peak at 7 days, but the expression level at 14 days was obviously lower than that at 2 days postoperatively. The VEGF level of group always exceeded that in group B at different time points (P < 0.05). The flap survival rate and microvessel density of group A was significantly higher than that in the other groups at 11 days postoperatively (both P < 0.05). In summary, co-transplantation of BMSCs and VEGF165-transfected HUVECs can promote survival of an ischemic flap in vivo through pro-angiogenic actions.

BACKGROUND: Vascularized bone tissue engineering is a hotspot of current research and early vascularization of tissue-engineered bone also becomes an urgent problem to be solved. Addition of bioactive factors and cell co-culture method both contribute to promoting the early vascularization. OBJECTIVE: To investigate the pro-angiogenic effect of human umbilical vein endothelial cells (HUVECs) transfected with vascular endothelial growth factor 165 (VEGF165) co-cultured with bone marrow mesenchymal stem cells (BMSCs). METHODS: HUVECs were transfected with VEGF165 and then co-cultured with BMSCs which were purified from mouse femoral bone marrow. There were six groups in this experiment: (1) AdVEGF165-HUVECs+BMSCs, (2)AdVEGF165-HUVECs, (3) AdGFP-HUVECs+BMSCs, (4) AdGFP-HUVECs, (5) HUVECs+BMSCs, and (6) HUVECs (blank control). Cell counting kit-8 detection was applied to analyze the proliferative ability of HUVECs. The abilities of HUVECs migration and vascularization were then detected by crystal violet staining and matrigel determination, respectively. RESULTS AND CONCLUSION: Compared with the blank control group, the proliferation of HUVECs was significantly increased in the other groups except for AdGFP-HUVECs group (P < 0.05). Compared with the blank control group, the migration and vascularization abilities of HUVECs were significantly stronger in the group of AdVEGF-HUVECs+BMSCs (P < 0.05). To conclude, the co-culture of HUVECs transfected with VEGF165 and BMSCs could promote early vascularization effectively.

BACKGROUND/AIMS: Recent papers have highlighted the role of diet and lifestyle habits in irritable bowel syndrome (IBS), but very few population-based studies have evaluated this association in developing countries. The aim of this study was to evaluate the association between diet and lifestyle habits and IBS. METHODS: A food frequency and lifestyle habits questionnaire was used to record the diet and lifestyle habits of 78 IBS subjects and 79 healthy subjects. Cross-tabulation analysis and logistic regression were used to reveal any association among lifestyle habits, eating habits, food consumption frequency, and other associated conditions. RESULTS: The results from logistic regression analysis indicated that IBS was associated with irregular eating (odds ratio [OR], 3.257), physical inactivity (OR, 3.588), and good quality sleep (OR, 0.132). IBS subjects ate fruit (OR, 3.082) vegetables (OR, 3.778), and legumes (OR, 2.111) and drank tea (OR, 2.221) significantly more frequently than the control subjects. After adjusting for age and sex, irregular eating (OR, 3.963), physical inactivity (OR, 6.297), eating vegetables (OR, 7.904), legumes (OR, 2.674), drinking tea (OR, 3.421) and good quality sleep (OR, 0.054) were independent predictors of IBS. CONCLUSIONS: This study reveals a possible association between diet and lifestyle habits and IBS.
Adult ; Case-Control Studies ; China ; Diet/*adverse effects ; Female ; *Food Habits ; Healthy Volunteers ; Humans ; Irritable Bowel Syndrome/*etiology ; *Life Style ; Logistic Models ; Male ; Middle Aged ; Surveys and Questionnaires

BACKGROUNDPost-resuscitation myocardial dysfunction has been implicated as a major cause of fatal outcome in patients who survive initially successful cardiopulmonary resuscitation (CPR). In our previous study, we found that impaired myocardial β-adrenergic receptor (AR) signaling is a key mechanism in post-resuscitation myocardial dysfunction and Shen-Fu injection (SFI) can attenuate post-resuscitation myocardial dysfunction. However, whether SFI can prevent impaired post-resuscitation myocardial β-AR signaling is not yet known. In this study, we investigated the effect of SFI on impaired myocardial β-AR signaling occurring post-resuscitation in a porcine model of cardiac arrest.

METHODSVentricular fibrillation was induced electrically in anesthetized male landrace domestic pigs. After 4 minutes of untreated ventricular fibrillation, cardiopulmonary resuscitation was initiated. Sixteen successfully resuscitated pigs were randomized to receive a continuous infusion of either SFI (0.5 ml/min; n = 8) or saline (placebo; n = 8) for 6 hours, beginning 15 minutes after the return of spontaneous circulation (ROSC). Hemodynamic and echocardiographic data were recorded. β-AR signaling was assessed at 6 hours after the intervention by measuring myocardial adenylate cyclase activity, β-AR density and β-AR kinase expression.

RESULTSTreatment with SFI produced better maximum rate of left ventricular pressure increase (dp/dt(max)) and maximum rate of left ventricular pressure decline (-dp/dt(max)), cardiac output, and ejection fraction after ROSC. SFI treatment was also associated with lower myocardial β-adrenergic receptor kinase expression, whereas basal and isoproterenol-stimulated adenylate cyclase activity and the total β-AR density were significantly increased in the SFI group when compared with the placebo group.

CONCLUSIONSFI attenuated post-resuscitation myocardial dysfunction by preventing impaired myocardial β-AR signaling after CPR.

Animals ; Cardiopulmonary Resuscitation ; adverse effects ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Male ; Receptors, Adrenergic, beta ; metabolism ; Signal Transduction ; drug effects ; Swine