Objective To develop the contents of Family Type Integration of Medical Care and Health Services in Hangzhou based on the Guiding Opinion on Promoting Integration of Medical Care and Pension issued by the State Council,Promotion Measures of Integration of Medical Care and Health Services in Hangzhou issued by the municipal government,and needs of health services for the elderly living in community.Methods The draft was formulated based on literature review,semi-structured interviews and expert meeting.Then,Delphi technique was used to identify the indicators through two rounds of expert consultation among 16 experts.Results The experts' authority coefficient was 0.790,the coefficient of determination was 0.906,and the familiar coefficient was 0.675.The contents of the Family Type Integration of Medical Care and Health Services in Hangzhou consisted of 8 firstlevel indicators,47 second-level indicators.The coordination coefficients of indicators were 0.341,0.222,and 0.426.Coordination of experts opinion had statistical significance (P＜0.01).Conclusion The contents of the Family Type Integration of Medical Care and Health Services in Hangzhou is reliable and scientific,which can be used as a basis for the formulation of items of the family type integration of medical care and health services in Hangzhou.

Objective To evaluate the left ventricular(LV) impaired relaxation(IR) by kinetic energy of blood flow in early diastole (Ek) in patients with normal ejection fraction(EF).Methods 42 patients with impaired LV relaxation while normal EF (IR group) and 38 controls volunteers with normal LV relaxation (NR group) underwent conventional echocardiography and real-time three-dimensional echocardiography (RT-3DE).Pulsed-wave (PW) Doppler imaging and PW tissue Doppler imaging (PWTDI) were performed in all the subjects.PW Doppler imaging indices included peak E velocities (VE),peak A velocities (VA) and VE/VA.PW-TDI indices included velocities of septal and lateral sides of the mitral annulus in early diastole Se',Le'),then the average of Se' and Le' described as e') were calculated.RT3DE indices included end diastolic volume EDV),ejection fraction EF) and flow volume of peak E QE).Results There were significant difference between Ek of two groups P ＜0.05).There were significant positive correlation between Ek and e' in both the two groups P ＜0.05).And Ek was less influenced by age or systolic blood pressure.Area under curve of the ROC of Ek was 0.654,sensitivity was 63.2 ％ and specificity was 61.9％,respectively.And the specificity of Ek was higher than that of e' and VE/VA.Conclusions Ek was less influenced by age or afterload,which can be used to detect impaired LV relaxation.

Objective: To investigate the effectiveness and adverse effects of Cyberknife stereotactic body radiotherapy (SBRT) on liver metastases from PCa. METHODS: From June 2009 to September 2016, we treated 20 cases of PCa liver metastases by Cyberknife SBRT, at a total dose of 36 (30－50) Gy, on 1－3 liver metastatic lesions, for 3－5 times, with a prescription isodose line of 70－92%. We assessed the therapeutic effect according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST), calculated the survival and disease-control rates using the Kaplan-Meier method, and analyzed the adverse events based on the National Cancer Institute Common Terminology Criteria for Adverse Events－Version 4.0 (CTCAE 4.0). RESULTS: Of all the cases treated, complete response (CR) was found in 8 (40.0%), partial response (PR) in 9 (45.0%), stable disease (SD) in 2 (10.0%), and progressive disease (PD) in 1 (5.0%), with a local control rate (CR+PR) of 85.0% and a disease-control rate (CR+PR+SD) of 95.0%. Among the 14 patients with elevated PSA, 10 (71.4%) showed a significant decrease after treatment. The median follow-up time was 17 months, the 1- and 2-year survival rates were 85.0% and 15.0%, respectively, and the median survival time of the 20 patients was 16.5 months (95% CI: 12.12－22.88). Cyberknife SBRT was well tolerated in all the patients, with only a few mild adverse events (mainly grades 1 and 2 but no 4 and 5) during the whole course of treatment. CONCLUSIONS Cyberknife SBRT is safe and effective in the treatment of PCa liver metastases, with a high local control rate, and capable of reducing the PSA level and raising the long-term survival rate of the patients.

OBJECTIVE To strengthen the management of earthquake victims with nosocomial infection,in order to prevent and control the multidrug-resistance transmission,and the nosocomial infection outbreak. METHODS All 77 earthquake victims were under real-time monitoring. RESULTS Of 77 cases,53 were infected (69.74%). From 83 samples,83 pathogenic bacteria were isolated. The Gram-positive cocci were 19 (meticillin-resistant Staphylococcus aureus 3,Meticillin-resistant S. epidermidis 7),58 were Gram-negative bacilli (Acinetobacter baumannii 21,multi-drug resistant strains 10,ESBLs positive Escherichia coli 10,Pseudomonas aeruginosa 9) and the fungi were 6 strains,The resistance rates of Gram-positive cocci to penicillin,ampicillin/sulbactam and cefazolin were 89.47%,68.42% and 89.47%; the resistance rates of Gram-negative bacillis to imipenem,cefoperazone/sulbactam,piperacillin/tazobactam,azithromycin,tobramycin,and cefoxitin were 37.93%,60.34%,48.83%,98.28%,98.28% and 70.69%,respectively. CONCLUSIONS Under the situation of higher infection rate and a serious drug resistance in earthquake area,there are no multidrug-resistance transmissionm and the spread of nosocomiol infection outbreak happened in hospital due to strictly enforced prevention meassures and access real-time monitoring and management,

Objective To investigate the correlation between the expression level of BLM and its clinical significance in leukemia.Methods 125 bone marrow specimens of inpatients and outpatients with leukemia were collected in Anhui provincial hospital from January 2011 to December 2011.125 leukemia patients were diagnosed and classified into acute leukemia (AL,n =66) and chronic myelogenous leukemia (CML,n =59) by Morphologic and Immunologic criteria,5 non-tumor individuals were included as control group.The BLM mRNA expressions were by reverse transcription-polymerase chain reaction(RT-PCR).The specimens were devided into groups according to the age,gender,leukemia type,peripheral blood leukocyte counts,hepatomegalia and(or) splenomegaly,fusion gene,chromosome karyotype,whether first visit and transplantation.The expression of BLM gene in each group and the correlation with above factors were retrospectively analysed.The statistical methods such as chi-square test,single factor variance analysis,t test and Pearson correlation test were mainly used.Results BLM mRNA was detected in leukemia.In bone marrow cells,the BLM gene expression was positive in 71 patients and negative in 54 patients.But none of 5 non-tumor bone marrow cells expressed BLM gene.The difference of BLM expression between patients and controls was statistically significant in two groups,i.e.peripheral blood leukocyte counts and fusion gene (x2 =14.730,22.399 ; P ＜ 0.05),but there is no statistical significant differences in other groups.The expressions of BLM mRNA in leukemia patients who had been treated with chemotherapy were lower than those newly diagnosed (0.1788 ± 0.1091 vs 0.3276 ± 0.2016 ; P ＜ 0.05).Moreover,BLM mRNA level in post-bone marrow transplant patients was lower than those not treated (0.1271 ± 0.1009 vs 0.2902 ±0.2034 ; P ＜ 0.05).Pearson correlation analysis showed that higher BLM mRNA expression positively correlated with fusion gene (r =0.357,P ＜ 0.01) and chromosome abnormality (r =0.279,P ＜ 0.05).Conclusion The BLM mRNA expression level of measurement can be used as judgment for leukemia patients disease severity and the index of prognosis,testing the level may provide a basis for clinical and curative effect judgment.

Objective To establish a novel method for detecting circulating tumor cells (CTCs) in phripheral blood of lung cancer patients with high sensitivity and specificity.Methods Experimental study.42 cases of initial treatment patient who underwent resection and diagnosed to be non-small cell lung cancer by biopsy were studied,including 7 patients at stage Ⅰ,9 patients at stage Ⅱ,16 patients at stage Ⅲ and 10 patients at stage Ⅳ.As a control group,20 cases of healthy volunteers were selected.A series of experiments was conducted to determine the efficiency of tumor cells isolation,in which varied concentration (50,100,200,500,1000 cells) of A549 cells spiked into 2 ml peripheral blood drawn from healthy donors.The blood was removed of unwanted erythrocytes by lysis buffer,and made the rest of nucleated cells incubate with anti-EpCAM magnetic beads,then separated and enriched by a specific detector.All epithelia cells were retained on a slide because of a magnetic force and identified by H&E staining protocol.On the basis of cell recovery rate we calculated the sensitivity of tumor cells isolation.20 blood samples taken from healthy individuals were also detected to validate the specificity of this method.Samples of 42 patients with lung cancer were assayed for CTCs detection by above method.The correction of CTCs quantity with the patients' clinical features,for example,ages,gender,clinical stage,tumor size was analyzed in lung cancer patients by chi-square statistics.The correction of recovery cells with the spiked cells were assayed by linear correlation.Results The recovery rate was ranging from 68％ to 82％ by spiking varying numbers of A549 lung cancer cells into 2ml blood samples of healthy volunteers.Regression analysis of number of recovered vs.spiked A549 cells yielded a regression equation of Y =0.6419X + 8.8875.The number of CTCs detected has signification correlate with the cells spiked (R2 =0.9916,P ＜ 0.05),Eighteen of the 42 patients (43％) were found have CTCs in peripheral blood.The detection rate of lung cancer cells was 0 at stage Ⅰ,the detection rate of lung cancer cells was 11.1％ at stage Ⅱ,the detection rate of lung cancer cells was 62.5％ at stage Ⅲ and the detection rate of lung cancer cells was 70％ at stage Ⅳ.The positive rate of CTCs has no signification correlate with ages and gender of patients and tumor size (P ＞ 0.05),has signification with the clinical stage (P ＜ 0.05).None of the peripheral blood samples of the 20 healthy subjects analyzed was found to have CTCs.Conclusions This novel immunomagnetic separation technology is a sensitive and specific method,which provides a new tool allowing for feasible and specific detection of CTCs in lung cancer patients.The level of CTCs increases with the clinical stage and tumor size increased,which has important value to discover the early stage micrometastasis and redefine the clinical stage.But further multicenter and large sample clinical research are needed to confirm its clinical value.

Objective　To investigate the role of the p75 neurotrophic receptor (p75 NTR) in the cognitive impairment induced by laparotomy surgery of aged mice,and to explore the possible mechanism.Methods　Thirty eighteen-month-old male mice were equally randomized into three groups (n=10):control group,surgery group,surgery+TAT group.Open field test was performed 5 days after the surgery to record the exploration distance and the time in the center.Fear-conditioned training was performed 6 days after the surgery,and fear-conditioned test was performed 7 days after the surgery to record the freezing time.The hippocampus was harvested immediately after the behavioral test.Western blot was applied to detect the levels of p75NTR,BDNF,PSD95,TrkB and pCREB in the hippocampus,immunofluorescence was applied to detect the number of caspase-3 positive cells in the hippocampus,and Golgi staining was applied to observe the changes of dendritic spines in hippocampal CA-1 region.Results　In the open field test,the total distance and the time in the center had no significant difference among the three groups (P>0.05).In the fear conditioning test,compared with control group,the percentage of the contextual conditional freezing time decreased significantly in surgery group (P<0.05),and the expressions of BDNF，PSD95，TrkB and pCREB and the number of dendritic spines in CA-1 were significantly decreased (P<0.05),the expression of p75NTR and the number of caspase-3 positive cells were increased significantly in the surgery group (P<0.05).Compared with the surgery group,the percentage of the contextual conditional freezing time increased significantly in surgery+TAT group,and the expressions of BDNF,PSD95,TrkB,and pCREB and the number of dendritic spines in CA-1 were significantly increased,the number of caspase-3 positive cells were decreased significantly in the surgery+TAT group (P<0.05).Conclusion　Hippocampal p75 NTR plays a key role in the pathophysiology of POCD.

Objective To investigate the changes of macrophage polarization during acute rejection (AR) after intestinal transplantation. Methods Six Brown Norway (BN) rats and 24 Lewis rats were divided into the sham operation group (6 Lewis rats), syngeneic transplantation group (Lewis→Lewis, 6 donors and 6 recipients) and allogeneic transplantation group (BN→Lewis, 6 donors and 6 recipients). At postoperative 7 d, the intestinal graft tissues in all groups were collected for hematoxylin-eosin (HE) staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. Pathological manifestations and cell apoptosis were observed. The expression levels of serum cytokines related to M1 and M2 macrophage polarization were determined by enzyme-linked immunosorbent assay (ELISA). Surface markers of M1 and M2 macrophages of intestinal graft tissues in each group were co-localized and counted by immunofluorescence staining. Results HE staining and TUNEL assay showed that the intestinal epithelial morphology and structure were normal and no evident apoptotic bodies were found in the sham operation and syngeneic transplantation groups. At 7 d after transplantation, the epithelial villi structure of intestinal graft tissues was severely damaged, the number of crypts was decreased, the number of apoptotic bodies was increased, and inflammatory cells infiltrated into the whole intestinal wall, manifested with moderate to severe AR in the allogeneic transplantation group. ELISA revealed that the expression levels of serum cytokines related to M1 macrophage polarization, such as tumor necrosis factor (TNF)-α, interferon (IFN)-γ and interleukin (IL)-12, of the recipient rats in the allogeneic transplantation group were higher than those in the sham operation and syngeneic transplantation groups. The expression levels of serum cytokines related to M2 macrophage polarization, such as IL-10 and transforming growth factor (TGF)-β, in the syngeneic transplantation group were higher compared with those in the sham operation and allogeneic transplantation group, and the differences were statistically significant (all P<0.05). Immunofluorescence staining showed that the number of M1 macrophages in the allogeneic transplantation group was higher than those in the sham operation and syngeneic transplantation groups, and the number of M2 macrophages in the syngeneic transplantation group was higher than those in the sham operation and allogeneic transplantation groups, and the differences were statistically significant (all P<0.05). Conclusions Among the allografts with AR after intestinal transplantation, a large number of macrophages, mainly M1 macrophages secreting a large number of pro-inflammatory cytokines, infiltrate into the whole intestinal wall. Regulating the direction of macrophage polarization is a potential treatment for AR after intestinal transplantation.

Objective: To study the clinical pathological characteristics, immunophenotype, molecular changes and prognosis of the papillary renal neoplasm with reverse polarity (PRNRP). Methods: Nine cases of PRNRP, diagnosed from 2013 to 2019, were retrieved from the Department of Pathology of Nanjing Jinling Hospital, Nanjing University School of Medicine. Histomorphology, immunophenotype and molecular genetics were analyzed with review of the literatures. Results: There were five male and four female patients, aged from 49 to 70 years, with an average age of 60.1 years. During a mean follow-up of 29 months, one patient died for other cause, and the others survived without disease. Microscopically, the tumor cells arranged in papillary structure with a fibrovascular core, the surface of which was covered with a single layer of cuboidal or columnar cells. The most prominent feature was that the tumor nuclei located at the top of the cytoplasm far from the basement membrane, and they were monotonous in size and arranged neatly with no or few nucleoli. Immunohistochemically, all nine cases of PRNRP showed diffuse positive expression of CK7 and E-cadherin, various degrees of P504s expression, and no expression of CD10 and CD117, with a Ki-67 index of 1%-3%. Unlike other papillary renal cell carcinoma, the nine cases of PRNRP all showed characteristic positive expression of GATA3. The fluorescence in situ hybridization assay showed that the majority of PRNRPs (8/9) did not have triploids on chromosomes 7 and 17. The sequencing of the KRAS gene confirmed the presence of a nonsense KRAS mutation in 8 of the 9 cases. Conclusions: PRNRP is a subtype of papillary renal cell carcinoma with characteristic morphological, immunophenotypic and molecular features, and indolent behaviors. More data are needed to define PRNRP as "carcinoma", and a definitive diagnosis of PRNRP is of great significance for proper treatment choice and accurate prognostication.
Biomarkers, Tumor ; Carcinoma, Renal Cell/genetics* ; Female ; Humans ; In Situ Hybridization, Fluorescence ; Kidney ; Kidney Neoplasms/genetics* ; Male ; Middle Aged ; Prognosis

Humans ; Laparoscopy ; methods ; Pancreaticoduodenectomy ; methods ; Prospective Studies ; Robotics ; methods