Objective This article analyzed the characteristics of the health service in medium cities and the impact on community health service.Methods Summary and statistical analysis of the outcomes from the Fourth National Health Service Survey by the category of metropolitans,sub-provincial cities and provincial capital cities,and non-provincial-capital cities.Results In the medium cities,the geographical accessibility is high against low economic and technology accessibility.These cities have lower 2-week morbiditv rate but high children morbidity rate.These cities also feature high self-rated health status among residents and high health risk factors prevalence at the sarne time.Conclusion Medium cities are recommended to further build their CHS system,enhance their ties with larger cities,so as to elevate their technical competence,for meeting such public health needs of the people in infectious disease control,health promotion and vulnerable population healthcare.

Objective:To investigate the clinical significance of detecting Epstein Barr virus (EBV) infection in evaluating recent curative and long-term effects in patients with extranodal natural killer (NK)/T-cell lymphoma. Methods:The EBV-DNA copies in the plasma of 109 patients, who were pathologically and immunohistochemically diagnosed with extranodal natural killer/T-cell lymphoma in the First Affiliated Hospital of Zhengzhou University between January 2011 and April 2014, were monitored via quantitative re-al-time polymerase chain reaction. Subsequently, the difference in recent curative and long-term effects between EBV positive and EBV negative patients was compared. Results:Among the 109 patients with extranodal NK/T-cell lymphoma, 34 (64.2%) cases of EBV posi-tive patients were at the advanced stage (Ⅲ~Ⅳ stages), and 22 (39.3%) cases of EBV negative patients were at the terminal stage (Ⅲ~Ⅳstages). EBV positive patients who accompanied by B symptoms were 33 (62.3%) , and there were 21 (37.5%) cases with B symptoms in EBV negative patients, the differences between stages and B symptoms were statistically significant. The attained objec-tive response rate of the EBV-DNA negative patients (34, 60.7%) was significantly higher than that of the EBV-DNA positive patients (22, 41.5%) (P<0.05). Similarly, the 2-year progression-free survival (PFS) rate of EBV negative patients was better than that of EBV positive patients (P<0.05). Conclusion:Detecting EBV in plasma has clinical significance in evaluating the recent curative effect and the 2-year PFS rate in patients diagnosed with extranodal NK/T-cell lymphoma.

Objective:To analyze clinical characteristics, treatment, and prognosis of B-cell lymphoma, unclassifiable, with features in-termediate between diffuse large B-cell lymphoma and Burkitt lymphoma (DLBCL/BL). Methods:The clinical and pathological data of 13 DLBCL/BL patients, who were treated in the First Affiliated Hospital of Zhengzhou University between January 2013 and December 2014, were collected. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Through the log-rank test, survival curves were compared among groups classified by clinical stage, age, serum lactate dehydrogenase (LDH) lev-el, international prognostic index (IPI) score, or first chemotherapy regimen. Results:Among the 13 patients with DLBCL/BL, 12 pa-tients showed extra-nodal involvement. The median OS and PFS were only 10 and 6 months, respectively. Univariate analysis showed that the LDH levels and IPI scores exerted statistically significant effects on prognosis. Some borderline differences in survival were not-ed among the CHOP, CHOP-like, and intensive chemotherapy groups. Conclusion:DLBCL/BL is an aggressive B-cell lymphoma with a short survival time. The majority of patients presented extra-nodal involvement. DLBCL/BL did not respond well to CHOP or CHOP-like regimen, and more intensive chemotherapy may improve survival. Elevated LDH levels and high IPI scores were predictors of poor sur-vival.

Background and purpose:Extranodal natural killer/T-cell lymphoma (ENKTL) is a form of non-Hodgkin’s lymphoma. The ENKTL incidence in China is much higher than that in the Western countries. The disease is highly malignant, not sensitive to chemotherapy, has short survival period and poor prognosis. Epstein-Barr virus (EBV) infection has close relationship with the development of the disease. However, there are still a few patients without EBV infection. This study aimed to discuss the clinical features and prognosis of EBV-encoded small RNA (EBER) in situ hybridization negative ENKTL.Methods:From Aug. 2011 to Oct. 2015, 326 cases were diagnosed with ENKTL from the First Affliated Hospital of Zhengzhou University. The expression of EBER was detected by in situ hy-bridization technique. The clinical pathological characteristics and prognosis of EBER-negative patients were analyzed. Results:In 326 patients with ENKTL, the negative rate of EBER was 2.45% (8/326). In 8 EBER-negative patients, the median survival time was 17 months. The log-rank test revealed that there was a signiifcant difference between EBER-negative and EBER-positive curves (χ2=6.407,P=0.011). Multivariate Cox proportional hazards regression analysis showed that in EBER-negative ENKTL, only lactate dehydrogenase (LDH) predicted survival time (P=0.008). EBV-DNA copy number in plasma was not signiifcantly correlated with survival time (P>0.05).Conclusion:The inci-dence of EBER-negative ENKTL is low. Patients with EBER-negative ENKTL have poorer prognosis than EBER-posi-tive patients. Elevated LDH may be a factor indicating poor prognosis.

Objective To observe the effects on and the possible mechanism of early exercise training underlying the mobilization of circulating endothelial progenitor cells in patients with acute ischemic stroke.Methods One hundred and twenty patients with acute ischemic stroke were randomized into two groups:an early exercise group (treated with exercise training,n =60) and a control group(no exercise training,n =60).Meanwhile,each group was divided into two different age groups (50-68 years group of 32 cases,＞ 68 years group of 28 cases in exercise group;50-68 years group of 29 cases,＞ 68 years of 31 cases in control group).The amount of circulating endothelial progenitor cells in peripheral blood was accounted by flow cytometry (FCM),while the level of vascular endothelial cell growth factor (VEGF) in blood serum was examined by enzyme-linked immunoassay (ELISA).National Institutes of Health Stroke Scale (NIHSS),Fugl-Meyer Assessment (FMA) and modified Barthel index (MBI) were used to evaluate the patients at 1st day and 14th day after exercise.Results The amount of circulating progenitor cells after 14 days of exercise training in exercise group (from 27.93 ± 6.08/ml to 457.49 ± 73.02/ml)is higher than in control group(from 28.29 ± 5.93/ml to 81.87 ± 9.92/ml) (P ＜ 0.01).Compared with the control group,the level of VEGF at 14th day of exercise group is significantly higher (P ＜ 0.01).The score of NIHSS,FMA,MBI were not significantly different between exercise group and control group (P ＜ 0.01).However,the score of NIHSS was decrease in both exercise group and control group after treatment.Furthermore,the amount of circulating progenitor cells was not significantly different between the age groups either in exercise group or control group (P ＞ 0.05).Conclusion Early Exercise training may promote the mobilization of the circulating progenitor cells,which might be related to the increase of VEGF.The mobilization of the EPCs has no effect on the early neurological function after acute ischemic stroke.Age is not associated with the amount of circulating endothelial progenitor cells.

Objective To explore the effects of combination of traditional Chinese medicine (TCM)and western medicine on a variety of allergen induced severe perennial seasonal allergic rhinitis patients who were treated invalidly with antihistamines and intranasal flixonase for more than two years.Methods 16 patients with moderate to severe allergic rhinitis who were uncontrolled with antihistamines and intranasal flixonase for one week were treated by combination with TCM of Xin-Yi-Qing-fei San or Gyokubeifu-san mixed formula for two weeks.Nasal symptoms,its effects on the quality of daily life,and telephone follow-up half a year later were evaluated.Mini Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) and Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ) were used to evaluate the quality of life.Results After 2 weeks combination-treatment,the nasal symptoms of congestion,rhinorrhea,sneezing,nasal itching,and nasal obstruction were significantly improved compared with combination-before [(52.0± 11.1)％,(69.1±5.3)％,(68.3±12.3)％,(55.5±10.0)％to (10.9±2.4)％,(8.9±3.2)％,(12.5±4.3)％,(13.2±5.3)％,respectively].The before and after treatment of nasal function of nasal minimum cross-sectional area (MCA),nasal cavity volume (V5) and nasal airway resistance (R75 and R150) respectively were (0.58±0.12)cm2,(0.38 ± 0.23) Pa/cm3 · s-1,(0.44 ± 0.32) Pa/cm3 · s-1,(3.50 ± 2.33) cm2 to (0.48 ± 0.23) cm2,(0.31 ±0.33) Pa/cm3 · s-1,(0.31 ±0.37)Pa/cm3 · s-1,(2.24± 1.03) cm2 (P＜0.01).In addition,findings of patients with nasal symptoms by half year follow-up were significantly better than those of before.Conclusion The interventionof TCM can effectively control the perennial and seasonal severe symptoms of patients with AR,and improve the quality of life of patients.

Objective: To investigate the relationship between psychiatric nurses' self-efficacy, self-acceptance and coping style, and to explore the intermediary role of psychiatric nurses′ self-efficacy in self-acceptance and positive coping style. Methods: Totally 813 clinical nurses in 6 prefectural and municipal psychiatric hospitals in Shandong Province were investigated with general information questionnaire, simple coping style scale and self-acceptance questionnaire, and the results were analyzed. Results: The scores of self-efficacy and positive coping styles of psychiatric nurses were (2.40 ±0.54) and (2.09 ±0.47) points.The difference was statistically significant (t=-15.072, 12.76, P < 0.01), the total score of self-acceptance was (42.28 ±4.91) points, the score of self-acceptance factor was (21.76 ±3.60) points, the score of self-evaluation factor was (20.53 ±3.36) points. There was no significant difference compared with the domestic norm (P>0.05). Positive coping style was positively correlated with self-efficacy, self-acceptance and self-evaluation (P < 0.01), negative coping style was negatively correlated with self-acceptance and self-evaluation (P<0.01). Self-acceptance and self-efficacy were important predictors of coping style, Self-efficacy plays an intermediary role in self-acceptance and coping style, and the mediating effect was 0.155, 95%CI (0.117-0.202). Conclusion Improving self-efficacy of psychiatric nurses was one of the effective ways to improve coping style of nurses.

Objective To investigate the clinical characteristics, pathogenesis, diagnosis, treatment and prognosis of acute myeloid leukemia secondary to angioimmunoblastic T-cell lymphoma. Methods The clinical data of 3 patients with acute myeloid leukemia secondary to angioimmunoblastic T-cell lymphoma including immunohistochemistry and flow cytometer analysis were analyzed retrospectively, then the literature was reviewed. Results All the 3 patients were elderly men and the initial diagnosis was angioimmunoblastic T-cell lymphoma. The 3 cases developed secondary acute myeloid leukemia in 8 months, 14 months and 34 months after treating primary neoplasms respectively. After diagnosed acute myeloid leukemia, one case died 10 months later without treatment, one case died 13 months later despite aggressive treatment and one case lost follow-up. Conclusion Angioimmunoblastic T-cell lymphoma has risk to developing acute myeloid leukemia, and there is a poor survival and the pathogenesis is unclear.

Objective:To analyze and summarize the application and significance of the computer-assisted surgery system in precision surgery of mediastinal tumors in children.Methods:The clinical data of 54 children that underwent mediastinal tumor resection surgery in the Affiliated Hospital of Qingdao University from August 2008 to November 2021 were collected.According to whether the Hisense CAS computer-assisted surgery system was used before the operation, the patients were divided into three-dimensional (3D) reconstruction group (29 cases, 53.70%) and two-dimensional (2D) CT group (25 cases, 46.30%). The surgical indicators, postoperative hospital stay, and the incidence of surgical complications were compared between the two groups.The t-test, Mann- Whitney U test, χ2 test or Fisher′ s exact test were carried out for statistical analysis.Simulated surgery and actual surgery were compared for both 3D reconstruction and 2D CT groups. Results:There were no significant differences in gender, age, height, weight, maximum tumor diameter and tumor location between the 3D reconstruction group and 2D CT group (all P>0.05). The operation time of the 3D reconstruction group was [(125.14±41.37) min] was shorter than that of the 2D CT group [(149.24±44.53) min] ( P=0.044). The intraoperative blood loss in the 3D reconstruction group [15.00(13.50, 25.00) mL] was less than that in the 2D CT group [36.00(30.00, 75.00) mL] ( P<0.001). In addition, the indwelling time the closed thoracic drainage tube [4.00 (3.00, 5.50) d] and postoperative hospitalization days [(8.83±3.39) d] in the 3D reconstruction group were shorter than those in the 2D CT group [7.00(5.00, 11.50) d, (11.00±4.10) d] ( P=0.001, 0.038). No significant difference in postoperative complication rates was found between the 3D reconstruction group and 2D CT group ( P>0.05). The simulated operation was consistent with the actual operation in the 3D reconstruction group. Conclusions:3D reconstruction by the computer-assisted surgery system can truly reveal the anatomical relationship between tumors and surrounding organs and blood vessels, and improve the accuracy and safety of surgical resection of mediastinal tumors in children.

Objective:To evaluate the effect of general anesthesia guided by electroencephalography (EEG) monitoring on postoperative delirium (POD) in elderly patients with non-acute fragile brain function.Methods:Sixty patients of both sexes with non-acute fragile brain function, aged 65-85 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with body mass index of 18-30 kg/m 2, undergoing hip replacement, were divided into 2 groups ( n=30 each) by a random number table method: conventional general anesthesia group (group C) and general anesthesia guided by EEG monitoring group (group E). Anesthesia was maintained by intravenous infusion of propofol 50-150 μg·kg -1·min -1 and remifentanil 0.05-0.30 μg·kg -1·min -1 and intermittent intravenous boluses of rocuronium.In group E, the dose of anesthetic was reduced when the EEG burst-suppression ratio≥10% for more than 1 min or anesthesia index (AI) <40.If the situation mentioned above still existed after 1 min, the dose of anesthetic was continued to be reduced or norepinephrine was injected intravenously.In group C, the amount of intraoperative anesthesia was adjusted according to the changes in hemodynamics.Norepinephrine 4-10 μg or dopamine 1 mg was given intravenously in the light of the patients′ heart rates when intraoperative hypotension occurred.At 10 min after anesthesia induction, immediately after skin incision, immediately at the end of surgery and at 1 h after surgery, blood samples were obtained from the artery and jugular venous bulb for blood gas analysis and for calculation of jugular bulb blood oxygen content (CjvO 2), artery-jugular bulb blood oxygen content difference (Ca-jvO 2), cerebral oxygen uptake rate (CERO 2) and jugular-arterial blood lactate concentration difference (Djv-aLac). The emergence time, amounts of intraoperative anesthetics, use of noradrenaline, cumulative time of EEG burst inhibition and duration of AI<40 were recorded.The development of POD was assessed within 5 days after surgery by the confusion assessment method for the intensive care unit and the duration was recorded. Results:Compared with group C, recovery time, cumulative time of EEG burst inhibition and duration of AI<40 were significantly shortened, the intraoperative consumption of propofol and remifentanil was decreased, the requirement for intraoperative noradrenaline was increased, CjvO 2 was increased, Ca-jvO 2 and CERO 2 were decreased immediately at the end of surgery and at 1 h after surgery, the incidence of POD within 5 days after surgery was decreased, and POD duration was shortened in group E ( P<0.05). Conclusion:General anesthesia guided by EEG monitoring can reduce the development of POD in elderly patients with non-acute fragile brain function.