Myeloid-derived suppressor cells (MDSCs) play an important immunosuppressive role during the tumor development process.And the progression of many tumors are always accompanied with abnormal accumulation of MDSCs.Moreover,both the accumulation and functions of MDSCs could be affected by complicated factors.Therefore,how to effectively reduce the immunosuppressive effects of MDSCs in oncotherapy has become the focus of scholars.Recent studies show that anti-tumor drugs can affect many biological behaviors of MDSCs.

Objective To establish patient-experience based key indicators for quality of care.Methods Literature review,collection of proven surveys on patient experience and satisfaction,study of China's conditions,with demonstrations by experts team.Results A framework was built for patientexperience based key indicators on quality of care.Level-1 indicators within the framework are tangibility,reliability,responsiveness,assurance,care and continuity.There are 28 level-2 indicators and 83level-3 indicators.Conclusion Such key indicators are highly practical as the basis for developing the scale of patient experience.

Purpose Placenta implantation (PI) is a rare but severe pregnancy complication, and imaging diagnosis is always difficult. This paper aims to explore the ideal fast-imaging MRI sequences for PI and to provide high quality images for diagnosis. Materials and Methods The MRI images of 21 cases with pathology confirmed PI were retrospectively analyzed. Prenatal MRI of 2D fast-imaging employing steady-state acquisition (2D FIESTA) and single-shot fast spin echo (SSFSE) sequences were performed, and the imaging quality rating and the accuracy in detecting PI were compared. Results Satisfactory images were acquired in 71.4% (15/21) of the patients using 2D FIESTA, and 38.1% (8/21) using SSFSE with statistically significant difference (χ2=4.790, P<0.05). The MRI features of PI included placenta heterogeneity, low-signal-intensity bands, abnormal placental vascularity, uterine junction zone interruption, placental tissue invading the myometrium, placenta tissue into uterine serosa, and the detection rates of 2D FIESTA and SSFSE sequences on the above features were 57.1%, 57.1%, 28.6%, 61.9%, 66.7% and 14.2%, respectively; 90.4%, 71.4%, 38.1%, 42.9%, 28.6% and 6.5%, respectively. The detection rates of placenta heterogeneity and placental tissue invading the myometrium using these two sequences are statistically different (χ2=4.560 and 6.109, P<0.05). Conclusion The images quality of 2D FIESTA sequence is higher than those of the SSFSE sequence. 2D FIESTA sequence shows better delineation of the border of the placenta and uterine, and SSFSE sequence shows better contrasts of the placenta;therefore, combining these two can improve MRI diagnostic value for PI.

Gastrointestinal stromal tumor (GIST) is originated from the gastrointestinal mesenchymal stem cells,composed of undifferentiated or pluripotent spindle and epithelioid cells,often occurs in the whole range of the gastrointestinal tract and occasionally in the omentum,mesenterium and other areas which are outside of digestive tract.The treatment is difficult due to broad-spectrum biological behaviour of GIST,while surgery may be the only potential method for curing GIST with a risk of recurrence.Currently,there is still not an evaluative standard in the choice of surgery or imatinib therapy as well as the risk of recurrence.The F/NIH consensus,Armed Forces Institute of Pathology (AFIP) standard,modified standard of National Institutes of Health(NIH) and consensus of mathematical model which have been widely used cannot accurately evaluate risk probability of recurrence,so the current researches have focused on the postoperative risk assessment for GIST.In recent years,the nomogram model has been applied to predict the risk of GIST recurrence by some scholars,with the better outcomes.

Objective To evaluate clinical effects of vacuum sealing drainage ( VSD ) and conventional dressing in treatment of diabetic foot(DF)ulcers.Methods We searched PubMed, CNKI and WanFang data, and collected the Chinese and English randomized controlled studies on VSD and conventional dressing in treat-ment of DF ulcers.The retrieval time was from Jan.2000 to Jan.2014.RevMan5.2 software was used to make Meta-analysis.Results Seven papers including 646 cases met the standard and Meta analysis was conducted ac-cording to these data.The results showed that compared with conventional dressing, VSD treatment shortened the healing time, increased the complete healing rate, reduced hospital stay, and reduced hospital costs and seconda-ry amputation rates.The difference had statistical significance(P<0.05).Conclusion VSD is superior to con-ventional dressing method in terms of the healing time, healing rate, hospital stay, hospital costs and amputation rate.

Objective To analyze the relationship between soluble brain proteoglycan (PG) and brain development. Methods SD rats were divided into three groups: new-born, young adult and near-old groups. Soluble brain PGs of each group were extracted with 4 mol?L -1 guanidine HCl and purified by DEAE-sephacel chromatography, their molecular sizes were identified by Sepharose 4B chromatography, and their GAG compositions were characterized by two dimensional electrophoresis. Results The extraction amounts of soluble brain proteoglycans were decreased with age; soluble brain PGs could be divided into four fractions according to molecule size. The percentage of the large size CSPG aggregate increased with age, but its HA declined. The percentage of the small sized fraction containing DSPG declined with age increase. Conclusion Soluble brain PGs change with age and are related to brain development.

An evaluation scale of medical services quality was developed on the basis of "patients' experience". The questionnaires were developed by, among others, searching relevant literature, collecting well-established assessment scales, measuring patients' experience and satisfaction, brain-storming, literature analysis. Delphi method was adopted for expert consultation. Scale items were screened and revised. The key indexes were converted. Field surveys were conducted for testing the reliability and validity of the scale. Our modified evaluation scale for measuring medical services quality based on "patients' experience" included 6 dimensions (tangibility, reliability, responsiveness, assurance, empathy and continuity), and 50 items. The novel scale based on "patients' experience" may better serve the purpose of assessing medical services quality.

Child ; Hemorrhagic Fever with Renal Syndrome ; Humans

Objective To investigate the clinicopathology characteristics, immunopheotypic of anaplastic large cell lymphoma (ALCL) in order to improve its diagnostic and therapeutic accuracy. Methods The clinical, immunophenotypic and histopathologie features of 19 cases ALCL were retrospectively studied. The expression of CD30, ALK, CD43, CD45RO, EMA and TIA-1 was detected using EnVision immunohistochemical technique. Results All patients were primary systemic ALCL. Among the 19 patients, 11 were males and 8were females. The age ranged from 2 to 71 years, average age 26 years old. It shows a broad morphologic spectrum of the tumor cell and the hallmark cells characterized by sheets of large lymphoid cells withchromatin-poor horseshoe-shaped nuclei containing multiple nucleoli were encountered in all ALCL variants. 16patients (84.2 %) showed B-symptoms, and extranodal involvement was present in 14 (73.7 % ).Immunohistochemical study showed that the tumor cells expressed CD30 (100 %), ALK (78.9 %), EMA(52.6 %), TIA-1 (73.7 %) and 2 cases (10.5 %) neither expressed ALK, nor EMA,TIA-1.17 cases were reached the correct diagnosis according to combination of clinic, histological and immunological features.Conclusion The correct diagnosis of ALCL may be reached by combination of clinic, histological and immunological features according to WHO classification. Immunohistoehemical staining for CD30, ALK, EMA and TIA-1 is useful in making a correct diagnosis.

Objective To evaluate the short term results of shoulder hemi-arthroplasty. Methods Twenty-one patients with comminuted intra-articular fracture of proximal humerus underwent Neer type (Link, Germany) humeral head replacement from August 2000 to January 2004, which involved 5 males and 16 females,with an average age of 70 years (range, 64-76 years). According to AO M?ller classification, 3 cases were of C1 type, 8 C2 type, and 10 C3 type. The important steps of the procedure included insertion of the prosthesis in 40 degree retroversion and reconstruction of the rotary cuff of shoulder. The rehabilitation training course was divided into three stages. The patients were trained passively in the first stage (1 day-6 weeks); The muscles around the shoulder undertook isometric contraction once the bone fusion of greater and lesser tuberosity were obtained on X-ray for the second stage (7 -12 weeks); The improvement of the muscle strength and ROM of the shoulder were targeted throughout the third stage (13-24 weeks). All cases were followed up with Neer's scoring system comprising the symptoms, function, range of motion (ROM) of shoulder, and position of the prosthesis. Results The follow-up was performed twice a month within one year postoperatively, and one time three months after that.The mean duration of follow-up was 34.5 months (range, 14 to 55 months). Only slight pain was complained occasionally in 4 cases. No difficulty in active daily life was found in 21 cases .The average ROM of shoulder was flexion 115?(range, 65?-165?),extension 42.5?(15?-70?),abduction 85?(50?-120?), adduction 32.5?(20?-45?), external rotation 40?(20?-60?),and internal rotation 50?(10?-90?). No dislocation or subluxation of shoulder occurred in all cases. Assessed by Neer's scoring system, 8 cases were rated as excellent, 9 as good, 3 as fair and 1 as poor. The excellent and good rate was 80.9%. The patients' satisfactory rate was 90%. Conclusion The shoulder hemi-arthroplasty show good short term results for comminuted intra-articular fractures of the proximal humerus. The key points to improve the postoperative results are presented as follows: less invasive technique, appropriate retroversion angle for humeral head prosthesis, very solid reconstruction for rotary cuff of shoulder, and correct consecutive physical therapy after surgery.