Objective To investigate the relationship between the maturity and function of dendritic cells (DC) and hepatitis B virus covalently closed circular DNA (HBV cccDNA) load in the peripheral blood mononuclear cells (PBMC)/monocyte-derived DC in patients with chronic hepatitis B (CHB). Methods The peripheral blood samples were collected from 29 patients with CHB and 10healthy controls. PBMC were isolated freshly and induced with granulocyte/macrophage colony stimulating factor (GM-CSF) and interleukin-4 (IL-4). A large amount of DC were harvested after seven days of culture. The expressions of CD209, CD80, CD86, human leucocyte antigen (HLA)-DR and CD1a of DC were analyzed by flow cytometry. The HBV cccDNA load in PBMC and DC were measured by real-time polymerase chain reaction (PCR). The interleukin-12 (IL-12) level in the culture supernatant of DC was determined by enzyme linked immunosorbent assay (ELISA). The effects on T lymphocyte proliferation induced by DC were tested by mixed lymphocyte reaction (MLR). The data was compared by t test and analysis of variance. Results HBV cccDNA could be detected in PBMC from 16 patients, but not in DC from all 29 patients. HBV cccDNA load was all negatively correlated with the expressions of CD209 (r= -0. 793, P＜0.01), CD80 (r= -0. 581,P＜0.05), CD86 (r=-0. 698, P＜0.01), HLA-DR (r=-0. 817, P＜0.01), CD1a (r=-0. 734, P＜0.01), IL-12 level (r=-0. 632, P＜0.05) and allogenic T lymphocyte proliferation induced by DC (r=-0. 617, P＜0.05). The expressions of CD209, CD80, CD86, CD1a and HLA-DR on DC,IL-12 level in culture supernatant of DC and the allogenic T lymphocyte proliferation induced by DC in patients with positive PBMC HBV cccDNA were all significantly lower compared to those in healthy controls, and the changes of the parameters mentioned above were greater in PBMC HBV cccDNA positive patients than those in PBMC HBV cccDNA negative patients (P ＜ 0. 05 or P ＜ 0. 01).Conclusions The function and maturity of DC are impaired in CHB patients. HBV cccDNA can be detected in PBMC from CHB patients. Moreover, the higher PBMC HBV cccDNA is, the worse DC function and maturity are, which could be one of the important mechanisms of HBV persistent infection.

Objective To provide a scientific basis for prevention of Keshan disease by observing the changes of electrocardiogram in residents from Keshan disease area and urban residents in Ju County.Method In 2013,four countries (towns) of Sangyuan,Anzhuang,Qishan and Longshan were selected as the investigation sites across the Keshan disease areas in Ju County of Shandong Province,one village was selected in each country (town),no less than 200 people were chosen from each village.There were 36 residential communities in urban area in Ju County,one residential community was selected from 4 positions (east,west,south and north) in urban area,no less than 200 non-endemic urban residents were chosen from each residential community as control,the electrocardiogram examination was conducted.According to the Keshan Disease Diagnostic Standard (WS/T 210-2011),Keshan disease was diagnosed.Results Among the 964 inhabitants investigated in Keshan disease area,143 cases showed abnormal electrocardiogram and the detection rate was 14.83％;in the 926 cases of urban electrocardiogram,78 cases showed abnormal electrocardiogram,abnormal rate was 8.42％,the difference was statistically significant (x2 =18.80,P ＜ 0.01).There were 93 cases who met the 8 Keshan disease diagnostic criteria of abnormal electrocardiogram changes in the Keshan disease areas,abnormal rate was 9.65％;while there were 37 cases in urban residents,abnormal rate was 4.00％,the difference was statistically significant (x2 =23.55,P ＜ 0.01).Conclusion These residents who have lived in Keshan disease endemic areas have a higher rate of abnormal electrocardiogram in Ju County of Shandong Province,they are still threatened by the causative factors of Keshan disease,and the authority should strengthen the prevention measures of Keshan disease.

Objective To investigate the current situation and relevant factors related to the onset of Keshan disease (KSD) in Ju County of Shandong Province.Methods In 2012,one natural village was selected by means of random number table as the investigating site in Qishan,Anzhuang and Longshan towns,respectively,in KSD endemic areas of Ju County.Permanent residents of all age groups were taken as observation subjects.Then,clinical examination including electrocardiography (ECG) and X-ray for suspected patients was carried out.Fifteen hair samples were collected in every investigating site for detecting selenium content by fluorescence method.At the same time,economic income and per capita share of grain were investigated.Results There were 925 residents investigated in the 3 investigation sites and 27 cases of KSD were found; the total incidence rate was 2.92％.Among the 925 residents investigated,158 cases showed abnormal ECG,and total incidence of abnormal ECG was 17.08％.Among 11 X-ray films,5 cases of cardiac enlargement were found.The selenium content of hair was (0.430 ± 0.062) mg/kg; the average economic income was 9 561 yuan,and the per capita share of grain was 820 kg.Conclusions The incidence rate of KSD in Ju County is low and steady.Keshan disease is controlled in Ju County.

Objective:To explore the clinical effect of hyperbaric oxygen plus magnetic stimulation and Xingnaojing injection on the coma patients with severe brain injury.Methods:120 coma patients with severe brain injury who were treated in our hospital from September 2011 to March,2016 were enrolled in the present study.According to different therapies,they were divided into the observation group (55 cases) and control group (65 cases).Both groups received conventional therapy and Xingnaojing injection,on the the basis of which,the control group received the Hyperbaric Oxygen therapy,while the observation group received Magnetic Stimulation on the basis of control group.The GCS,level of inflammatory factors,clinical prognosis as well as memory function were compared between the two groups.Results:After the therapy,the GCS score of both groups were obviously increased and that of observation group was significantly higher than control group (P＜0.05);the serum level ofCRP,TNF-oα,IL-6 levels were significantly decreased compared with those before therapy,and those of observation group were obviously lower than the control group (P＜0.05);the total effective rate of ob servation group was 94.55％ (52/55),which was equivalent to the control group (89.23％,P＞0.05);the long term memory,short term memory,instantaneous memory and memory quotient of observation group were significantly higher than those of the control group.Conclusion:Hyperbaric oxygen plus magnetic stimulation and Xingnaojing injectionon was effective on the coma patients with severe brain injury,it could down-regulate the inflammatory response,promote awake and recovery of memory function.

Objective:To explore the functions of cytokines and TM in the pathogenesis of acute cerebral infarction.Methods:The levels of IL-1、IL-6 、TNF and TM were detected by ELISA in 55 patients with acute cerebral infarction.Results:The levels of IL-1、IL-6 、TNF and TM were increased significantly in the patients with acute cerebral infarction in comparision with the controls ( P

Objective To discuss the clinical effect of normal saline flushing and heparinized saline flushing in invasive arterial blood pressure monitoring in the critical patients. Methods A total of 140 critical patients were randomly divided into the experimental group and the control group with 70 cases in each group according to the envelope method. The experimental group used normal saline for tube flushing, the control group used heparinized saline (5 U/ml) for tube flushing. The incidence of complications and coagulation index were compared between two groups. Results There was no statistically difference in the incidence of the catheter jam and local infection (P>0.05). The incidence of bleeding events was 14.3% (10/70) in the control group, which was higher than 2.9% (2/70) of the experimental group. The difference was statistically significant(χ2=4.466, P<0.05). The activated partial thromboplastin time, prothrombin time of the control group were (32.22 ± 4.22) s, (11.56 ± 2.12) s, which were longer than (29.84 ± 3.64) s, (10.66 ± 1.48) s of the experimental group. And international normalized ratio of the control group was 1.12±0.14, which was higher than 1.03±0.20 of the experimental group. The difference was statistically significant (t values were-3.573,-2.912,-3.084, P <0.05). Conclusions The normal saline flushing liquid was more safer and reliable in the invasive arterial blood pressure monitoring.

Objective To explore the characteristics of diffusion weighted imaging (DWI) of lumbar sacral nerve roots (LSNR)in normal and degenerative lumbosacral vertebrae. Methods The research recruited 20 normal volunteers and 31 patients with spinal stenosis on conventional MRI and DWI scans in lumbosacral spine. We measured the areas from lumbar 3 to sacral 1 at the intervertebral spaces and reconstructed the 3D maximum intensity projection (MIP) and counted the apparent diffusion coefficient (ADC)of LSNR and ganglions. Results In the control group, 196 (98%) LSNR ran symmetrically and lateroinferiorly and 200 ganglions were well defined on MIP of DWI. In the patients group, 74 LSNR showed changes of compression on both T1WI and T2WI, in which DWI appeared thin and distorted in 59 (80%). The ADC value of LSNR were(1.70 ± 0.40)× 10-3 mm2/s and(1.98 ± 0.57) × 10-3 mm2/s separately in normal volunteers and patients (P=0.000), while the ADC values of ganglions were(1.42 ± 0.21)× 10-3 mm2/s and (1.54 ± 0.53)× 10-3 mm2/s respectively in normal volunteers and patients (P=0.000). Conclusion DWI can display the pattern and course of LSNR and ganglions, which indicate that ADC values of compressed LSNR and ganglions are higher than normal ones.

Based on China's health-related policy documents,combining the development history of health concepts and quality management theories,the evolution of China's view of healthcare service quality is sorted out.Moreover,based on the objectives of payment reform and the possible impact on healthcare service quality,the focus of healthcare service quality evaluation in the context of health insurance payment reform is elaborated.It aims to explore the focus of medical service quality evaluation at the present stage,and to provide a reference for better utilization of the evaluation results to improve the quality of medical services.

Objective:To investigate the activity concentrations of 90Sr and 137Cs in water in Hangzhou urban area. Methods:From 2012 to 2020, Qiantang River water as an important drinking water source, tap water as direct drinking water for residents, and West Lake water in tourists crowded area were selected forwater quality monitoring with respect to conctnts of 90Sr and 137Cs. The activity concentrations of 90Sr and 137Cs in water samples, as collected in wet and dry seasons resepectively, were determined by radiochemical analysis, with the 137Cs to 90Sr activity ratios obtained. Results:From 2012 to 2020, the activity concentrations of 90Sr and 137Cs in tap water were (2.0±1.1) - (7.4±0.4) mBq/L and (0.45±0.06) - (7.1±0.6) mBq/L, respectively. The 137Cs to 90Sr activity ratios ranged from 0.07 to 2.40. The activity concentrations of 90Sr and 137Cs in Qiantang River were (3.7±1.1) - (17.0±4.4) mBq/L and (0.28±0.01) - (15.0±4.5) mBq/L, respectively. The 137Cs to 90Sr activity ratios ranged from 0.03 to 0.90. The activity concentrations of 90Sr and 137Cs in West Lake water were (2.2±0.5) - (11.0±2.0) mBq/L and (0.32±0.04) - (7.9±1.9) mBq/L, respectively. The 137Cs to 90Sr activity ratios ranged from 0.05 to 1.20. Conclusions:The activity concentrations of 90Sr and 137Cs in water in Hangzhou urban area were at the background levels, lower than the concentration limits, 10 Bq/L both for 90Sr and 137Cs recommended by WHO in the 4 th edition of Guidelines for Drinking Water Quality.

Objective:To investigate and analyze the radioactivity levels of 90Sr and 137Cs in drinking water and 137Cs in food after the installation of the first AP1000 nuclear power unit in China. Methods:From 2012 to 2019, four drinking water monitoring points around AP1000 nuclear power unit located at Sanmen nuclear power plant site were collected during the wet season and dry season, 90Sr and 137Cs and radioactivity concentrations were determined in drinking water. Local rice, cabbage, crucian and mullet were collected to determine the radioactivity concentration of 137Cs. Results:From 2012 to 2019, the radioactivity concentrations of 90Sr and 137Cs in drinking water were 1.2-9.8 mBq/L and 0.2-8.1 mBq/L, respectively. The radioactivity concentration of 137Cs in food were 1.1×10 -2-2.8×10 -1 Bq/kg, lower than the limits specified in the Limited concentrations of radioactive materials in foods (GB 14882-94). Conclusions:After the installation of the first AP1000 nuclear power unit in China, the radioactivity levels of 90Sr and 137Cs in drinking water and 137Cs in foods are stable, without environmental impact identified.