Objective To analyze the postoperative quality of life index and survival of Ⅱ,Ⅲ type adenocarcinoma of the esophagogastric junction (AEG) patients who were implemented radical surgery through the transthoracic approach or abdominal transhiatal approach.To explore the reasonable operative approach of Ⅱ,Ⅲ type AEG.Methods 139 cases of patients with Ⅱ,Ⅲ type AEG were prospectively enrolled into the group in Shanxi Cancer Hospital during March 2012 to September 2012.64 cases of them were in transthoracic approach (TT) group,and 75 cases in abdominal transhiatal approach (TH) group.The operative time,the residual incision margin cancer rate,the average number of lymph node dissection,postoperative hospital stay,the average number of days required for gastrointestinal function recovery,the incidence of cardiopulmonary complications,anastomotic leakage rate,postoperative bleeding rate,perioperative mortality,postoperative respiratory function decline rate within 1 year,the average weight loss after 1 year,postoperative reflux rate within 1 year,recurrence and metastasis rate within 1 year,and 1-year survival rate of two groups were respectively compared.Results Statistical analysis was done on the perioperative data of 139 patients,and regular follow-up was carried out for these 139 patients after they discharged from hospital,of which 26 cases were lost,the lost rate was 18.7 ％,so the followed-up cases were 113 cases.Postoperative hospital stay in transthoracic approach group was longer than abdominal transhiatal approach group with significant difference,(20.2±8.9) d vs (17.1±6.4) d (P ＜ 0.05),the average number of lymph node dissection in transthoracic approach group (15.2±7.5) was less than abdominal transhiatal approach group (23.0±13.0) with significant difference (P ＜ 0.05).No significant difference were observed in the operative time,the residual incision margin cancer rate,the average number of days required for gastrointestinal function recovery,the incidence of cardiopulmonary complications,anastomotic leakage rate,postoperative bleeding rate,perioperative mortality,postoperative respiratory function decline rate within 1 year,the average weight loss after 1 year,postoperative reflux rate within 1 year,recurrence and metastasis rate within 1 year,and 1-year survival rate of the two operation approaches (all P ＞ 0.05).Conclusions Abdominal approach,through the esophageal hiatus radical surgery is a preferred operative approach of Ⅱ,Ⅲ type AEG.The average number of lymph node dissection in abdominal transhiatal approach group was more than transthoracic approach group.It may have some influence on the prognosis.

Objective To investigate the risk factors of worsening renal function (WRF) in patients with chronic heart failure ( CHF) and WRF influence on prognosis. Methods A case-control study were undertaken to analyze independent risk factor statistically related to incidence of WRF, and to assess the influence of WRF on prognosis. Results The independent predictors of WRF were creatinine level at admission (OR 2.248,95% CI 1.088-4.647, P = 0.029) and NYHA class on admission ( OR 2.485, 95% CI 1.3854. 459, P = 0.002). The mortality of patient with WRF was obviously higher than that of control group during hospitalization( OR 3. 824,95% CI 2. 452-5. 637 ,P ＜0.015). Conclusions WRF is a common complication among patients hospitalized for CHF, and is obviously associated with mortality during hospitalization. Higher creatinine level and weak heart function are independent risk factors for incidence of WRF of patients with CHF.

Objective To synthesize 4 kinds of 111 In?TPP cations and evaluate their properties as tumor cationic radiotracers in vivo and in vitro. Methods DO3A?xy?TPP, DO3A?xy?mTPP, DO3A?xy?dmTPP and DO3A?xy?tmTPP were radiolabeled with 111 In;their lipid?water partition coefficients and in vivo and in vitro stability were evaluated. The binding affinities of 4 kinds of 111 In?radiotracers were determined in cell uptake and cell efflux assay using U87MG tumor cells. Biodistribution studies and γ imaging studies were performed using the athymic nude mice bearing U87MG human glioma xenografts to explore the biologi?cal properties of 4 kinds of 111 In?radiotracers. One?way analysis of variance was used. Results The labeling yields of 4 kinds of 111 In?radiotracers were all above 85%, and the radiochemical purity were all greater than 99% after purification. Binding assay in U87MG cells showed that 4 kinds of radiotracers had great binding affinity and cell retention ability, and 111In?DO3A?xy?mTPP had the best binding ratio (1?49%;F=177.8, P<0.05) . Gamma imaging and biodistribution results showed that the U87MG tumors could be clearly visualized by 111In?DO3A?xy?mTPP, 111In?DO3A?xy?dmTPP and 111In?DO3A?xy?tmTPP, and the liver uptake of the 3 tracers was lower than that of 111In?DO3A?xy?TPP. In particular, 111In?DO3A?xy?mTPP had the best tumor/liver ratio (0.13±0.05, 2 h postinjection;F=9.4, P<0?05). Conclusions The tumor?targeted ability of 111In?DO3A?xy?mTPP is better than those of 111In?DO3A?xy?dmTPP, 111In?DO3A?xy?tmTPP and 111In?DO3A?xy?TPP, suggesting that it has the potential to be a promising tumor cationic radiotracer.

Objective To investigate the effect of Verisyse iris-claw intraocular lens implantation on correction of high myopia.Methods9 patients with highly myopic (18 eyes and diopter between-6.75 DS to-28.00 DS) were treated with Verisyse intraocular lens implantation. All the treated eyes were observed for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure, anterior segment changes and corneal endothelium preoperatively and postoperatively.ResultsThe implantation was successfully performed in all of 18 eyes. After 3 months, 11 eyes (61.1%) had the uncorrected visual acuity (UCVA) ≥0.5; 9 eyes (50.0%) had the best corrected visual acuity (BCVA) ≥0.8. UCVA and BCVA of every eye were significant improved ( P<0.01); the mean corneal astigmatism and mean intraocular pressure were not different from preoperation ( P>0.05). In all patients, one eye was oval and 2 other eyes showed decentered phakic IOL; 2 patients (2 eyes) complained of halo and glare; no severe complications occurred.ConclusionThe implantation of Verisyse iris-claw intraocular lens for the correction of high myopia has a significantly effect.

Objective To investigate the relationship among the late-life depression ( LLD ) , cognitive function and white matter lesions ( WML) , after excluding vascular risk factors and brain atrophy.Methods The depression and cognition status of 277 patients were assessed using a variety of neurological scales, and the actually enrolled patients were divided into LLD group ( 77 cases ) and the non-depressed group (103 cases).The independent samples t test and multivariate Logistic regression were used to analyze independent risk factors for depressive symptoms with the model Ⅰ of controlling age , sex, years of education and the model Ⅱof controlling age, sex, years of education, high blood pressure, diabetes and coronary heart disease.Under the premise of controlling mode Ⅱand brain atrophy , partial correlation was used to analyze the correlations of depressive symptoms and cognitive function and WML , and the correlation between depressive symptoms and cognitive items.Results The results showed that the proportion of high blood pressure (90.9%vs 74.7%, χ2 =6.342,P=0.046), cognitive scores (19.23 ±7.05 vs 22.99 ± 6.71, t=3.343,P=0.001), WML level 2 proportion (65.1% vs 34.9%, χ2 =7.373,P=0.025) and temporal lobe atrophy of hippocampal sulcus ratio (0.24 ±0.03 vs 0.22 ±0.03, t=-2.041,P=0.044) had statistically significant difference between the two groups.Multivariate Logistic regression showed that cognitive function was an independent risk factor for depression ( OR=1.63,95% CI 1.01 -2.80, P=0.030).Controlling for all risk factors , partial correlation analysis showed that depressive symptoms were correlated with cognitive function ( r=-0.239,P=0.004) and WML ( r=0.222,P=0.008) and the atrophy of temporal lobe and hippocampus ( r=0.173, P=0.040 ).Under the model Ⅱ, depressive symptoms correlated with attention (r=-0.175, P=0.040), memories (r=-0.140, P=0.050) and drawing clock test ( r=-0.186, P=0.029 ).Conclusions Excluding vascular risk factorts , brain atrophy and WML , cognitive impairment has significant correlation with depressive symptoms.Vascular risk factors are involved in the occurrence of depression , and WML may be the severity of cognitive impairment reserve marker.LLD patients showed hippocampal atrophy similar with early AD , manifesting the cognitive feature of memory and executive dysfunction and attention disorder .

Objective To observe the clinical therapial value of functional reconstruction with Botulinum Toxin A (BTA) on spasitic cerebral palsy. Methods Thirty-two patients were treated by Achilles tendon lengthening and anterior transfer of posterior tibial tendon.According to the spasticity of triceps surae muscle,all cases were arranged by BTA injection 2 months later after operation.Results From Jan.2000 to Jan.2009,thirty-two cases with equinovarus foot of spasticitical cerebral palsy were collected,the muscle strength of ankle dorsal extensor increased from 0-2 grades to 4-5 grades,there was significant difference between preoperational muscle strength and postoperational one.There was also significant improvement to adjust yarus degrees of ankle joint.the musclar tension of triceps muscle of calf decreased from Ⅱ-Ⅳ grades to Ⅰ-Ⅱ grades. Conclusion Anterior transfer of posterior tibial tendon corresponding with Botulinum Toxin A injection not only release muscle spasticity but also improve dorsal extending strength of ankle joint.The clinical effect of these methods was reliable on cerebral palsy.

ObjectiveTo assess the effectiveness of tele-medicine and self-management goal(SMG) setting technique used in the diabetes management in the community setting.Methods It is a control-group study.415 type 2 diabetic residents were recruited from the Shanghai Wuliqiao community based on existing medical records.The subjects were divided into two groups,the study group was cared by general practitioners (GPs) specialists cooperation through the tele-medicine mechanism,the other was a control group.For the study group,a cooperation pathway between community health care centers and general hospitals were established.Standardized training and guidelines were provided to community health workers,regarding the setting of management goals of blood glucose and blood pressure,treatment plan,patient education,and SMG techniques.Fasting blood glucose ( FBG ) and 2 h postprandial blood glucose (2hBG) in the study group were monitored,followed by community health workers visiting monthly with seminars for diabetes education.At the baseline and the 12tb month,FBG,2hBG,HbA1C,blood pressure,triglyceride,total cholesterol,body mass index,waist-hip ratio were determined in each group.A survey was conducted to evaluate the costs of diabetes treatments,the knowledge base related to their disease,lifestyle,and the awareness of the new care model.The rates of achieving the goal of blood glucose,blood pressure,and HbA1Ccontrol were calculated.Internet case discussion between GPs-Specialists and referral to certain specialists were implemented when some patients did not reach the control goal.ResultsBy the 12 month follow up,FBG,2hBG,HbAIc,blood pressure of the study group were lower than the baseline,and as well as the control group with statical significance (P＜0.05).There are other improvcments:diabetes knowledge (29.1％ vs 5.5％ ),healthy diet (9.6％ vs -10.4％ ),blood glucose monitoring (30.3％ vs 10.8％ ),support for diabetes care in community (35.7％ vs 9.4％ ),and the preference of the new model (63.8％ vs 17.9％ ) with statistical significauce (P＜0.01 ).As for the medical costs,the study group's monthly costs were consistently lower than the control's.( -3.39Yuan vs 32.26 Yuan,P＜0.05).ConclusionsThe new diabetes care model based on GPs-Specialists tele-medicine and SMG in community opens the door to the community based care model formulation in regard to the health quality and costs control.The deployment of more technologies and management techniques could be explored further to improve the outcomes of community based chronic disease care model.

Objective:To evaluate the reliability and repeatability of thoracolumbar AOSpine injury score (TLAOSIS)and thoracolumbar injury severity score (TLICS) classification scoring system in guiding thoracolumbar fracture surgery, and to explore the main reasons for the consistency of classification scoring systems.Methods:Fifty-five thoracolumbar fracture patients with complete clinical data and radiologic data admitted to Second Affiliated Hospital of Zhejiang Chinese Medical University from January 2018 to December 2018 were enrolled. Based on their preoperative X-ray films, CT and MRI, six physicians were assigned to independently determine the classification using the TLAOSIS and TLICS.For the same patient, the classification was identified as inconsistency among 6 observers if there was an observer in a different type.After a 4-week interval, the 55 patients were presented in a random sequence to the same evaluators for repeated evaluation.All data did not contain any marks related to the type. The Cohen's Kappa coefficient was used to determine the interobserver reliability and intraobserver repeatability concerning fracture morphology, posterior ligament classification (PLC) injury classification and neurological function score. Kappa coefficients were used to observe the consistency of pre- and post-measure measurements within each observer.Results:The two classification scoring systems had good consistency and reproducibility in guiding surgery. For TLAOSIS classification scoring system, the interobserver and intraobserver Kappa values for fracture morphology were 0.806 and 0.667; neurological status were 0.937 and 0.891; PLC injury classification were 0.873 and 0.779; the final recommendation surgery were 0.816 and 0.764. For TLICS classification scoring system, the interobserver and intraobserver Kappa values for fracture morphology were 0.878 and 0.788; neurological status were 0.936 and 0.888; PLC injury classification were 0.809 and 0.691; the final recommendation surgery were 0.811 and 0.705. The two classification scoring systems were statistically significant in fracture morphology and PLC injury classification both in the reliability and repeatability analysis ( P<0.05), but there was no significant difference in the neurological function score ( P>0.05). Conclusions:TLAOSIS and TLICS have good consistency and reproducibility in guiding surgery. The fracture morphology and PLC injury classification are the factors influencing the consistency of surgical guidance for the two classification scoring systems.

Objective:To compare the differences between thoracolumbar AO spine injury score (TL AOSIS) and thoracolumbar injury classification and severity score system (TLICS) in guiding thoracolumbar fracture surgery.Methods:A retrospective study was conducted of the 55 patients with complete preoperative imaging data who had been treated for thoracolumbar injuries at Department of Spinal Surgery, The Second Affiliated Hospital to Zhejiang Chinese Medical University from January 2015 to December 2016. They were 34 men and 21 women, aged from 21 to 55 years (average, 37.5 years). Of them, 31 were identified as having normal neurological function and 24 as having impaired neurological function. TL AOSIS and TLICS were used to evaluate respectively all the patients, those with normal neurological function and those with impaired neurological function, and consequently made suggestions whether surgery should be performed or not.Results:Among the 55 patients, by the guidance of TL AOSIS and TLICS respectively, conservative treatment was suggested for 19 and 25 cases, either conservative treatment or surgery for 12 and 13 cases, and surgery for 24 and 17 cases. There was fine consistency between the 2 scoring systems in surgery suggestion for thoracolumbar fracture ( P=0.358). Among the 31 patients with normal neurological function, by the guidance of TL AOSIS and TLICS respectively, conservative treatment was suggested for 19 and 25 cases, either conservative treatment or surgery for 6 and 0 cases, and surgery for 6 and 6 cases. TLICS suggested surgery for significantly more patients than TL AOSIS did ( P=0.033). Among the 24 patients with impaired neurological function, by the guidance of TL AOSIS and TLICS respectively, either conservative treatment or surgery was suggested for 6 and 13 cases, and surgery for 18 and 11 cases. TL AOSIS suggested surgery for significantly more patients than TLICS did ( P=0.039). Conclusion:There is fine consistency between TL AOSIS and TLICS in surgery suggestion for thoracolumbar fracture, but TL AOSIS may lead to more surgery suggestions for the patients with complete burst fracture or impaired neurological function than TLICS.

Objective: To learn the epidemiological characteristics of coronavirus disease 2019（COVID-19）in Huzhou,so as to provide reference for prevention and control of COVID-19. Methods: All the confirmed cases of COVID-19 in Huzhou,diagnosed according to the COVID-19 Diagnosis and Treatment Plan（Sixth Version Trial）and reported from January 25 to February 7,2020,were recruited. The process of diagnosis and treatment,clinical manifestation,exposure history and close contacts were collected to analyze the epidemiological characteristics. Results: On January 25,the first confirmed cases of COVID-19 in Huzhou was reported. By February 7,totally 10 confirmed cases were reported and no asymptomatic infection was found. They were all imported,including three Wuhan residents,two with a trip to Wuhan,three with a trip to Suizhou,one with a trip to Hangzhou and one with a trip to Thailand（two Wuhan passengers on the same flight）. The ratio of male to female cases was 1∶1. The median age was 32 years old. Seven cases were found when they went to a doctor by themselves,and three cases were found during the quarantine. The main clinical manifestations were fever,dry cough and fatigue. The median time from onset to diagnosis was 3 days. By March 3,all the cases were discharged,with median course of 24 days. There were 312 close contacts,and all of them were released after 14 days of quarantine. Conclusions To prevent imported cases from outside and stop spread inside taken by Huzhou government was proved to be effective. All the COVID-19 cases in Huzhou were imported,mostly from Wuhan. No local cases were reported.