Objective: In order to better understand the influencing factors of vertical rural health services integration and put forward policy suggestions for its sustainable development.Methods: 288 residents were investigated through questionnaire survey in three sample areas of Jiangsu province in August 2015.Results: In this study, 4 common factors have been found, namely organizational management, incentive mechanism, policy and supporting measures, as well as information sharing and business communication.The overall scores given by health managers, doctors and nurses, and public healthcare professionals were 0.03, 0.04 and-0.02 respectively.Conclusions: Therefore, in order to succeed, it is very necessary to introduce targeted supporting policies, establish a mutual communication mechanism, and make an effective incentive mechanism.

Objective To investigate the effect and clinical significance of HBV replication on the serum levels of IL-12 and IL-18 in patients with hepatitis B-related cirrhosis.Methods The levels of HBV-DNA and IL-12 and IL-18 in peripheral blood from 136 patients with different clinic types chronic hepatic diseases(102 patients with chronic hepatitis B,34 patients with hepatitis B-related cirrhosis ),95 HBV carriers and 20 healthy people (as control group) were respectively detected with ELISA and real time PCR.Results The levels of IL-12 and IL-18 in chronic hepatitis B and hepatitis B-related cirrhosis groups were significantly increased compared with control group(P0.05); and there was positive relationship between prevalence of HBV replication and IL-12,IL-18 levels in different chronic hepatic disease groups(r=0.74,P

Objective To investigate the effects of human Rrain-derived neurotrophic factor-gamma fetopro-tein (hBDNF-GFP) gene-transfected neural stem cell (NSC) transplantation on BDNF expressions in the retina of rots after optic nerve (ON) crush injury. Method ①Seventy-eight Sprague-Dawley (SD) rats were randomly as-signed into a control group (n = 6) and ON crush group (n = 72). In the ON crush group, the right ON was crushed while the left NO was exposed as sham injury. Rats in the ON crush group were divided into three sub-groups: PBS group (intravitreons injection of 0.01 mol/L phosphate buffered solution); GFP group (intravitreous transplantation of GFP gene-transfected NSCs); and hBDNF-GFP group (intravitreous transplantation of hBDNF-GFP gene-transfected NSCs). Rats were sacrificed 3, 7, 14 and 28 days after transplantation, and BDNF expres-sions in retinal homogenates was detected by using enzyme-linked immunosorbent assay (ELISA). ②The hBDNF-GFP-NSCs were transplanted intravitreous into six rats after ON crush injury. Following this, two rats were sacri-riced 2, 4 and 8 weeks after transplantation. The survival and location of NSCs in host retina were observed by frozen section analysis. ③Adult SD rats were randomly divided into four groups: control group (n = 5); NSC group (NSC transplantation, n = 10); GFP-NSC group (GFP-NSC transplantation, n = 10); and hBDNF-GFP-NSC group (hBDNF-GFP-NSC transplantation, n = 10). Four and eight weeks after transplantation, five rats from every group were sacrificed. Western blot analysis was used to determine retinal BDNF expression. Results ① There was no significant difference in BDNF expression between the control group and sham-injury groups (P >0.05). Three days after NSC transplantation, BDNF expression increased significantly in the three injured sub-groups compared with the sham-injury group, (P < 0.05), whereas no significant inter-group differences in BDNF expressions among three injured sub-groups were observed (P > 0.05). Seven days after transplantation, there was a significant difference in BDNF expression between the GFP-NSC group and the sham-injury groups (P <0.05), whereas there were no significant differences in BDNF expressions among the PBS, hBDNF-GFP-NSC and sham-injury groups (P > 0.05). Fourteen and 28 days after transplantation, BDNF expressions decreased in the PBS group and the GFP-NSC groups, while BDNF expressions in the hBDNF-GFP-NSC group increased significant-ly compared with the other three groups (P < 0.05); ②Frozen section showed that transplanted hBDNF-GFP-NSCs could survive and gradually extended to all layers of the host retina. ③Westem blot revealed there were no differences in BDNF expressions between 4-week and 8-week intervals in the hBDNF-GFP-NSC group. Compared with other three groups, BDNF expressions in the retina increased significantly after hBDNF-GFP-NSC transplanta-tion. Conclusions The hBDNF-GFP gene-trausfected NSCs can survive in the host retina and BDNF expressions are stable at a high level.

ObjectiveTo understand the prevalence of urinary incontinence (UI) and its epidemiological characteristics in rural elderly people and to lay a scientific foundation for formulating the strategies oI prevention and treatment for UI. MethodsA cross-sectional study was carried out in two townships of Jixian County, Tianjin. People aged 60 years and over were selected with cluster sampling, and the prevalence of UI and its epidemiological characteristics were collected with a standardized structured questionnaire by face-to-face interview. ResultsPrevalence of UI was 33.4% among the people aged 60 years and over in two townships, and it was increased with ageing.The elderly women had a higher prevalence of UI than the elderly man (43.2% vs. 22.8%, P<0.0001). The prevalences of UI in groups of 60-, 65-, 70-, 75-, 80-, 85-95 years old were 28.6%,32.1%,34.1%,35.5%,47.8%and 30.0%, respectively, and increased with ageing (X2for trend=2.19,P=0.029). Mixed UI (MUI) was the most common in different types of UI, and the constitution ratios of stress UI (SUI), urge UI (UUI), MUI and other type of UI were 27.4%, 1.2%, 60.9%,10.5%, respectively. The prevalence of MUI was the highest among the four types of UI in each age group. In all age groups, the prevalences of SUI and UUI were the highest in 60～ age group, and the prevalence of MUI was the highest in 80 ～ 95 age group. ConclusionsPrevalence of UI is high among the elderly people in rural areas of Jixian County, Tianjin.

Objective To explore the relationship of chronic diseases and the history of gestation and delivery with urinary incontinence (UI) among elderly people of rural areas, so as to lay a scientific foundation for formulating strategies of prevention and treatment for UI. Methods A cross-sectional study was carried out in two towns of Jixian county, Tianjin. A total of 743 people aged 60 years and over were selected with cluster sampling, and all information were collected with a standardized structured questionnaire by face-to-face interview. The relationships of chronic diseases and the history of gestation and delivery with UI were analyzed with univariate analysis and multivariate Logistic regression method. Results Prevalence of UI was 33. 4% among the people aged 60 years and over in two towns of Jixian, and it was higher in females than in males (43. 2% vs. 22.8%, χ~2= 34.70, P<0.0001). Logistic regression analysis revealed that the chronic respiratory diseases, prostate disease, neurological diseases or motor system diseases were all associated with UI in men, and the elderly men who suffered from prostate disease and neurological diseases had the highest risk of UI (OR=11. 47, OR=11. 76). Constipation, chronic respiratory diseases, diabetes mellitus and motor system diseases were all associated with UI in women, and the elderly women with chronic respiratory diseases had the highest risk of UI (OR = 4. 84). Elderly women who had more gravidity (OR = 1. 03), more parity (OR= 1.02), perineal laceration (OR = 1.72) and wound infection (OR= 1. 65) during delivery had higher prevalence of UI. Conclusions Prevalence of UI is higher among the elderly people in rural areas of Jixian county, and several chronic diseases and gestation and delivery history in women are all associated with UI in the elderly. For the prevention of UI, the elderly should actively look for treating their chronic diseases and the medical workers should strengthen health education or health care for pregnant women.

ObjectiveTo explore the treatment and economic burden of urine incontinence (UI) in the rural elderly,and provide evidences for preventive intervention.MethodsA cluster sampling was carried out in 743 people (aged 60 years and over) from 5 villages dominated by Yanliu and Dafengshang health centers,Jixian County,Tianjin from 2007 to 2008.The information about general state of health,treatment and economic burden of disease were analyzed. Results The prevalence of UI was 33.4％ (248 cases) among the 743 elderly people.Only 12 patients (4.8％) with UI ever visited community health-care service centers or hospitals for diagnosis and treatment,among whom only 1 case visited hospital within 1 year,8 cases during 1 to 5 years,and 3 cases over 5 years.And the method of treatment was all drug therapy.Among 248 cases with UI,there were 227 cases (91.5％) without any treatment,9 cases (3.6％) buying medicines by themselves.The direct cost for treatment of UI was 80-12000 yuan RMB,including 2 cases below 100 yuan RMB,2 cases 100-1000 yuan RMB,7 cases 1001-5000 yuan RMB and 1 case over 10000 yuan RMB. Conclusions Prevalence of UI is high while hospital-visiting rate is very low,and the financial burden of disease is serious,thus intervention measures for UI should be taken for the elderly people in rural areas of Jixian County,Tianjin.

ObjectiveTo investigate the clinical outcome of laparoscopic nephroureterectomy (LUNT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients.Methods We conducted a retrospective analysis on 1130 RT recipients,and 9 patients (0.8％,9/1130) with native upper tract UC were identified. UC was confirmed pathologically in the 9 patients,including 3 cases of unilateral ureter tumor (2 on the right,and 1 on the left),4 cases of unilateral renal pelvis tumor (2 on the right,2 on the left),1 case of bilateral ureter tumor and 1 case of tumor in the right ureter and left kidney.Females predominated (8/9) in the 9 patients with upper tract UC.The patients with left upper urinary tract cancer underwent LUNT using a retroperitoneal approach with a technique of transurethral circumcision of the ureteral orifice.The patients with right upper urinary tract cancer were subjected to nephroureterctomy with ureterectomy and bladder cuff excision by complete laparascopy through a transperitoneal approach. Immunosuppressive protocol conversion from calcineurin inhibitors to sirolimus was performed on all cases. Results In the 9 patients,11 LUNTs were performed successfully without conversion to open surgery.The follow-up period was from 6 to 48 months. One patient died of lung metastasis at 8th month after tumor excision,and 1 patient displayed ductal cancer of the left breast at 7th month after LNUT.Another seven patients showed no evidence of disease during the follow-up period with normal renal function.ConclusionOur present clinical experience suggested that LNUT for the native upper tract cancer in renal transplant recipients is feasible,safe,and effective.

Objective To evaluate the application of inguinal incision in retroperitoneal laparoscopic nephroureterectomy(LNU)in the treatment of upper urinary urothelial carcinoma(UUUC).Methods From Mar.2007 to Jan.2012,186 retroperitoneal LNU procedures on 115 males and 71 females for the treatment of UUUC were performed in our institute.All cases were grouped as inguinal incision group(n =112)and lumbar incision group(n =74)according to specimen retrieval incision.Operative time,estimated blood loss,postoperative analgesia,hospital stay,incision complications,cosmetic satisfaction and tumor recurrence were compared between the 2 groups.Results All the 186 cases of operation were successfully accomplished.There were no differences in tumor stage,tumor grade,mean operative time,blood loss between the 2 groups.In inguinal incision group,the incidence of incision fat liquefaction,incision hernia,incision bulging,lumboabdominal unsymmetry and postoperative analgesia was less than that of lumbar incision group.In inguinal incision group,the mean hospital stay was shorter,cosmetic satisfaction(Ⅰ/Ⅱ/Ⅲ)was better(7/24/81 versus 22/18/34,P ＜ 0.01).Recurrence rate of UUUC in middle and inferior segment of ureter was fewer than that of lumbar incision group(5.3％ versus 35.0％,P ＜0.01).Conclusion Retroperitoneal LNU for UUUC combined with inguinal incision offers advantage of less trauma,less complications,higher cosmetic satisfaction and lower tumor recurrence.

Objective To analyze the importance and necessity of patient public education, and to explore its contents and approaches. Methods From September to October 2017, 2224 medical workers and patients from 9 tertiary public hospitals among southern, central and northern Jiangsu province were surveyed with the self-designed questionnaire. Demographic data of respondents and their views related to patient public education topics were surveyed. Descriptive analysis and chi-square test were used to analyze the data. Results Some patients were irrational in their cognition of patients′ obligations, risk of disease, expectation of curative effect, and responsibility for medical malpractice. 19. 9％ of them held that"patients were vulnerable groups who should not carry much obligations". Some of them were found with obvious negative emotions and unhealthy psychological characteristics. 54. 4％ of the medical workers held that"psychological conflicts among the various roles of patients lead to various behavioral contradictions", which obviously affected their medical work. Conclusions Patient public education can be an important approach to avoid irrationality of patients when they see doctors. Patient public education is an education activity against irrational cognition, psychology and behavior of the patients at large. It requires an orchestrated effort by the governments, schools, hospitals among other stakeholders.

Objective To compare the safety of laparoscopic live donor nephreetomy(LDN) and open live donor nephrectomy(ODN), evaluate the kidney function and blood pressure of living donors during 1 year follow-up. Methods Thirty cases of LDN and 30 eases of ODN were retrospectively reviewed. The operation time, warm ischemia time, operative blood loss, time to post-operative intake and time to ambulation of the 2 grouups were compared. According to the modified Clavien classifica-tion system procedure-related complications were described and compared. Serum creatinine(SCr) le-vels, blood pressure and 24-h urine protein excretion were measured before nephreetomy and 1 d, 7 d, 3 months, 6 and 12 months after nephrectomy. Glomerular filtration rate (GFR) were measured preo-pratively and at 6 and 12 months postoperatively. These data were statistically analyzed. Results The operation time was (98. 6+13. 6)rain and (96.3+19. 5)rain in the LDN and ODN groups, re- spectively. Warm ischemia time in the LDN group was (90.6±15.1)s, in the ODN group was (86.4±12.3)s. Operative blood loss was (105.2±634.8)ml and (206.3±126.4)ml in the LDN and ODN groups(P<0.01). For the time to post-operative intake and time to ambulation, LDN group was (28.5±2.9)h and (25.8±63.8)h, ODN group was (38.6±63.3)h and (36.5±65.3)h(P<0.01). Perioperative complications rates were 6.6%(2/30) and 23.3%(7/30) for LDN and ODN, respective-ly. SCr was (109.1±7.5), (105.4±69.5), (96.6±10.7), (89.4±11.5), (91.6±69.3)/zmol/L in the LDN group and (107.3±69.6), (103.3±68.4), (95.4±69.1), (90.5±13.6), (90.3±11.7)μmol/L in the ODN group 1 day, 7 days, 3 months, 6 months and 12 months after nephrectomy. The mean GFR of LDN and ODN was 64.7 and 65.8 ml/min at 6 months after nephrectomy, 65.9 and 67.5 ml/min at 12 months postoperatively, which were significantly different comparing with preoperative mean GFR in each group(P<0.05) but no significant difference was found between 6 months and 12 months after nephrectomy and between the 2 groups at the same time point respectively(P>0.05). Mean 24 h protein excretion was elevated after either LDN or ODN during 1 year followup, but was not significantly different either between predonation and 1 year after nephrectomy or between the 2 groups at the same period. Blood pressure increased or decreased slightly with the duration of follow-up,no significant blood presure changes were found before and after nephrectomy or between the two groups at the same period postoperatively. Conclusions LDN has the advantages of minimal trauma, less operative blood loss and quicker convalescence. It is safe and and has no adverse effects regarding kidney function and blood pressure during the first year after living kidney donation comparing to ODN.