Objective To evaluate correlation of CT features of tuberculous adrenal glands with duration of adrenal insufficiency and propose a new staging criteria for adrenal TB Methods CT features of 28 cases of documented adrenal tuberculosis were analysed retrospectively The patients were divided into 3 groups according to the duration of adrenal insufficiency: group A (10 cases , less than 1 year), group B (13 cases, 1 year to 4 years), group C (5 cases, longer than 4 years) The main CT features analyzed included size and shape of the adrenal gland, calcification ,and low density foci Results Enlargement of the adrenal gland: group A(10) , group B (13), group C (1) Basic configuration of adrenal gland were identifiable in group A ,whereas others had more irregular shape Calcification: group A (2) , group B (11),group C (5) Low density foci: group A (3), group B(0), group C (0) Conclusion CT features of adrenal glands correlated with duration of adrenal insufficiency in adrenal tuberculosis It is more reasonable to use tri phase criteria according to CT appearance in adrenal tuberculosis

Objective To better promote the health education and health promotion among patients with chronic disease, general practitioners (GPs) in the community should master the knowledge of non-communicable diseases (NCDs). This paper aimed to describe the current situation of GPs' knowledge about prevention and treatment of NCDs. Methods Self-designed questionnaires were issued to 1 077 GPs in community health service centers, and all GPs finished the questionnaire without assistance. The content of questionnaire includes the general information of GPs and six questions focusing on NCDs. Results Overall, 1 076 GPs completed the questionnaire, and the response rate was 99.9% (1 076/1 077). With regard to the six questions about NCDs, 90.4% (973/1 076) of GPs were well aware of the diagnosis of hypertension. Apart from that, the knowledge of diabetes mellitus (60.9%, 655/1 076), factors related to NCDs (70.2%, 755/1 076), the concepts of mental illness (52.0%, 560/1 076) and the clinical significance of tumor markers (87.9%, 946/1 076) among GPs were adequate, while more than half of the GPs did not know a lot about home oxygen therapy. Conclusion The mastering level of knowledge about prevention and treatment of NCDs among GPs varies that they need further improvement.

In recent ten years, general practitioner (GP) training and practice develops rapidly in China. It has established a relatively complete GP training system, including medical college education and standardized residency training. However, the path of continuing professional development and clinical skills improvement for GP after standardized residency training is still unclear. The concept of GP with special interest (GPSI) has been proposed these days, and it has put forward a new development direction for the career path of GP. In this article, on the basis of understanding the current status of GPSI in China, we try to discuss its advantages and problems, and then propose our suggestions for its future development.

Objective To evaluate the feasibility and safety of portal-superior mesenteric vein resection and end-to-end anastomosis in cases of colonic carcinoma invading portal vein undergoing combined right hemicolectomy (RH) and pancreaticoduodenectomy (PD) without the need of graft interposition.Methods From 2004 to 2011,5 patients underwent resection of right-sided colon and pancreaticoduodenectomy combined mesentericoportal vein resection at a length from 3 to 4 cm and end-toend anastmoses without graft.Results Surgery was successful in all 5 patients,with complete resection,no severe complications occurred,and all 5 patients were cured.Conclusions Cancers in hepatic flexure of the colon frequently infiltrates the head of the pancreas and duodenum,involving the portal vein.Conservative radical right hemicolectomy and pancreaticoduodenectomy combined long mesentericoportal vein resection and end-to-end anastmoses without graft is a reasonable and safe procedure.

Objective To study the protection effect of dexmedetomidine and ulinastatin on acute lung in-jury caused by hepatic ischemia reperfusion. Methods 50 rats were randomly divided into 5 groups: the blank group, saline group, the dexmedetomidine group, the ulinastatin group, the dexmedetomidine and ulinastatin group. Ischemia-reperfusion models were established and drugs were administrated through femoral vein. The levels of MDA, SOD and ICAM were detected. Results Compared with the blank group, the rest of the groups of PaO2, pH and SOD activity were significantly lower (P < 0.05), and BE, pathological grading, MDA, ICAM levels were significantly higher (P<0.05). PaO2, pH and SOD activity of ulinastatin group were significantly lower in the phys-iological saline group (P < 0.05), BE, pathological grading, MDA level, ICAM levels were significantly elevated in the physiological saline group (P<0.05). Conclusion Combination of dexmedetomidine and ulinastatin have protection effect on acute lung injury caused by hepatic ischemia reperfusion, its mechanism may be related to in-hibit neutrophil aggregation, improve their antioxidant capacity and inhibition of lipid peroxidation.

AIM: To explore the effects of processing on components group of Semen Raphani. METHODS: By comparing HPLC maps of Semen Raphani samples prepared with different methods and computing similarity,(analysis) the change law of the components group. RESULTS: The mechanism of inhibiting the enzyme by processing Semen Raphani was found and C3 was able to produce new compounds A209,B221. CONCLUSION: Processing Semen Raphani can change the components group through influencing the decoction process,eventually produce different clinical effects.

ObjectiveTo establish a method to induce heterotopic ossification (HO) after spinal cord injury. Methods10 New Zealand White rabbits underwent a complete transection of the thoracic (T10) spinal cord. Just after transection, the right hind limb of every rabbit was immobilized with a plaster support to keep the knee in extension and the hip unrestricted. The plaster was temporarily removed once a day (six times per week) to allow the knees passively mobilized at the maximum range for 5 min. Local swelling, local skin temperature and grade of ossification of the paraplegic limbs were observed. After 5 weeks, the rabbits were sacrificed, and the quadriceps muscles of the right hind limbs were removed for the histological examination. ResultsAfter 5-week immobilization and temporary passive mobilization, HO was successfully induced in all 10 rabbits. There was local skin temperature increase and local swelling in the right hind limbs. The histological changes were similar to those observed in clinical HO. Conclusion5-week immobilization and temporary passive mobilization approach may successfully induce HO, and it may be used to study the pathogenesis of HO after spinal cord injury.

Objective:To analyze the satisfaction degree and related factors of community health services among residents in Zhejiang province.Methods:A service satisfaction survey was conducted during July to October 2019; using purpose sampling method three community health service centers were selected as survey sites in Hangzhou, Jiaxing, and Lishui cities, representing high, medium, and low economic development levels in Zhejiang province. The short-form Patient Satisfaction Questionnaire (PSQ-18) was used in the survey. SPSS 19.0 was adapted for data analysis, and multivariate logistic regression was applied use of analyze the affecting factors of satisfaction.Results:A total of 464 questionnaires were distributed, and 429 valid ones were returned with a response rate of 92.46%. Among them, 112 were from Hangzhou, 159 from Jiaxing, and 158 from Lishui. The overall satisfaction score of community health services was (4.22±0.59), and the satisfaction rate was 85.8%(368/429).Among the three cities, the overall satisfaction score in Lishui was the highest (4.28±0.51) with a satisfaction rate of 88.7% (140/158). The satisfaction scores of service quality, doctors' interpersonal communication ability, doctor-patient communication level, economic efficiency of service, timeliness of service, and accessability of service were (3.99±0.57), (4.10±0.77), (4.27±0.56), (3.54±0.84), (4.13±0.68) and (3.88±0.55); the satisfaction rates of those items were 59.6%(256/429), 79.4%(340/429), 86.3%(370/429), 43.6%(187/429), 78.9%(338/429)and 50.3%(216/429), respectively. Multivariate logistic regression analysis indicated that the quality of service, doctors' interpersonal communication ability, doctor-patient communication level and accessability of service were the affecting factors of the residents' satisfaction to community health services ( OR=3.734, 2.928, 7.732, 4.275; P<0.05). Conclusion:The residents of Zhejiang province have a high overall satisfaction with community health services. The quality of service, doctors' interpersonal communication ability, doctor-patient communication level and accessability of service are the affecting factors of the overall satisfaction degree.

Objective To evaluate the therapeutic efficacy of stereotactic body radiotherapy (SBRT) with gamma knife on stage Ⅰ-Ⅱ non-small-cell lung cancer(NSCLC)and the quality of life of the patients undergoing this therapy.Methods Twenty NSCLC patients with the median age of 76,10 at stage Ⅰ and 10 at stage Ⅱ who were unable or unwilling to undergo surgery were given SBRT with gamma knife at the doses of 3-6 Gy in 8-15 fractions,finished within 2 to 3 weeks.The prescription isodose line was 50％,the marginal dose was 39-56 Gy,the central dose was 78-112 Gy,and the total biologically effective dose was 51-83 Gy.The patients were observed after admission and followed up by chest CT 1,3,6,and 12 months after treatment until progressive disease or death.EORTC QLQ-LC43 questionnaire was used to investigate the changes in quality of life.Results The 20 patients were followed up for 24 (12-46) months.At six months after the treatment,the overall response rate was 80％,and the complete response rate was 35％.The 1,2 and 3-year local control rates were 100％,95％ and 95％,respectively.The 1,2 and 3-year overall survival rates were 95％,80％ and 50％ respectively; The 1,2,and 3-year progression free survival rates were 85％,64％ and 33％,respectively.The failure rate was 20％ and the rate of progress within the planning target volume was 5％.No acute toxicity at grade 3 and over occurred in any patient during the treatment.15％ of the patients developed grade 1-2 radiation pneumonia.Age,gender,pathologic index or not were weakly correlated with the overall survival.The emotional function was improved significantly after treatment (P ＜ 0.05),dyspnea and cough were improved at different degrees,however,not significantly.There were no significant changes in the physical function and symptoms,such as fatigue,lack of appetite,insomnia,etc.Conclusions Significantly improving the motional function and maintaining the quality of life,SBRT with gamma knife is effective for elderly NSCLC patients with high local control rate fair overall survival rate and few side effects.