Changes in Disease Patterns in Rural China,With an Explanatory Framework

Data on the disease pattern in rural China over the past hundred years show that chronic diseases have now replaced infectious diseases as the major health problems plaguing rural residents.From the perspective of life-course research,taken together with medical anthropology's emphasis on bio-sociocultural integrity,we can divide chronic diseases into two:the chronic diseases of excessive depletion and the chronic diseases of excessive intake.The former are mainly the result of societal experiences engraved on the body;chronic diseases represented by arthritis and intervertebral disc disease arc the marks left on the human body by the"hard times"of the early years.The latter is the result of the transformation of working life in which the abundance of material resources and the reduction of physical exertion occur simultaneously;the rapid arrival of the"good times"mean that bodies that have long suffered from hunger and exhaustion find it hard to adapt.Hypertension and diabetes are the physical manifestations of this distress.Fundamentally,chronic diseases falling into the over-intake category may appear to originate from the sweetness of current life,but they are in fact the physical reproduction of earlier experiences.Our village case study fleshes out this explanatory framework,allowing us to see the complex relationship between social institutions,livelihood patterns,cultural mindsets,bodily habits,and disease.

TRAF1/C5 rs3761847 SNP Is Associated with Severe Pattern of Rheumatoid Arthritis in Greek Patients

The era of whole genome study analysis has introduced a profound research in the genetics of autoimmune diseases. Some of the new genetic loci that have been associated with the development or the severity of autoimmune diseases have been thoroughly studied, conferring a more detailed understanding of disease pathophysiology. Furthermore, single nucleotide polymorphisms (SNPs) have been described not only in coding regions of the human genome but also in non-coding areas (introns), the importance of which has not been yet clarified. Over the last years, such an SNP has been associated with the development of rheumatoid arthritis, the most frequent autoimmune disease. This SNP is at the position 122730060 of chromosome 9 in the TRAF1/C5 region and consists of a substitution of the nucleotide base guanine (G)—which is considered the ancestral phenotype— by alanine (A). It has been indicated that G is the aggravating nucleotide, and that G/G is the disease predisposing phenotype, conferring >1.3× risk for RA. On this background, we performed a genome study on a Greek population of northern Greece (Macedonia) in order to identify the association of this SNP with RA in our group.

Pattern Classification of Enterovirus 71-Associated Hand, Foot, and Mouth Disease in Chinese Medicine: A Retrospective Study in 433 Cases

Objective： To determine whether patterns of enterovirus 71（EV71）-associated hand, foot, and mouth disease（HFMD） were classified based on symptoms and signs, and explore whether individual characteristics were correlated with membership in particular pattern. Methods： Symptom-based latent class analysis（LCA） was used to determine whether patterns of EV71-HFMD existed in a sample of 433 cases from a clinical data warehouse system. Logistic regression was then performed to explore whether demographic, and laboratory data were associated with pattern membership. Results： LCA demonstrated a two-subgroup solution with an optimal fit, deduced according to the Bayesian Information Criterion minima. Hot pattern（59.1% of all patients） was characterized by a very high fever and high endorsement rates for classical HFMD symptoms（i.e., rash on the extremities, blisters, and oral mucosa lesions）. Non-hot pattern（40.9% of all patients） was characterized by classical HFMD symptoms. The multiple logistic regression results suggest that white blood cell counts and aspartate transaminase were positively correlated with the hot pattern（adjust odds ratio=1.07, 95% confidence interval： 1.006–1.115; adjust odds ratio=1.051, 95% confidence interval： 1.019–1.084; respectively）. Conclusions： LCA on reported symptoms and signs in a retrospective study allowed different subgroups with meaningful clinical correlates to be defined. These findings provide evidence for targeted prevention and treatment interventions.

Important role of acute care surgery during pandemic time

Pandemic impacts acute care surgery for diseases,such as gallbladder disease and acute appendicitis.At the early stage of coronavirus disease 2019(COVID-19)pandemic,the case number of patients needing surgery decreased in hospitals from different countries.This decline was associated with the stay-home order and fear of getting COVID-19 infection.However,recent reports show that the case number for acute surgery returns to the normal level,which is comparable to that before the beginning of the pandemic.In addition,a variety of diseases show more severe than the cases before the pandemic,which might be caused by factors such as lack of regular follow-up and screening diagnosis and infection of viruses.

Study of Serum Metabonomics and Formula-Pattern Correspondence in Coronary Heart Disease Patients Diagnosed as Phlegm or Blood Stasis Pattern Based on Ultra Performance Liquid Chromatography Mass Spectrometry

Objectives： To study the characteristics of serum metabonomics in coronary heart disease （CHD） patients diagnosed as phlegm or blood stasis pattern and explore effects of formula-pattern correspondence treatment. Methods： A total of 102 stable CHD patients were enrolled and divided into phlegm group （P group, n=52） and blood stasis group （BS group, n=50） according to pattern identification. Gualou Xiebai Banxia Decoction （瓜萎薤白半夏汤, GXBD） and Xuefu Zhuyu Decoction （血府逐瘀汤, XZD） were used as drug interventions. Relevant indicators of metabonomics were observed by ultra performance liquid chromatography mass spectrometry （UPLC-MS） and pattern recognition. Results： Levels of amino acids and phosphatidylethanolamine （PE） in the CHD group were much higher than those in healthy control group, while the levels of unsaturated fatty acids, sphingosine, Lyso, phosphatidylcholine （PC） were significantly lower （P〈0.01）. Most of the differential metabolites between the CHD and the healthy groups were also common metabolites of phlegm and blood stasis. 7（Z）, 10（Z）- hexadecadienoic acid and DPA were decreased in the P group and increased in the BS group. According to the quantity of retraced metabolites, improvement in metabonomics by formula-pattern correspondence was superior to that without correspondence in the BS group. Based on the varieties of metabolites, GXBD could improve the levels of docosapentaenoic acid （DPA）, sphingomyelin （SM） （d34：1）, and L-Lactic acid and XZD could ameliorate the levels of sphingosine and Vit E in the P group, in the BS group, GXBD could improve vitamin E level and XZD could make improvements in the levels of octadecanoic acid, phosphoglycerol, and SM （d34：1）. Conclusions： Phlegm and blood stasis in CHD patients present specific differential metabolites, and share common metabolites. Remarkable differences have been displayed in pathological properties and severity of phlegm and blood stasis. Patients with phlegm are more likely to have lipid metabolism disorders. However, in patients with blood stasis, problems mainly lie in glucose, protein and fat metabolism and the injury of vascular cell membrane is relatively severe. The metabolic disorder is more complicated in blood stasis pattem than that in phlegm pattem. Compared with non-correspondence, improvement of differential metabolites is more comprehensive and targeted in formulapattern correspondence with a better effect.

Thoughts about Person-Centered Care for the Adult Population with Multimorbidity

Patients with multimorbidity are becoming the norm rather than the exception. The management of patients with several chronic diseases is now the most important challenge facing health care systems in developed countries. Based on the actual medical records of ambulatory care visits, this study investigated the prevalence and patterns of multimorbidity in 55 and older population. Among a cohort comprised of 300,000 beneficiaries selected randomly from the National Health Insurance Research Database of Taiwan in 2001, 42,441 were eligible. These were followed longitudinally 10 years. The prevalence of chronic disease rose from 62.3% to 79.8% and multimorbidity rose from 57.4% to 75.7%. Multimorbidity patterns were found fell in-to four clusters: metabolic diseases, cardiac diseases, mental joints and gastrointestinal tract disorders. Hypertension and diabetes mellitus, as well as hyperplasia of the prostate in men, were the most common chronic diseases. The prevalence of chronic disease increased with age, especially high at age 75 - 79. Thought about the health care system for an ageing society is necessary. Applying the concept of customer experience and strengthening people-centered management in an integrated model of health care, enhancing knowledge and skills in the long-term management of chronic disease, revising clinical guidelines and training professionals in caring for the elderly, reinforcing preventive health services, especially in men’s health, modifying the materials for health education, and planning for health manpower resources will provide a better model to ensure the health care for people with multimorbidity.