Objective To investigate the effect of the stage-change model on the behavior changes of patients with non-insulin dependent diabetes mellitus (NIDDM). Methods A total of 169 cases NID-DM patients were randomly divided into the control group (84 cases )and the experimental group(85 cases ).The regular health education for the self behavior changes was carried out among patients in the control group,while besides the regular health education conducted in the control group,the stage- change model was additionally used in patients of the experimental group.By virtue of the self-design questionnaire,the surveys were performed on 2 groups respectively before the implementation,6 months and 12 months after the implementation.The behavior stages and behavior changes for the patients in 2 groups were compared. Results The end period of stage behavior and behavior change for patients in the experimental group were obviously better than those in the control group. Conclusions The stage-change model could accelerate the behavior change of patients with non-insulin dependent diabetes mellitus.

Objective To explore a variety of sustainable development under the network environment of doctor-patient communication service platform in the role of reproductive medicine nursing,to improve the reproductive efficiency of medical care services in the new environment,build new doctor-patient communication platform.Methods In reproductive medicine nursing practice,based on the internet to build diversification of doctor-patient communication information service platform,such as reproductive center website,QQ group of doctor-patient communication,Wechat public service platform.Through the questionnaire survey form,understand reproductive center patients through various network platform in the query,the information,make an appointment for reproductive assisted reproduction related information and interact with staff and other aspects of the usage and satisfaction.Results Recycling effective questionnaire was 517 papers.A total of the use of network platform for the overall coverage was more than 80％ of patients,among them the most widely Wechat public platform,utilization rate was 78.1％ (400/512);60.8％ (312/513) patients think Wechat platform using the most convenient.The overall satisfaction rate for center web services platform was 89.5％ (460/514).Conclusions Online platforms provide better nursing efficiency and quality,as well as improving doctor-patient communication based on the internet environment.It provides a new way for sustainable development for nursing system in the field of reproductive medicine.

Objective To assess the clinical features,diagnosis,treatment and prognosis of duodenal papilla tumors.Methods The clinical data of 76 patients diagnosed as tumor of duodenal papilla for endoscopic or surgical treatment,in the Second Affiliated Hospital of Zhejiang University,School of Medicine since April 2004 to April 2015 were collected and analyzed retrospectively.There were 50 male and 26 female patients aging from 38 to 83 years with a median age of 62 years.All patients were diagnosed by ultrasound,CT or endoscopic retrograde cholangiopancreatography.All the 76 patients accepted surgical treatment,among which 61 cases accepted pancreaticoduodenectomy,6 cases accepted trans-duodenum papillae resection and reconstruction,5 cases accepted endoscopic duodenal papilla tumor resection and 4 cases accepted palliative operations.Kaplan-Meier method was used to analyze the survival rate.Results Among the 76 cases of patients,the pathological diagnosis included 10 cases of benign tumors,8 cases of precancerous lesions,58 cases of malignant tumor.Death cases were not caused by postoperative complications.Coincidence rate of preoperative biopsy and postoperative pathological diagnosis was 77.6％.Postoperative follow-up was 2 to 120 months,the results showed that the 1,3,5 year survival rates were 73.2％,51.8％,32.1％ for 53 patients with duodenal papillary carcinoma.Conclusions Duodenal papilla tumors had varied clinical manifestations,ultrasound,CT and endoscopic examination and ERCP can improve the diagnostic rate of duodenal papilla tumors.For benign tumors and early stage malignant tumors,local excision or endoscopic resection was safe and effective.For advanced malignancies,radical pancreaticoduodenectomy was essential.

Objective To assess the clinical features,diagnosis,treatment and prognosis of duodenal papilla tumors.Methods The clinical data of 76 patients diagnosed as tumor of duodenal papilla for endoscopic or surgical treatment,in the Second Affiliated Hospital of Zhejiang University,School of Medicine since April 2004 to April 2015 were collected and analyzed retrospectively.There were 50 male and 26 female patients aging from 38 to 83 years with a median age of 62 years.All patients were diagnosed by ultrasound,CT or endoscopic retrograde cholangiopancreatography.All the 76 patients accepted surgical treatment,among which 61 cases accepted pancreaticoduodenectomy,6 cases accepted trans-duodenum papillae resection and reconstruction,5 cases accepted endoscopic duodenal papilla tumor resection and 4 cases accepted palliative operations.Kaplan-Meier method was used to analyze the survival rate.Results Among the 76 cases of patients,the pathological diagnosis included 10 cases of benign tumors,8 cases of precancerous lesions,58 cases of malignant tumor.Death cases were not caused by postoperative complications.Coincidence rate of preoperative biopsy and postoperative pathological diagnosis was 77.6％.Postoperative follow-up was 2 to 120 months,the results showed that the 1,3,5 year survival rates were 73.2％,51.8％,32.1％ for 53 patients with duodenal papillary carcinoma.Conclusions Duodenal papilla tumors had varied clinical manifestations,ultrasound,CT and endoscopic examination and ERCP can improve the diagnostic rate of duodenal papilla tumors.For benign tumors and early stage malignant tumors,local excision or endoscopic resection was safe and effective.For advanced malignancies,radical pancreaticoduodenectomy was essential.

Objective To prepare human vascular endothelial growth factor receptor 2 (VEGFR2)-targeted liquid perfluorocarbons-filled nanocapsules ultrasound contrast agent,and to investigate its ability of targeting human umbilical endothelial vein cells(HUEVC) and the peculiarity of the enhancing ultrasound imaging in vitro.Methods Rotary evaporation/emulsion technique was used to prepare biotinylated liquid perfluorocarbons-filled nanocapsules (LNCs).VEGFR2-tageted LNCs (V2-LNCs) was further made through conjugating the ligand (biotinylated anti-VEGFR2 antibody) to the surface of LNCs by biotin-avidin system and its appearance,distribution,size and zeta-potential properties were assessed.Immunofluorescent staining assay was used to identify the combination of ligand with the nanocapsules.The ability of V2-LNCs targeting with HUEVC in vitro was evaluated under the fluorescence microscope.Quantitative and statistical analysis were performed to evaluate the ultrasound contrast enhancement of the nanocapsules in vitro.Results The V2-LNCs are uniform and stabilized with size about (98.45 ± 0.07)nm.The ligation of antiVEGFR2 antibody and nanocapsules was positive in immunofluorescent straining assay.In vitro,targeting ability research showed the V2-LNCs could actively adhere to HUEVC,while the control was negative.At the same time,using anti-VEGFR2 antibody to pre-incubation with HUVEC could effectively block the interaction between V2-LNCs and HUEVC.The ultrasound images proved both V2-LNCs and LNCs can significantly enhanced ultrasound imaging contrast agent effect at a concentration of 5 mg/ml in vitro.Conclusions A stable VEGFR2-targeted liquid perfluorocarbons-filled nanocapsules was prepared successfully with biotin-avidin method and effectively bound to HUVEC specially in vitro.Also the liquid perfluorocarbons-filled nanocapsules can strongly enhance the ultrasound contrast in vitro,which might be taken as a kind of vascular ultrasound contrast agent and to get the basic experimental data for the later research.

Objective To investigate the alterations in killer cell immunoglobulin-like receptors (KIRs)2D and their specific HLA-Cw ligands in patients with ankylosing spondylitis(AS)and determine whether the changes were correlate to the pathogenesis of AS.Methods Polymerase chain reaction of sequence specific primerB(PCR-SSP)was employed for genotyping the presence or absence of five KIR2D genes(KIR2DL1,2DS1,KIR2DL2,2DL3,2DS2)as well as HLA-Cw01-08 alleles from genomic DNA in 105 individuals with AS,together with 51 individuals with osteoarthritis(OA)and 120 healthy controls.Then HLA-C10-08 was divided into two groups.HLA-Cwasn and HLA-Cwlys to calculate the frequency of KIRID genotype.HLA-Gu alleles and KIR/HLA-Cw genotypes.Results The frequencies of HLA-Cwlys genes were significandy higher in patients with AS(0.269 7)compared with those in OA controls(0.148 2)and healthy controls(0.138 8,P=0.024,P=0.001,respectively).The frequency of KIR2DS1/HLA-Cwlys combination Was also markedly higher in AS group(26.67%)than that in OA controls(11.76%)and healthy controls(13.33%,P=0.039,P=0.018,respectively).Condusion The data suggest that the HLA-Cwlys allele may be associated with genetic susceptibility to AS and moreover.in the existence of HLA-Cwlys.the individuals with KIR2DS1 gene are likely to be at increased risk of AS.

Objective:To investigate the molecular epidemiological characteristics of norovirus (NoV) in hospitalized children with sporadic acute gastroenteritis in Tianjin in 2019.Methods:Fecal specimens and clinical data were collected from 3 116 hospitalized children with sporadic acute gastroenteritis possibly caused by viral infection in Tianjin Children′ Hospital between January and December, 2019. Real-time quantitative PCR was used to detect NoV. Partial sequences of RNA-dependent RNA polymerase (RdRp) and capsid genes of NoV were amplified by RT-PCR. Sequence alignment and phylogenetic analysis were performed for further analysis.Results:Among the 3 116 specimens, 809 (26.0%) were positive for NoV. There were significant differences in NoV detection rate between different age groups ( P=0.000), and the highest NoV detection rate (31.6%) was observed in the age group of 7-12 months. Moreover, the detection rate of NoV varied with seasons ( P=0.000), and the NoV detection rate was highest in winter (39.0%). Based on the sequence analysis of RdRp and capsid genes, 286 identified NoV strains belonged to six genotypes, which were GⅡ.P12-GⅡ.3, GⅡ.P16-GⅡ.2, GⅡ.P17-GⅡ.17, GⅡ.Pe-GⅡ.2, GⅡ.Pe-GⅡ.3 and GⅡ.Pe-GⅡ.4. The predominant genotype was GⅡ.Pe-GⅡ.4 Sydney 2012 (61.2%), followed by GⅡ.P12-GⅡ.3 (33.6%, 96/286), GⅡ.Pe-GⅡ.3 (2.4%, 7/286), GⅡ.P16-GⅡ.2 (2.1%, 6/286), GⅡ.Pe-GⅡ.2 (0.3%, 1/286) and GⅡ.P17-GⅡ.17 (0.3%, 1/286). Patients carrying the NoV of GⅡ.Pe-GⅡ.4 Sydney 2012 genotype were likely to suffer from vomiting than those positive for NoV of GⅡ.P12-GⅡ.3 genotype. Conclusions:NoV was an important pathogen causing acute gastroenteritis in children. GⅡ.Pe-GⅡ.4 Sydney 2012 and GⅡ.P12-GⅡ.3 were the major genotypes of NoV in hospitalized children with sporadic acute gastroenteritis in Tianjin in 2019.

Objective:To analyze the epidemiological characteristics and molecular classification of Human adenovirus (HAdV) and Human bocavirus (HBoV) infection in hospitalized children with acute respiratory infection in Tianjin Children′s Hospital.Methods:A total of 1 171 nasopharyngeal aspirates were collected from children with acute respiratory infection in Tianjin Children′s Hospital from March 2019 to February 2020. The specific primers designed by gene sequence were amplified by polymerase chain reation (PCR), and the positive amplification products were determined by sequencing. The sequences of HAdV and HBoV were compared in GenBank, molecular typed and phylogenetic tree analyzed of HAdV by MEGA7.0.26. The positive rate of HAdV and HBoV in different age groups(<6 months, 6-11 months, 12-23 months, 24-35 months, 36-47 months, ≥48 months) and seasons were compared by SPSS20.0.Results:Thirty HAdV were detected in 1 171 specimens, with a positive rate of 2.56% (30/1 171) and 84 cases with HBoV, with a positive rate of 7.17% (84/1 171).The positive detection rates of HAdV and HBoV in different age groups were 1.02% (4/392)-6.61% (8/121) and 4.09% (7/171)-11.45% (26/227), respectively. There was a significant difference in the positive detection rate of HAdV and HBoV in each age group (χ2=12.862, P=0.025; χ2=14.178, P=0.015).Winter is the peak period of HAdV infection, with a positive rate of 5.54% (15/271). The peak of HBoV infection is autumn and winter with a positive rate of 12.00% (36/300) and 12.5% (34/271), respectively, higher than that of the other two seasons (χ2=43.753, P<0.05). There was a significant difference in different season groups (χ2=13.287, P=0.004; χ2=43.753, P<0.05). The sequences of 29 adenoviruses were HAdV-3, 7 serotypes of HAdV-B subgroup and HAdV-1, 2, 5 serotypes of HAdV-C subgroup. Conclusion:HAdV and HBoV play important roles in children′s respiratory tract infections, and are closely related to factors such as the season and the age of the child. They should attract clinical attention.

Objective:To evaluate the prevalence of human rhinovirus (HRV) infection in hospitalized children in Tianjin and investigate the clinical impact of HRV infections.Methods:From July 2017 to December 2019, 2 945 nasopharyngeal secretion specimens were screened for HRV using polymerase chain reaction (PCR). VP4/VP2 sequences of HRV were further characterized. The clinical characteristics of the HRV infection were analyzed. The detection results of HRV for different groups and different months were compared using SPSS 19.0.Results:HRV-positive specimens accounted for 8.15% (240/2 945), of which 74.78% (86/115) were diagnosed with pneumonia, 40.83%(98/240) had co-infections with other common pathogens. HRV infections could be detected throughout the year with peaks in spring (11.00%, 66/660) and autumn (9.29%, 81/872). The positive rate of HRV was 4.14%(29/700) in winter. By VP4/VP2 sequence analysis, HRV-A was the most frequently detected strain(50.00%, 78/156), followed by HRV-C (41.67%, 65/156).46.15% (30/65) of HRV-C infections occurred in October and November. There were several different HRV-A types and HRV-C types. The most commonly detected HRV-A types were A12(11.54%, 9/78), A49(6.41%, 5/78), A22, A101, and A66(5.13%, 4/78), etc. The most common HRV-C types were C2(20.00%, 13/65), C22(9.23%, 6/65), C26, C43, C54 and C53(4.62%,3/65). Patients with HRV-A infections are more likely to show fever symptoms than HRV-C (χ2=5.411, P<0.05). No significant difference in other symptoms were found between the two types. Conclusions:HRV was a commonly detected virus among infants and had a clear seasonal distribution. It′s also possible for the HRV patients to have co-infections with other pathogens.HRV showed high genetic diversity.

Objective To investigate the reference intervals of mean corpuscular volume (MCV) ,mean corpuscular hemoglo‐bin(MCH) and mean corpuscular hemoglobin concentration (MCHC) examined by the MindrayBC‐6800 hematological analyzer to establish the reference intervals suitable for our laboratory .Methods According to the method recommended by the NCCLS C28‐A3 ,600 healthy adult individuals were selected as the reference individuals .MCV ,MCH and MCHC levels were determined by the MindrayBC‐6800 hematological analyzer for constructing the reference intervals ;other 150 healthy persons undergoing the physical examination were selected and their MCH ,MCV and MCHC detection results were collected for verifying the established reference intervals .Results The detection results of MCV ,MCH and MCHC in healthy adults showed a normal distribution ,MCV had sta‐tistical difference among different age periods (P<0 .05);the reference intervals :82 .278 -94 .242 fL for young adults ,83 .032-94 .608 fL for the middle‐aged persons and 83 .137-96 .343 fL for the elderly .MCH had statistical differences between different se‐xes and among different age periods ;the reference intervals :27 .785-32 .415 pg for male young adults ,28 .324-32 .456 pg for male middle‐aged persons and 28 .274-32 .966 pg for male elderly ;27 .367-31 .973 pg for female young adults ,27 .445-32 .215 pg for female middle‐aged persons and 27 .532 -32 .468 pg for female elderly .MCHC had statistical difference between different sexes (P<0 .05) ;the reference intervals :328 .611-352 .810 g/L for male and 323 .771-348 .750 g/L for female .In 150 individuals un‐dergoing the physical examination ,the proportion of individuals locating at the outside of reference interval was less than 10 .0% , therefore the newly established intervals were suitable for this laboratory .Conclusion The sex difference or/and age differences of MCV ,MCH and MCHC exist among adult populations .So the reference intervals are respectively established according to the prac‐tical situation ,which are suitable for this laboratory by verification .