Objective To study the standardization of medical records writing by residents in hospitals. Methods With both quantitative and qualitative analysis, medical records made by residents were sampled in groups to study their standardization. Results Recognition rate of such medical records was 82. 55%, and the excellence rate was 24. 50% in the grade evaluation. For senior residents, their rate of writing excellence falls below those of junior ones; whether the evaluators have medical background bears no significant difference for grade evaluation of medical records writing, yet a significant difference was found with the recognition rate. Conclusion Writing of medical records by residents is found with incompliance now and then, and the recognition rate ought to be improved.

Objective To determine the effects of tacrolimus (FK506) pretreatment on the liver ischemia reperfusion (IR) injury.Methods 32 mature SD rats were randomly assigned into four groups,which were sham-operated group (S),ischemia reperfusion group (IR),low-dose FK506-treated group (L) and high-dose FK506-treated group (H).After the treatment of liver ischemia for 60 minutes and reperfusion for 6 hours,the levels of serum ALT and AST in rats were tested.The TNF-α and IL-1β levels were evaluated by enzyme linked immunosorbent assay.Liver damage was assessed by paraffin sections stained with H&E.The quantitative real-time PCR,the immunohistochemistry and Western blot were used to detect the expression of HMGB1 mRNA and protein with or without FK506 pretreatment.Results The levels of serum ALT [(424.0 ± 137.4)U/L,(291.0 ±42.0)U/L],AST [(554.2 ± 127.7)U/L,(410.2 ±7.0)U/L],TNF-α [(115.1±49.0)ng/L,120.4±28.5) ng/L] and IL-1β [(424.5 ±105.2) ng/L,(612.1 ± 49.6) rig/L] decreased markedly in the group L and group H compared with the group IR (P ＜ 0.05).The liver in the IR group showed hepatic sinusoids congestion,neutrophil infiltration and necrosis.In contrast,tissue damage of the L group and the H group was significantly decreased.The expressions of HMGB1 mRNA and protein reduced significantly when pretreatment with FK506 after reperfusion (P ＜ 0.01).However,there was no significant difference between the group L and group H (P ＞ 0.05).Conclusion FK506 pretreatment can protect the liver by reducing the expression of HMGB1,inhibiting the release of inflammatory cytokines and alleviating cell necrosis after the liver ischemia reperfusion injury in rats.

Objective Although heart transplantation surgery has become more common,little is known about the psychological status of patients waiting for a heart transplant.Method Ninety-three patients registered for heart transplantation from March 2013 to March 2014 in a large general hospital in Shanghai were assessed by a psychiatrist using the Hamilton Depression Scale (17 items) and the Hamilton Anxiety Scale.Out of them 36 were preoperatively admitted to the Cardiac Surgery Department.The scales were assessed repeatedly at the 1st day,3rd day,7th day,10th day and so on until the operation took place.Result The mean scores of HAMD and HAMA of 93 patients in the waiting list were separately 13.11 ±3.81 and 14.20±4.57.Among them 18(19.4％) were classified as moderately depressed,31(33.3％) had moderately anxious symptoms,and 14(14.1％) had severe anxious symptoms.Thirty-six patients were preoperatively admitted to hospital.Their mean scores of HAMD and HAMA were separately 13.19-± 3.82 and 16.17 ± 4.35.Among them 7(19.4％) were classified as moderate depression at the time of admission,16 (44.4％) had moderately anxious symptoms and 9 (25.0％) had severe anxious symptoms.The scores of HAMD had significant difference (t =3.383,P =0.002) before and after admission.Paired t test was separately conducted to analyze the first assessment and the 3rd-day assessment of HAMA and HAMD total scores after admission of all the inpatients.The results showed the scores were statistically different (for HAMA,t =2.786,P =0.009; for HAMD,t =14.024,P =0.000).Repeated ANOVA was used to analyze the recipients who had three assessments.The results had statistical difference (for HAMA,F =4.568,P=0.020; for HAMD,F=5.626,P =0.034) and the difference of HAMD score at different time points had a linear trend (F =8.273,P =0.013).Conclusion After hospital admission,the depression symptoms will be significantly alleviated.When waiting for the transplant in the hospital,the anxiety symptoms alleviate slightly in three days and then aggravate significantly.The depression symptoms alleviate slightly continuously.

Full-speed development of the primary health care centering on community health service is key to the ongoing health reform in China. Building a new management mechanism for these grass-root health centers is an innovative approach of such a reform as carried out in Zhejiang province.The authors described the present management mechanism in the province, and focused on the specific measures and main outcomes of the nine Group-scale model as used by a district health bureau in Hanzhou since end of 2007. The paper aims at building an ideal model for group-scale management of community health centers, and improving the new city primary health care system centering on community health service.

Objective To investigate the correlation of spiral CT features with expression of E-cadherin(E-cad) in peripheral lung cancer.Methods Spiral CT scans were performed in 58 patients with peripheral lung cancer confirmed by pathology.Expression of E-cad in 58 cases were detected with SP immunohistochemical techniques.Spiral CT findings were compared with expression of E-cad.Results The abnormal expression of E-cad was showed in 32 cases(55.17%).The positive rates of E-cad expression were 40.63% in I-II cell differentiation group and 73.08% in III-IV cell differentiation group,and the difference was significant(P＜0.05).The abnormal expression of E-cad was associated with the CT features,such as lymph node metastasis,pleural invasion and the size of tumor(P＜0.05),but not the cavity sign,spicular sign and vessel convergence sign(P＞0.05).Conclusion E-cad gene over expression may play an important role in the pathogenesis and CT appearances of lung cancer.

OBJECTIVE To understand pathogen distribution and drug sensitive rate of urinary system infection in our hospital,in order to avoid the clinic to use antibiotics blindly,make the resistant strains decreasing in number,and improve efficacy.METHODS The distribution and drug sensitivity of the pathogens causing urinary infection among the patients with urinary system infection were rectrospectively analyzed.RESULTS Totally 549 strains were isolated,G-bacteria were 333 strains,accounted for 60.66%,from them E.coli was 293 strains,accounted for 87.99%;and G+bacteria were 216 strains,accounted for 39.34%,from them Enterococcus,and Staphylococcus were the main ones.Of E.coli strains,the ESBLs(+) were 36.86%.The MRCNS accounted for 81.91%.The result of drug sensitivity showed that the sensitive rate of E.coli to meropenem and imipenem was 100.0%.The sensitive rate of ESBLs(+) E.coli to cefepime,cefotaxime and aztreonam was all lower than 50%,but that of ESBLs(-) to the above drugs was much higher than ESBLs(+).The sensitive rate of Enterococcus to vancomycin and teicoplanin was 100%.The sensitive rate of CNS to Vancomycin was 100%.CONCLUSIONS In order to decrease the produceing bacteria resistance and the disseminating the resistance genes,it′s necessary to enhance the monitoring and study of bacteria resistance,normlalize the clinical medicine application,and enhance the infection control measures.

Objective To explore the image quality of gastric cancer improved by dual-energy CT,and to evaluate the clinical utility in staging gastric cancers.Methods 55 patients suspected gastric cancers were included in the study.Patients underwent dual-phasic scans using dual-energy CT with a dual-source scanner.The relationships image quality parameters in 100 kV,120 kV and 70 keV images were evaluated.Image quality parameters comprised mean density,signal-to noise ratio (SNR) and objective noise.The 120 kV and 70 keV images were compared in TNM staging.Results In arterial and portal phase,the attenuation was significantly higher at 70 keV and 100 kV compared to 120 kV images (P＜0.001).In arterial phase,the SNR were higher at 120 kV and 70 keV in comparison to 100 kV(P＜0.01).In portal phase,the SNR were higher at 70 keV in comparison to 120 kV and 100 kV(P＜0.01).Overall accuracy in assessment of tumor invasion of the gastric wall (T stage) was 83.7％ with 70 keV images and 72.1％ with 120 kV images,this difference was not significant (P=0.25);Overall accuracy for lymph node (N) staging was significantly better with 70 keV images(74.4％) than with 120 kV images(62.8％) (P＜0.05).Conclusion The image quality of gastric cancers using dual-energy CT can be improved by optimizing the energy level.The 70 keV images may be used to improve the N-staging accuracy.

Objective:To explore the expression of B7-1,B7-2 and B7-H1 on tumor-infiltrating dendritic cells(TIDC) and on splenic dendritic cells(SDC),and to investigate TIDC-mediated and SDC-mediated T-cell function after blocking B7-H1 expression in these dendritic cells.Methods: The TIDCs and SDCs were isolated from tumor-bearing mice using anti-mouse CD11c magnetic beads.The expression of B7-1,B7-2 and B7-H1 on TIDC and SDC was analyzed using flow cytometer.T cells were co-cultured with TIDCs or SDCs for the mixed lymphocyte reaction(MLR),and monoclonal antibodies to B7-H1 or the isotype control antibodies were added to the MLR cultures.T-cell proliferation was assessed using XTT method and the secretion of IL-10 was detected using ELISA.Results: B7-1 and B7-2 positive TIDCs were significantly less than SDCs(P0.05).T-cell proliferation stimulated by TIDCs was weaker than that stimulated by SDCs;T cells produced more IL-10 after TIDCs stimulation than after SDCs stimulation(P

Objective To investigate the relationship between serum anticardiolipin antibody-immune globulin G (ACA-IgG),interleukin-10 (IL-10 ),IL-17 levels and intracranial large-artery atherosclerotic stenosis in patients with ischemic stroke. Methods From March 2014 to March 2015,a total of 176 consecutive patients with the first-ever ischemic stroke admitted to the Department of Neurology,Liaocheng People′s Hospital,Shandong Province,China,and performed DSA were enrolled prospectively. Seven of the patients with cardiogenic embolism,5 with moyamoya disease,8 with arteritis,2 with artery dissection,9 with autoimmune diseases or acute and chronic inflammation were excluded,21 with extracranial arterial stenosis were not enrolled,and finally 124 were enrolled in the study. According to the findings of DSA,the degrees of intracranial large artery stenosis were divided into a stenosis-free group (n = 34),a mild-stenosis group (n = 30),a moderate-stenosis group (n = 32),and a severe-stenosis group (n = 28). The differences of serum ACA-IgG,IL-10,IL-17 levels and baseline factors of the 4 groups were compared,and multivariate logistic regression analysis was used to analyze several factors that affected intracranial large-artery stenosis. Results There were no significant differences in sex,age,alcohol consumption rate,smoking rate,and incidence of hyperlipidemia among the 4 groups of patients (all P >0. 05). Compared with the stenosis-free group,there were significant differences in the incidences of hypertension and diabetes among the mild-stenosis,moderate-stenosis and severe-stenosis groups (the incidence of hypertension,80. 0% [n = 24],93. 8% [n = 30],89. 3% [n = 25]vs. 55. 9% [19 cases];χ2 = 8. 271,8. 920,and 10. 877,respectively;P = 0. 038,0. 032,and 0. 014,respectively). The incidences of diabetes were 33. 3% (n = 10),43. 8% (n = 14),60. 7% (n = 17)vs. 8. 8% (n = 3),(χ2 = 7. 960, 8. 733,and 9. 285,respectively;P = 0. 043,0. 035,and 0. 027,respectively). Incidence of diabetes of the severe-stenosis group was higher than that of the mild-stenosis group (χ2 = 9. 348,P = 0. 025). There were no significant differences in the incidences of hypertension and diabetes among other groups (all P >0. 05). There were significant differences in ACA-IgG levels (23 ± 5,39 ± 8,51 ± 9,and 65 ± 10 kU/ L);IL-10 levels (108 ± 33,85 ± 25,77 ± 21,and 62 ± 19 ng/ L),and IL-17 levels (38 ± 10,58 ± 22,63 ± 31, and 75 ± 26 ng/ L)among the stenosis-free,mild,moderate and severe-stenosis groups (F = 17. 754,9. 827, and 12. 656;respectively;all P < 0. 01). Compared with the stenosis-free group,the ACA-IgG and IL-17 levels of the patients in the mild,morderate,and severe stenosis groups increased significantly (ACA-IgG level:t =2. 307,2. 559,and 3. 374,respectively;P = 0. 026,0. 014,and 0. 001,respectively,the IL-17 levels:t =2. 183,2. 549 and 3. 159,respectively;P = 0. 037,0. 013,and 0. 002,respectively),while the IL-10 level decreased significantly. There were significant differences among the groups (t = 2. 036,2. 351,and 2. 762, respectively;P = 0. 042,0. 023,and 0. 006,respectively). Compared with the mild-stenosis group,the ACA-IgG and IL-17 levels of the severe stenosis group increased significantly (t = 3. 154 and 2. 976 respectively;P = 0. 002 and 0. 004 respectively). There were no significant differences among the pairwise comparisons of other groups (P >0. 05). The results of logistic regression analysis showed that hypertension, diabetes,ACA-IgG level,and IL-17 level were the risk factors for intracranial large-artery stenosis (OR, 3. 043,95% CI 1. 606 -5. 875,P = 0. 003;OR,2. 912,95% CI 1. 513 -5. 824,P < 0. 01;OR,1. 837,95% CI 2. 057-3. 416,P = 0. 037;OR,1. 453,95% CI 1. 346 -2. 721,P = 0. 014). Conclusion ACA-IgG and IL-17 may play an important role in the occurrence and development processes of intracranial large-artery atherosclerotic stenosis.