Effects of daily telephone-based re-education before taking medicine on Helicobacter pylori eradication: A prospective single-center study from China

AIM: To investigate the effects of daily telephonebased re-education(TRE) before taking medicine for the eradication of Helicobacter pylori(H. pylori) on the compliance and the eradication rate in a Chinese patient population.METHODS : Aprospective, physician-blind e d, randomized, controlled clinical study was conducted. The patients were randomly assigned to receive TRE every day before taking medicine(TRE group) or no TRE(control group). The patients in the TRE group received regular instructions before taking medicine for the eradication of H. pylori during the entire courseof treatment through telephone calls. The patients in the control group received detailed instructions at the time of seeing a doctor for the guidance. The primary outcome was the H. pylori eradication rate after treatment. The secondary outcomes included the clinical remissions after treatment, adverse events, compliance, and patients' satisfaction.RESULTS: A total of 140 patients were randomized, 70 to the TRE group and 70 to the control group. As the primary outcome, the H. pylori eradication rates in the TRE and control groups were 62.7% and 71.2% in per protocol analysis(P = 0.230), and 52.9% and 52.9% in intention-to-treat analysis(P = 0.567), respectively. As the secondary outcomes, there were no significant differences in the patients' satisfaction between the two groups(good, 79.7% vs 76.9%; fair, 13.6% vs 19.2%; poor, 6.7% vs 3.9%, for the TRE group and control group, respectively; P > 0.05 for all); the rates of adverse effects were 15.2% and 63.5% in the TRE and control groups, respectively(P < 0.001); the compliance rates in the TRE and control groups were 85.7% and 74.3%, respectively(P = 0.069).CONCLUSION: Daily TRE before taking medicine had no significant impact on the patients' compliance, satisfaction, or H. pylori eradication, but reduced the rate of adverse events.

PCA3 and TMPRSS2-ERG gene fusions as diagnostic biomarkers for prostate cancer

The incidence of prostate cancer （PCa） is rising steadily among males in many countries. Serum prostate-specific antigen （PSA） is widely applied to clinical diagnosis and screening of PCa. However, the so-called grey area of PSA levels 4.0-10.0 ng/mL has a low specificity of 25-40% resulting in a high rate of negative biopsy and overtreatment. So in order to treat PCa patients in early stage, there is an urgent need for new biomarkers in PCa diagnosis. The PCA3 gene, a non-coding RNA （ncRNA） that is highly expressed in prostate cancer （PCa） cells, has been identified as a molecular biomarkers to detect PCa, of which PCA3 has already under clinical application. PCA3 is strongly overexpressed in malignant prostate tissue compared to benign or normal adjacent one. Newly, PCA3 is considered to be a promising biomarker in clinical diagnosis and targeted therapy. The diagnostic significance of PCA3, however, is awaiting further researches. Moreover, it has been demonstrated recently that TMPRSS2-ERG gene fusion is identified as the predominant genetic change in patients diagnosed with PCa. Recent study revealed that combination of the PC43 and TMPRSS2-ERG gene fusion test optimizes PCa detection compared with that of single biomarker, which would lead to a considerable reduction of the number of prostate biopsies. In this review, we focused on the potential use of PCA3 and TMPRSS2-ERG gene fusion detection in the diagnosis of PCa.

Association of iodized salt with goiter prevalence in Chinese populations: a continuity analysis over time

Background: Iodine deficiency disorders(IDD) refer to diseases that are caused by insufficient iodine intake, and the best strategy to prevent IDD is the addition of iodine to dietary salt. Because iodine deficiency is a common cause of goiter, the prevalence as effectively controlled after the implementation of universal salt iodization(USI) in China. However, there is substantial controversy as to whether the incidence of thyroid disorders is related to iodized salt intake. Therefore, we aimed to clarify whether the risk of goiter can be promoted by USI.Methods: A longitudinal continuous study based on the national monitoring results of IDD in China was performed for 3 consecutive years. We recorded the following indicators of IDD from 31 provinces: goiter number, two degrees of goiter(the degree of goiter severity) and cretinism(three endemic diseases), iodized salt intake, median urinary iodine concentration(UIC), soil iodine content and coverage rates of iodized salt. One-way Analysis of Variance(ANOVA) and linear regression analyses examined the differences between the three groups and correlations, respectively. Data were collected from the Chinese national IDD surveillance data in 2011-2013, and the background values of Chinese soil elements were published in 1990.Results: A reference male's daily intake of maximum iodine was 378.9μg, 379.2μg and 366.9μg in 2011, 2012, and 2013, respectively. No statistical association between daily iodized salt intake and the three endemic diseases was observed in 2011-2013(P >0.05). No association was observed between daily iodized salt intake and the UIC of children in 2011(P>0.05). Linear regression revealed no significant correlation between the soil iodine content and three endemic diseases. The present study indicated no difference in the daily iodized salt intake in each province during three years(F=0.886, P=0.647). The coverage rate of iodized salt remained above 98.7%, and goiter rates were stable in 2011-2013.Conclusion: There was no significant association between iodized salt intake and the three endemic diseases, suggesting that the current nutrition level of iodized salt did not cause the high goiter prevalence.

Association between smoking and the risk of acute mountain sickness： a meta-analysis of observational studies

Background: People rapidly ascending to high altitudes(>2500m) may suffer from acute mountain sickness(AMS). The association between smoking and AMS risk remains unclear. Therefore, we performed a meta-analysis to evaluate the association between smoking and AMS risk.Methods: The association between smoking and AMS risk was determined according to predefined criteria established by our team. Meta-analysis was conducted according to the PRISMA guidelines. We included all relevant studies listed in the Pub Med and Embase databases as of September 2015 in this meta-analysis and performed systemic searches using the terms "smoking", "acute mountain sickness" and "risk factor". The included studies were required to provide clear explanations regarding their definitions of smoking, the final altitudes reached by their participants and the diagnostic criteria used to diagnose AMS. Odds ratios(ORs) were used to evaluate the association between smoking and AMS risk across the studies, and the Q statistic was used to test OR heterogeneity, which was considered significant when P<0.05. We also computed 95% confidence intervals(CIs). Data extracted from the articles were analyzed with Review Manager 5.3(Cochrane Collaboration, Oxford, UK).Results: We used seven case-control studies including 694 smoking patients and 1986 non-smoking controls to analyze the association between smoking and AMS risk. We observed a significant association between AMS and smoking(OR=0.71, 95% CI 0.52–0.96, P=0.03).Conclusion: We determined that smoking may protect against AMS development. However, we do not advise smoking to prevent AMS. More studies are necessary to confirm the role of smoking in AMS risk.

The update of prostatic ductal adenocarcinoma

Since initially described in 1967, prostatic ductal adenocarcinoma （PDA） has engendered a series of controversies on its origin, histological features, and biological behavior. Owing to the improvement of molecular biological technique, there are some updated findings on the characteristics of PDA. In the current review, we will mainly analyze its origin, clinical manifestations, morphological features, differential diagnosis, immunophenotype and molecular genetics, with the purpose of enhancing recognition of this tumor and making a correct diagnosis and treatment choice.

Association between acute mountain sickness(AMS) and age: a meta-analysis

Background: Acute mountain sickness(AMS) is a potentially lethal condition caused by acute hypoxia after ascending to altitudes higher than 2500 m in a short time. The main symptom of AMS is headache. Numerous risk factors of AMS have been examined, including gender, obesity, ascent rate, age and individual susceptibility. In previous studies, age was considered a predisposing factor for AMS. However, different opinions have been raised in recent years. To clarify the association between AMS and age, we conducted this meta-analysis.Methods: We obtained observational studies that explored risk factors for AMS by searching PubMed, Embase, China National Knowledge Internet(CNKI), the Wanfang database and CQVIP for articles published before March 2017.The studies included were required to provide the mean age and its standard deviation for subjects with and without AMS, the maximum altitude attained and the mode of ascent. The Lake Louse Score(LLS) or the Chinese AMS score(CAS) was used to judge the severity of AMS symptoms and incidence. Studies were pooled for the analysis by using a random effects model in RevMan 5.0. Meta-regression and subgroup analyses were conducted to identify sources of heterogeneity using Stata 14.2 and RevMan 5.0.Results: In total, 17 studies were included, and the overall number of subjects with and without AMS was 1810 and3014, respectively. The age ranged from 10 to 76 years. Analysis of the 17 included studies showed that age was not associated with AMS(mean difference(MD)=0.10; 95%CI: —0.38-0.58; P=0.69).Conclusions: This meta-analysis suggests that there is no association between age and the risk of AMS. Race, age,and ascent mode are common sources of heterogeneity, which may provide an analytical orientation for future heterogeneity analyses.

Association between endothelial nitric oxide synthase(ENOS) G894T polymorphism and high altitude(HA) adaptation： a meta-analysis

Objective: Highland natives adapt well to the hypoxic environment at high altitude(HA). Several genes have been reported to be linked to HA adaptation. Previous studies showed that the endothelial nitric oxide synthase(ENOS) G894 T polymorphism contributed to the physiology and pathophysiology of humans at HA by regulating the production of NO. In this meta-analysis, we evaluate the association between the ENOS G894 T polymorphism and HA adaptation through analyzing the published data. Methods: We searched all relevant literature about the ENOS G894 T polymorphism and HA adaptation in Pub Med, Medline, and Embase before Step 2015. A random-effects model was applied(Revman 5.0), and study quality was assessed in duplicate. Six studies with 634 HA native cases and 621 low-altitude controls were included in this meta-analysis. Results: From the results, we observed that the wild-type allele G was significantly overrepresented in the HA groups(OR=1.85; 95% CI, 1.47–2.33; P<0.0001). In addition, the GG genotype was significantly associated with HA adaptation(OR=1.99; 95% CI, 1.54–2.57; P<0.0001). Conclusion: Our results showed that in 894 G allele carriers, the GG genotype might be a beneficial factor for HA adaptation through enhancing the level of NO. However, more studies were needed to confirm our findings due to the limited sample size.

Changes in oxygen saturation can not help diagnose acute mountain sickness(AMS)： ascending to Lhasa on the Qinghai-Tibet train

Objective: Acute mountain sickness(AMS) is a common condition in individuals who ascend to altitudes over 2 500 m. There is no measurements that can reliably predict or diagnose this condition. We therefore determined whether pulse oximetry data are associated with the development of AMS and can help diagnose AMS. Methods: We studied 58 young male undergraduates who traveled from Chongqing(300 m) to Lhasa(3 658 m) by train. We collected data on the ascent profiles and AMS symptoms based on the Lake Louise Score(LLS). The resting arterial oxygen saturation(R-Sp O2) and pulse rate were then measured using finger pulse oximetry. Results: In Golmud(2 800 m) and Tanggula(5 200 m), R-SpO_2 was significantly lower in the AMS group than in the group without AMS(P<0.05). However, upon arrival in Lhasa(3 658 m), the R-SpO_2 was higher in the AMS group than in the non-AMS group(P<0.05). In Tanggula, the change in the SpO_2(CR-SpO_2) in the AMS group was higher than that in the non-AMS group(P<0.05). But in Lhasa, the CR-SpO_2 in the AMS group was lower than that in the non-AMS group(P<0.05). We also monitored heart rate(HR) throughout the study. In Xining(2 200 m) and Golmud, the HRs in the AMS group were higher than those in the non-AMS group. However, the HRs in the AMS group were lower than those in the non-AMS group in Tanggula and Lhasa. Conclusion: Based on the results of this study, the R-SpO_2 graph was not consistent. We can thus conclude that the utility of SpO_2 remains limited in the diagnosis of AMS. The results suggest that using pulse oximetry to diagnose AMS is not valuable in people ascending to Lhasa on the Qinghai-Tibet train.

Role of medical resource level in iodine deficiency disorder

Background:Iodine deficiency disorders(IDDs)refer to a series of diseases caused by the human body's insufficient iodine intake.Edible salt became iodized in China in 1996,which yielded remarkable results.We have known that IDDs is associated with iodine in the human body,but it is not clear whether IDDs is related to medical resource level.Methods:We collected the number of IDDs cases and an index for the level of medical resource from 31 provinces,autonomous regions and municipalities directly under the central government in China.All data came from the China Statistical Yearbook of Health and Family Planning issued in 2013 by the Peking Union Medical College Publishing House.Data standardization and linear regression analysis were used.Results:The results showed that IDDs correlated with the number of beds in medical and health institutions,number of medical health personnel,number of medical and health institutions,total health expenditure,average health expenditure per capita,medical insurance for urban resident and new rural cooperative medical rural residents(P<0.01).In a multiple linear regression,IDDs was most significantly associated with the number of beds in hospitals,the number of rural health personnel,the number of basic medical and health institutions and government health expenditure for these institutions. Conclusion:Based on the experimental data,we concluded that IDDs had a positive connection with the medical resource level,and basic and rural areas had a more significant association with IDDs.This analysis provides new and explicit ideas for iodine prevention and control work in China.

The benign mimickers of prostatic acinar adenocarcinoma

As the most frequent malignant histological subtype in prostatic cancer, prostatic acinar adenocarcinoma （PAA） has a series of benign mimickers including prostatic or non-prostatic lesions and normal structures, which may lead to an erroneous diagnosis and inappropriate treatment. It is very important to be aware of the existence of these mimickers and to recognize their histological features. The differential diagnosis should be based on a comprehensive evaluation of clinical history, histological structure, cytological morphology and the results of immunohistochemistry （IHC） straining, rather than on single criteria （e.g., the presence of prominent nueleoli or basal cell layer）.

Epidemiology of esophageal squamous cell carcinoma

Esophageal cancer( EC) caused about more than390 000 deaths in 2010. EC is the fourth leading cause of cancer death in China. Esophageal squamous cell carcinoma( ESCC) is the predominant histologic type in China. This study briefly reviews the epidemiology of ESCC,especially focus on the environmental and genetic risk factors of ESCC.

Experiences and challenges in the health protection of medical teams in the Chinese Ebola treatment center,Liberia:a qualitative study

Background:Health care workers are at the frontline in the fight against infectious disease,and as a result are at a high risk of infection.During the 2014-2015 Ebola outbreak in West Africa,many health care workers contracted Ebola,some fatally.However,no members of the Chinese Anti-Ebola medical team,deployed to provide vital medical care in Liberia were infected.This study aims to understand how this zero infection rate was achieved.Methods:Data was collected through 15 in-depth interviews with participants from the People’s Liberation Army of China medical team which operated the Chinese Ebola Treatment Center from October 2014 to January 2015 in Liberia.Data were analysed using systematic framework analysis.Results:This study found numerous bio-psycho-socio-behavioural risk factors that directly or indirectly threatened the health of the medical team working in the Chinese Ebola Treatment Center.These factors included social and emotional stress caused by:(1)the disruption of family and social networks;(2)adapting to a different culture;(3)and anxiety over social and political unrest in Liberia.Exposure to Ebola from patients and local co-workers,and the incorrect use of personal protective equipment due to fatigue was another major risk factor.Other risk factors identified were:(1)shortage of supplies;(2)lack of trained health personnel;(3)exposure to contaminated food and water;(4)and long working hours.Comprehensive efforts were taken throughout the mission to mitigate these factors.Every measure was taken to prevent the medical team’s exposure to the Ebola virus,and to provide the medical team with safe,comfortable working and living environments.There were many challenges in maintaining the health safety of the team,such as the limited capability of the emergency command system(the standardized approach to the command,control,and coordination of an emergency response),and the lack of comprehensive international protocols for dealing with emerging infectious disease pandemics.Conclusions:The comprehensive and multidisciplinary measures employed to protect the health of the medical team proved successful even in Liberia’s resource-limited setting.The global health community can learn valuable lessons from this experience which could improve the safety of health care workers in future emergencies.These lessons include:establishing capable command systems;implementing effective coordination mechanisms;providing adequate equipment;providing training for medical teams;investing in the development of global health professionals;and improving research on ways to protect health care workers.

Sequencing and analysis of the complete mitochondrial genome in Anopheles sinensis(Diptera:Culicidae)

Background:Anopheles sinensis(Diptera:Culicidae)is a primary vector of Plasmodium vivax and Brugia malayi in most regions of China.In addition,its phylogenetic relationship with the cryptic species of the Hyrcanus Group is complex and remains unresolved.Mitochondrial genome sequences are widely used as molecular markers for phylogenetic studies of mosquito species complexes,of which mitochondrial genome data of An.sinensis is not available.Methods:An.sinensis samples was collected from Shandong,China,and identified by molecular marker.Genomic DNA was extracted,followed by the Illumina sequencing.Two complete mitochondrial genomes were assembled and annotated using the mitochondrial genome of An.gambiae as reference.The mitochondrial genomes sequences of the 28 known Anopheles species were aligned and reconstructed phylogenetic tree by Maximum Likelihood(ML)method.Findings:The length of complete mitochondrial genomes of An.sinensis was 15,076 bp and 15,138 bp,consisting of 13 protein-coding genes,22 transfer RNA(tRNA)genes,2 ribosomal RNA(rRNA)genes,and an AT-rich control region.As in other insects,most mitochondrial genes are encoded on the J strand,except for ND5,ND4,ND4L,ND1,two rRNA and eight tRNA genes,which are encoded on the N strand.The bootstrap value was set as 1000 in ML analyses.The topologies restored phylogenetic affinity within subfamily Anophelinae.The ML tree showed four major clades,corresponding to the subgenera Cellia,Anopheles,Nyssorhynchus and Kerteszia of the genus Anopheles.Conclusions:The complete mitochondrial genomes of An.sinensis were obtained.The number,order and transcription direction of An.sinensis mitochondrial genes were the same as in other species of family Culicidae.

Medical humanity： how do we learn it？

Medical humanity, as ambiguous and inclusive as the concept seems at first glance, is broadly defined as an interdisciplinary field in humanities, social science and the arts, involving such extensive fields as ethics, history, religion, cultural studies, sociology, psychology, literature, etc., and their application to medical education and practice.1 In the United States, Europe and Canada, many medical universities have integrated the learning of medical humanities in their curricula, which many scholars claim may help medical students to build up a humane and holistic orientation in the future.2

Military-related posttraumatic stress disorder and mindfulness meditation:A systematic review and meta-analysis

Purpose:Posttraumatic stress disorder(PTSD)is a significant global mental health concern,especially in the military.This study aims to estimate the efficacy of mindfulness meditation in the treatment of military-related PTSD,by synthesizing evidences from randomized controlled trials.Methods:Five electronic databases(Pubmed,EBSCO Medline,Embase,PsychINFO and Cochrane Library)were searched for randomized controlled trials focusing on the treatment effect of mindfulness meditation on military-related PTSD.The selection of eligible studies was based on identical inclusion and exclusion criteria.Information about study characteristics,participant characteristics,intervention details,PTSD outcomes,as well as potential adverse effects was extracted from the included studies.Risk of bias of all the included studies was critically assessed using the Cochrane Collaboration's tool.R Statistical software was performed for data analysis.Results:A total of 1902 records were initially identified and screened.After duplicates removal and title&abstract review,finally,19 articles in English language with 1326 participants were included through strict inclusion and exclusion criteria.The results revealed that mindfulness meditation had a significantly larger effect on alleviating military-related PTSD symptoms compared with control conditions,such as treatment as usual,present-centered group therapy and PTSD health education(standardized mean difference(SMD)=-0.33;95%CI[-0.45,-0.21];p<0.0001).Mindfulness interventions with different control conditions(active or non-active control,SMD=-0.33,95%CI[-0.46,-0.19];SMD=-0.49,95%CI[-0.88,-0.10],respectively),formats of delivery(group-based or individual-based,SMD=-0.30,95%CI[-0.42,-0.17],SMD=-0.49,95%CI[-0.90,-0.08],respectively)and intervention durations(short-term or standard duration,SMD=-0.27,95%CI[-0.46,-0.08],SMD=-0.40,95%CI[-0.58,-0.21],respectively)were equally effective in improving military-related PTSD symptoms.Conclusion:Findings from this meta-analysis consolidate the efficacy and feasibility of mindfulness meditation in the treatment of military-related PTSD.Further evidence with higher quality and more rigorous design is needed in the future.