Background:The relationship between dietary vitamin B6 and stroke risk is controversial; thus, we analyzed their correlation using data from the National Health and Nutrition Examination Survey (NHANES). Method:Data from 2005 to 2018 were collected from the NHANES database. Two 24-h dietary recalls and a standard questionnaire were used to evaluate vitamin B6 intake and stroke prevalence. We used logistic regression models to estimate the association between dietary vitamin B6 intake and stroke risk and investigated the nonlinear relationship between them using a restricted cubic spline (RCS). Sensitivity analysis was conducted using propensity score matching (PSM). Results:Among 24,214 participants, 921 were patients diagnosed with stroke, while 23,293 were without stroke. The multivariate logistic regression model revealed that individuals in the highest quartile of vitamin B6 consumption had a significantly lower stroke risk than those in the lowest quartile under the fully adjusted model (OR: 0.48, 95 % CI: 0.35-0.66, P < 0.001). Subgroup analyses showed that dietary intake of vitamin B6 was a significant protective factor against stroke risk in different populations, with the most pronounced effect in the population engaging in moderate-intensity physical activity (OR: 0.34, 95%CI: 0.20-0.57). The RCS models revealed a non-linear L-shaped relationship (P for nonlinearity = 0.006) between stroke and dietary intake of vitamin B6. Conclusions:Our study shows that an increased intake of vitamin B6 could be an effective strategy in reducing the risk of stroke.

Objective:To evaluate the application value of Chen's liver-hanging maneuver in robot-assisted laparoscopic right hepatectomy.Methods:Clinical data of 17 patients who underwent laparoscopic right hepatectomy in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 2018 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 13 patients were male and 4 female, aged from 19 to 74 years, with a median age of 55 years. In the robot-hanging group, Chen's liver-hanging maneuver was applied in robot-assisted laparoscopic right hepatectomy (n=5), whereas in the robot-no-hanging group, Chen's liver-hanging maneuver was not delivered during robot-assisted laparoscopic right hepatectomy (n=4). In the laparoscopy-hanging group, traditional laparoscopic right hepatectomy combined with Chen's liver-hanging maneuver was adopted (n=8). Perioperative conditions of patients were observed in 3 groups. The liver-hanging time, the time of liver dissection, intraoperative blood loss and the length of postoperative hospital stay among 3 groups were compared by rank sum test. The success rate of liver-hanging maneuver was compared by Fisher's exact test.Results:In the robot-hanging group, liver-hanging maneuver was successfully performed with a success rate of 5/5, and the median time of liver-hanging maneuver was 6(6) min. In the laparoscopy-hanging group, liver-hanging maneuver was successfully conducted in 6 cases with a success rate of 6/8, and the median time of liver-hanging maneuver was 12(11) min. The median time of liver-hanging maneuver in the robot-hanging group was significantly shorter than that in the laparoscopy-hanging group (Z=-2.487, P=0.013), and no significant difference was observed in the success rate between2 groups (P=0.053). No accidental injury to surrounding tissues or blood vessels, or massive bleeding occurred during two surgical procedures. In the robot-hanging, robot-no-hanging and laparoscope-hanging groups, the time of liver dissection was 65(80), 75(80) and 50(50) min, the intraoperative blood loss were 225(450), 300(500) and 225(340) ml, and the length of postoperative hospital stay were 8(12), 10(5) and 13(12) d, respectively. No significant differences were noted among 3 groups (H=2.784, 0.538, 1.857; P>0.05). No postoperative complications or death occurred with postoperative30 d in 3 groups.Conclusions:It is safe and feasible to apply Chen's liver-hanging maneuver in robot-assisted laparoscopic right hepatectomy. Compared with traditional laparoscopic hepatectomy, robot-assisted laparoscopic hepatectomy combined with Chen's liver-hanging maneuver is more convenient and faster.

Restricted by an insufficient understanding of the compositional and structural characteristics of the sensing materials that affect the sensing performances, the YSZ-based CO gas sensor remains in a dilemma in terms of further promoting sensitivity, selectivity and long-term stability. In this work, two bimetallic oxides with different crystal structures, perovskite SmMnO3 and mullite SmMn2O5, were prepared and adopted to elucidate the roles of the Mn3+, Mn4+ and surface oxygen vacancies. Compared with SmMnO3, the coexisting coordination modes of Mn3+ and Mn4+ in SmMn2O5 is conducive to generating oxygen vacancies. Furthermore, a SmMn2O5- based sensor with more oxygen vacancies demonstrates a relatively faster response/recovery speed and enhanced sensitivity of 2.05 times that of SmMnO3 under the same operation conditions. Such work may broaden insight into the development of efficient sensing materials that introduce oxygen vacancies through the construction of phase structures without complicated operations. Overall, the sensor attached to SmMn2O5 exhibits a low detection limit (5 ppm), a feasible response/recovery speed (24 s/28 s toward 40 ppm CO operating at 450 degrees C), satisfactory CO selectivity and long-term stability, highlighting its potential for CO monitoring in harsh environments.

Objective: To investigate the effect and its underlying molecular mechanisms of essential oil from Saussurea costus in esophageal cancer cell line Eca109. Methods: The chemical composition of essential oil from Saussurea costus was investigated by gas chromatography-mass spectrometry (GC-MS). The anti-proliferative, anti-migrative, and apoptotic effects of essential oil from Saussurea costus against Eca109 cells were analyzed. Moreover, the expression of proteins associated with cell cycle, metastasis, and apoptosis was determined. Results: GC-MS analysis showed that essential oil from Saussurea costus was predominantly comprised of sesquiterpenes. Saussurea costus essential oil inhibited the viability of Eca109 cells in a dose-and time-dependent manner with IC50 values of (24.29±1.49), (19.16±2.27) and (6.97±0.86) μg/mL at 12, 24, and 48 h, respectively. The expression levels of target proteins in the cell cycle (phase G1/S), including cyclin D1, p21, and p53, were affected by Saussurea costus essential oil. The essential oil also downregulated the expression of metastasis-related proteins MMP-9 and MMP-2. Moreover, it induced apoptosis of Eca109 cells through the mitochondrial pathway, as well as inhibition of STAT3 phosphorylation. Conclusions: The essential oil from Saussurea costus exhibited anti-proliferative, anti-migrative, and apoptotic effects on Eca109 cells, and could be further explored as a potential anti-esophageal cancer agent.

肝胆外科学是外科学教学中一门综合性强、教学难度高的重点学科.我国肝胆疾病具有发病率高、发病人群以老年人多见、诊断及治疗复杂等特点,在肝胆外科快速发展及我国人口老龄化的背景下,肝胆外科教学需要在传统教学方式的基础上取得突破.课程思政是将思政元素融入专业课程的一种创新教学方式,通过提高带教老师"思政"的意识与能力、挖掘肝胆外科教学思政元素、改进教学手段并建立科学的教学评价体系等措施,在提升学生专业能力的同时,进行潜移默化的思想政治教育.课程思政将思想价值引领贯穿在整个肝胆外科教学中,通过促进学生健康全面的发展,为提升肝胆外科教学水平、培养符合社会发展需要的人才提供了解决方案.

Previous studies show inconsistent associations between niacin supplementation and diabetes mellitus (DM) in high-risk population, but little is known about the relationship between dietary intake of niacin and DM in the generation population. Our study aimed to explore the associations of dietary niacin intake with the risk of DM in the United States (US) adult population. These data were derived from the National Health and Nutrition Examination Survey (NHANES) 2003–2018 of 35,606 individuals aged 20 years or older. Niacin intake and food sources were measured by two 24-h dietary recall interviews. The diagnosis of DM was established according to the American Diabetes Association (ADA) criteria. Binary logistic regression and restricted cubic spline models were applied to evaluate the association of dietary niacin intake and DM. Among the 35,606 individuals, the prevalence of DM was 11.47%. The full-adjusted odds ratio(aOR) of DM was 1.27(95%CI 1.06–1.52) for quartile (Q) 4 v. Q1 of dietary niacin intake. In the dose–response analysis, the shape of the association of niacin intake with the risk of DM was approximately J-shaped (non-linear, p < 0.05). Energy-adjusted niacin of 26.08 mg/day was the optimal cut-off value for predicting DM. High dietary niacin intake was positively associated with DM among US adults. Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Objectives The acute nystagmus characteristics of posterior circulation stroke (PCS) were assessed and compared to acute vestibular neuritis (AVN) in the emergency department (ED) Methods Video-nystagmography (VNG) was prospectively conducted in ED at one Australian metropolitan tertiary referral hospital over a three-year period, recording ictal nystagmus in 101 patients with radiologically confirmed PCS and 104 patients with AVN. Results PCS locations were in the brainstem alone (34.7%), cerebellum alone (29.7%), both cerebellum and brainstem (19.8%) or other/multiple locations (15.8%) were recruited. Common PCS territories included: posterior-inferior-cerebellar-artery (38.6%), multiple-territories (20.8%), pontine-perforators (18.8%), anterior-inferior-cerebellar-artery (6.9%) and posterior-cerebral-artery (5.9%). In PCS, 50.5% of patients had no spontaneous nystagmus. Remaining PCS patients had primary position horizontal (37.2%), vertical (8.9%) and torsional (3.9%) nystagmus. Horizontal nystagmus was 51.7% ipsiversive and 48.3% contraversive in 29 lateralised PCS. 28.4% of PCS patients had pathologic gaze-evoked nystagmus. Most PCS patients with horizontal nystagmus (60.5%) had unidirectional 'peripheral-appearing' nystagmus In contrast, AVN patients almost universally (98.1%) had primary position horizontal nystagmus. No AVN patient had gaze-evoked nystagmus. Horizontal nystagmus with SPV≥5.4○/s distinguished AVN from PCS with sensitivity and specificity of 90.3% and 89.1%. Absent nystagmus, gaze-evoked direction-changing nystagmus, and vertical/torsional nystagmus were all highly specific for PCS (100%, 100% and 98.1%). Conclusion Most patients with PCS had concerningly benign features such as absent nystagmus or unidirectional 'peripheral-appearing' horizontal nystagmus acutely. Comparatively, all AVN patients had nystagmus acutely. This study reinforces a new paradigm in vestibular neurology that absence of findings does not equate to absence of pathology.

深圳市长期以来一直沿用"院办院管"的社区卫生管理运作模式,但随着社康中心的发展,该模式的弊端逐渐显现.为推动医院院本部与下属社康中心深化合作,促进专科、全科高度融合发展,落实国家分级诊疗政策,宝安区人民医院集团创新探索"居民-社区-社区健康服务中心-医院(集团)"专病健康管理模式的四方联动,实现医院和社康中心共同管理患者,提高社区居民健康水平.通过对"四方联动"模式的概念、建设方案、实施效果进行介绍,为进一步完善"四方联动"发展模式提出政策建议.

目的:分析我国医疗资源配置效率,为进一步合理配置医疗卫生资源提供科学依据.方法:采用2000—2020年《中国统计年鉴》和《中国卫生健康统计年鉴》数据,运用数据包络分析法对我国医疗资源配置效率进行评价,同时采用Malmquist模型进行动态分析.结果:1999—2019年,我国医疗资源配置效率不断提高,但受多因素综合影响,地区间差异较大,东部地区最优,西部次之,中部最低.结论:我国医疗卫生资源配置效率不断提高,但地区和省际间资源配置效率差距明显,部分省市配置的低效率和投入的规模不足问题并存.因此,政策制定和实施者应重视医疗资源配置问题,一方面要增加资源的有效供给,合理布局医疗资源;另一方面要优化资源投入和投入结构,提高产出效率.

Objective:To investigate the antibacterial effect of silver ion dressing on chronic refractory wound healing and its effect on promoting wound healing.Methods:Selected from February 2017 to April 2019 our hospital 60 patients with chronic wounds, according to random number table method was divided into observation group and control group, 30 cases in each group. Two groups of patients were treated with conventional treatment such as resistance to infection, and improved tissue circulation. On the basis, the control group was given traditional sterile dressing treatment, observation group was given the silver ion dressings. Meanwhile, the positive rate of bacterial culture, wound pain, healing time, dressing change time, hospitalization cost and satisfaction were compared between the two groups before and after treatment. T test was used for measurement data and χ2 test was used for counting data. Results:The positive rate of bacterial culture in the observation group was (55.3±11.4)%, (38.2±13.2)%, (14.4±7.3)% at 1, 2 and 3 weeks after treatment, which were lower than that in the control group (76.9±10.8)%, (60.7±15.6)%, (34.8±11.5)%. The difference was statistically significant ( t=7.534, 6.031, 8.203, P<0.05). VAS scores of the observation group at 1, 2 and 3 weeks after treatment were (4.2±0.4), (2.4±1.1), (2.0±0.6) points, respectively, lower than those of the control group (6.1±0.6), (4.2±0.7), (3.8±0.6) points. The difference was statistically significant ( t=14.432, 7.562, 11.619, P<0.05). The healing time and dressing change times of the observation group were (4.3±0.6) weeks and (11.2±2.6) times, respectively, lower than those of the control group (7.0±0.7) weeks and (34.5±10.5) times, with statistically significant differences ( t=16.040, 11.798, P<0.05). The satisfaction of the observation group was 93.33% (28/30), higher than that of control group 73.33% (22/30), with statistically significant differences ( χ2=4.320, P<0.05). Conclusion:Silver ion dressing has significant antibacterial effect on chronic refractory wounds, can effectively relieve patients′ pain and promote wound healing and improve patient satisfaction.

我国分级医疗制度探索较早,研究内容丰富,但发展过程曲折,且存在较多亟待解决的问题.本文系统梳理我国分级医疗体系的发展历程,分析新医改以来我国分级医疗体系的建设现状及成效,明确存在的问题,提出完善我国分级诊疗体系的合理化建议.

Mixed-potential sensors using CrVO4 sensing electrodes were prepared for monitoring ammonia at high temperatures. NH3 sensitivity for the sensors sintered at 800 °C, 850 °C and 900 °C were −56.5, −75.0 and −32.1 mV/decade respectively for the NH3 above 10 ppm. High sintering temperature strengthens the bond of electrode and electrolyte, thus increasing the amount of TPB sites. Thinner electrode weakens the heterogeneous catalytic consumption of NH3. More reaction sites combined with higher NH3 concentration result in greater sensitivity for 850 °C-sintered sensor. 900 °C sintering leads to decomposition of CrVO4 into Cr2O3 and V2O5, which exhibits low NH3 sensitivity. In operating temperature range of 500 °C–600 °C, NH3 detection limit is 2 ppm. The sensor shows the biggest responses at 500 °C, but the optimum NH3 sensitivity of −75.0 mV/decade was obtained at 550 °C for the concentrations higher than 10 ppm. For the oxygen of 4–10 vol %, response is less affected by the change of oxygen content, the influence of water vapor with content of 5–6 vol % could also be ignored. The characteristics of high NH3 selectivity, sensitivity, long-term stability and anti-interference performances indicate that it is meaningful to use CrVO4 for ammonia detection in exhaust.

目的:针对肠道恶性肿瘤病人靶向药物治疗中引起的皮肤毒性反应研究预防及护理对策.方法:按照国际统一分级标准,观察皮肤毒性痤疮样改变及手足综合征特点并评估,采用分级预防及处理,硅基修复材料联合维生素E或尿素乳膏对皮疹及手足综合征的效果.结果:多数病人的皮肤不良反应得以减轻或治愈,不影响靶向药物的继续治疗.结论:结合标准化的皮肤护理,硅基修复材料联合维生素E或尿素乳膏有助于改善恶性肿瘤病人靶向药物治疗引起的皮肤毒性反应,配合完成抗肿瘤治疗.

目的 探究我国社区首诊研究的现状、热点和未来发展方向.方法 以中国学术期刊网络出版总库(CNKI)期刊全文数据库为数据来源,借助Citespace软件绘制知识图谱,运用文献计量学方法,从发文量、作者及机构合作、关键词等角度对社区首诊相关研究文献进行分析.结果 我国社区首诊研究起步较晚,发文数量不稳定,近两年有所减少;研究机构间合作网络较为松散,核心研究团队尚未形成;社区首诊制度、社区首诊影响因素和分级诊疗是该领域的研究热点.结论 当前我国社区首诊研究仍处于探索阶段,医保、基层人才培养、基本药物制度以及社区首诊实施效果评价等主题将成为该领域的未来研究方向.

Most previous studies of the family doctor contract services (FDCS) evaluated its quality by using residents’ signing rates, awareness, and satisfaction. We hypothesize that renewal willingness could be another important indicator to examine the quality of FDCS. To measure residents’ willingness to maintain contracts with family doctors and examine the influencing factors. Cross-sectional study. 11,250 residents in 31 provincial administrative regions across China. A multistage stratified random sampling method was used to recruit participants. Univariate analysis, mixed-effect regression model analysis, and stepwise multivariate logistic regression analysis were performed to determine the influencing factors of residents’ willingness to maintain contracts with family doctors. About 71.3% participants who contracted with and received healthcare services from family doctors were willing to maintain contracts with family doctors in China. Residents registering as local households (OR = 1.192, 95% CI = 1.039–1.368), enrolled in medical insurance (OR = 1.299, 95% CI = 1.011–1.668), reporting better health (OR = 1.246, 95% CI = 1.100–1.413), with shorter walking time to the nearest healthcare center (compared with > 30 min walking time, < 15 min: OR = 1.209, 95% CI = 1.003–1.458; 15–30 min: OR = 1.288, 95% CI = 1.124–1.475), and trusting in (OR = 4.403, 95% CI = 3.849–5.036) and satisfied with (OR = 18.514, 95% CI = 16.195–21.165) their family doctors had significantly higher willingness to maintain contracts with family doctors. Residents’ willingness to maintain contracts with family doctors could be another evaluation indicator of the quality of FDCS in China. Improving the accessibility and quality of healthcare services from family doctors may increase residents’ willingness to keep contracts with family doctors and promote the implementation of FDCS.

BackgroundSocial support could improve college students’ mental health status. However, mental health varies across different geographic areas, and most of previous studies only included small sample sizes, thus the nationwide survey are warranted. This study sought to estimate the association between social support quality (SSQ) and mental health among Chinese college students using data yielding from a nationwide survey.MethodsA cross-sectional study with a web-based questionnaire survey was conducted in Wuhan, China, from October 2017 to February 2018. A total of 11093 college students were recruited from 18 colleges or universities through multi-stage random cluster sampling method. The Multidimensional Scale of Perceived Social Support scale and 12-items General Health Questionnaire were used to estimate students’ SSQ and mental health status, respectively. Logistic regression analysis was used to identify the association between SSQ and the mental health disorder in college students.ResultsA total of 10,676 (96.24%) college students were included in this study. Of them, 21.4% were identified as having a mental disorder. Students being a female, aged 18-22 years old, whose mother held a college degree and above, and drinking alcohol had more risks of being mental health problems (P <0.05). However, having general or higher family economic levels, working and resting regularly, and sleeping ≥ 7 hours could be preventive factors for mental health problem (P <0.05). Especially, with the improvement of SSQ, there was a decreasing trend in the risk of being mental disorder.ConclusionMental health disorder is an important public health challenge among college students in China. Improving SSQ could be the practical and valuable method to prevent college students’ mental problem.

14-3-3s present in multiple isoforms in human cells and mediate signal transduction by binding to phosphoserine-containing proteins. Previous studies demonstrate that the isoform 14-3-3 ζ acts as a key factor in promoting chemoresistance of cancer. Here, our work is devoted to developing the predictive models that can determine the binding affinity of phosphopeptide fragments against 14-3-3 ζ by the random forest approach. Based on the variable matrix built by the simple descriptors DPPS and statistical methods coupled with optimized hyperparameters, the robust models are obtained by a combinatorial peptide microarray dataset (n = 385 for N-terminal sublibrary, n = 384 for C-terminal sublibrary). For the test set, the R2 and RMSE are 0.8532 and 0.4516 at the N-terminal sublibrary (n = 96) and are 0.7998 and 0.5929 at the C-terminal sublibrary (n = 94), respectively. We also find that the distinct physiochemical properties function on the 14-3-3 ζ interaction. Overall, our results demonstrate that the computational methods based on QSAR analysis can be used for building the predictive models on the binding affinity of phosphopeptide against 14-3-3 ζ and contribute to the further research on clinical research.

目的:比较东中西部全科医生的职业倦怠现状,分析其主要影响因素,为促进全科医生心身心健康提供参考.方法:采用分层随机抽样方法,对我国东中西部社区卫生服务机构的全科医生进行问卷调查,并进行方差和多元逐步回归分析.结果:全科医生情绪耗竭为(24.80±13.17)分,去人格化为(5.76±6.36)分,个人成就感为(34.44±10.05)分,不同地区的差异有统计学意义(P<0.001).年龄、文化程度、职称、收入水平、是否加班、职业发展机会和工作压力影响情绪耗竭;年龄、工作年限、性别、收入水平、行政职务和工作压力是影响去人格化的主要因素;年龄、婚姻状况、收入水平、是否加班和职业发展机会影响个人成就感.结论:我国全科医生的职业倦怠发生率较高,不同地区存在显著性差异.应加大投入,稳定全科医生队伍,提高全科医生的工作积极性,降低职业倦怠.

Objective:To establish a primary cell tumor model of breast cancer and investigate the effects of intermediate-conductance calcium-activated potassium channel (KCa3.1) expression on proliferation and tumor angiogenesis of breast cancer in vivo. Methods:Twenty-three fresh tissue samples of invasive breast cancer were collected during clinical operations. Twenty-two primary cell tumor models of breast cancer in nude mice were established.Nude mice were randomly divided into experimental group (eleven cases, siRNA interference) and control group (eleven cases, negative control). Cholesterol modified small interfering RNA (siRNA) was synthesized and its transfection efficiency was identified. The effects of KCa3.1 on the proliferation and angiogenesis of breast cancer was detected in vivo. Results:Designed siRNA1 and siRNA2 could effectively interfere with KCa3.1 in primary breast cancer cells. The interference efficiency detected by Western blotting was (71.03±9.97)% and (65.81±9.18)% ( t=21.034, 20.883, P<0.05) respectively. Twenty-two BALB/c nude mice models of primary breast cancer cells were established successfully, and the tumorigenicity rate was 70.96%. The interference efficiency of KCNN4 was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) in tumorigenic tissues. The expression of KCNN4 mRNA in Chol-siRNA group was significantly lower than that in the control group ( t=6.541, P<0.05). The expression of tumor cytokines in the tumor tissue was detected by immunohistochemistry. The positive expression rate of VEGF was (43.42±7.89)% in the control group and (13.19±4.32)% in the siRNA group ( t=11.146, P<0.05). The positive rate of CD31 was (17.49±4.15)% in the control group and (9.28±5.86)% in the siRNA group ( t=3.792, P<0.05). The positive expression rate of proliferating cell nuclear antigen (Ki-67) was (88.77±7.61)% in the control group and (58.17±9.62)% in the siRNA group ( t=8.274, P<0.05). Conclusion:KCa3.1 participates in the regulation of cell proliferation and tumor angiogenesis in breast cancer. The verification of the inhibition on tumor formation induced by intervening KCa3.1 was accomplished in vivo.