Objective To compare the effect of the cochlear stem cells transplantation in treating the noise in-duced hearing loss model and toxic hearing loss model.Methods The Experimental guinea pigs were divided into three groups:the group of the noise induced hearing loss model treated with the cochlear stem cells,the blank con-trol group of toxic hearing loss model treated with the cochlear stem cells and noise induced hearing loss model and the blank control group of toxic hearing loss model.The cochlear stem cells suspension and physiological saline were transplanted into the cochlear inner ears of the three groups,respectively.ABR detection and immunofluorescence observation were implemented three times in 7 days,28days and 56 days after the operation,respectively.Results Nestin positive cells and Myosin ⅦA positive cells were detected in both of the two models treated with cochlear stem cells,but the number of Nestin positive cells and Myosin ⅦA positive cells detected in noise induced hearing loss model was higher than that in the toxic hearing loss model.The ABR responses decreased on the noise induced hearing loss model and toxic hearing loss model treated with cochlear stem cells transplantation,but the hearing re-covery of guinea pigs in the noise induced hearing loss model was superior to the toxic hearing loss model at 28 days and 56 days after operation.Conclusion The cochlear stem cells transplantation is more effective in treating noise in-duced hearing loss than toxic hearing loss model.

Objective To understand the distribution of medical resources in the various regions of Zhejiang so as to provide basis for furthering the rational allocation of health resources.Methods Using two-step cluster analysis based on intelligence cluster theories,medical resources in the 11 regions of Zhejiang were classified by calculating and comparing log-likelihood distances.Results The 11 regions were clustered into 4 different types of distribution according to AIC value,BIC value,and the principles of maximum distances and most optimal cluster and differentiation between the various types: type 1 included Hangzhou and Ningbo;type 2 included Zhoushan,Jinhua and Lishui;type 3 included Huzhou and Quzhou;type 4 included Wenzhou,Jiaxing,Shaoxing and Taizhou.Conclusion Medical resources in Zhejiang are unevenly distributed.The various regions there ought to take relevant measures to rationally allocate medical resources and improve the structure for the allocation of medical resources.

ObjectiveTo evaluate the intraoperative neuromonitoring of the external branch of the superior laryngeal nerve (EBSLN) during Micooli's endoscopic thyroidectomy in order to avoid nerve injury.MethodsIn this study,36 patients with 56 nerves at risk were enrolled from February 2011 to September 2011.A positive signal is determined by observing contractions of the cricothyroid muscle to locate the EBSLN.The relationship between EBSLN and the upper pole of the thyroid or the inferior constrictor muscle was studied.The VHI-10 table was used for evaluation pre- and postoperatively. ResultsAll 56 nerves were located successfully,26 nerves(46.4％ ) crossed the superior thyroid artery more than 1 cm apart from the upper pole of the thyroid gland,while the other 30 nerves(53.6％ ) did less than 1 cm.In cases where the diameter was longer than 5 cm,the nerves crossed the artery at less than 1.0 cm from the upper pole in 73％ cases(P =0.006).There was no significant difference between VHI-10 results before and after surgery (P ＞ 0.05). ConclusionsIntraoperative neuromonitoring is useful and helpful in avoiding nerve injury by locating EBSLN.

BACKGROUND:Combining Chinese medicine with stem cel transplantation opens up a new avenue for the use oftraditional Chinese medicinein thestem cel transplantation. It is expected to improve survival and differentiationof cochlear stem celsintohair cels through Chinese medicine interventions.
OBJECTIVE:To observe the influenceofGuiqi Dihuang Tangon the treatment of sensorineural deafness with cochlear stem cels.
METHODS:Guinea pigs with sensorineural deafness were randomly assigned into three groups:combined group intervened with cochlear stem cel suspension with medicated serum, cel transplantation group with cochlear stem cel suspension, and blank control group with normal saline injection. At 7, 28 and 56 days after treatment, al guinea pigs were detected for auditory brainstem response and immunofluorescent observation.
RESULTS AND CONCLUSION:Nestin positive cels and MyosinVIIA positive cels were observed in the combined and cel transplantation groups, and the number of positive cels was higher in the combined group than the cel transplantation group. Auditory brainstem response threshold of guinea pigs was decreased in the combined and cel transplantation groups, and the recovery of hearing was better in the former group. These findings indicate that the intervention ofGuiqi Dihuang Tangcan remarkably improve the survival rate of transplanted stem cels and the differentiation ratioof transplanted celsintohair cels.

Objective To detect the expression of Toll-like receptor 9 (TLR9) in pancreatic cancer,and to explore its clinical significance. Methods The real-time PCR, Western blotting and immunohistochemistry were used to examine the expression of TLR9 in 30 samples of pancreatic cancer and the adjacent tissues, and 10 samples of normal pancreatic tissues. The relationships of TLR9 with clinicopathological parameters were analyzed. Results Compared with normal pancreatic tissues, the amplification value of TLR9 mRNA expression was 2.32 fold (1.41 ～ 3.22 ) in human pancreatic cancer, was 1.23 fold (1.18 ～ 1.28) in paracancerous tissues, respectively, and the difference was statistically significant (P ＜ 0.05 ). The percentage of positive cells expressing TLR9 protein in human pancreatic cancer tissues,paracancerous tissues and normal tissues were 73.3% (22/30), 33.3% (10/30) and 20.0% (2/10), and the relative expressions of TLR9 protein were 0.780 ±0. 026,0. 400 ±0.018,0. 173 ±0.043 ,respectively, and the difference was statistically significant( P ＜ 0.05 ). The highly expressed TLR9 was positively correlated with the degree of tumor differentiation, TNM stage and lymph node metastasis. Conclusions TLR9 was highly expressed in pancreatic cancer tissues. TLR9 expression plays a role in the canceration of pancreatic tissues.

Objective To detect the expression of Toll-like receptor 9 (TLR9) in pancreatic cancer and to study the effect of CPG ODN2216 on the biological behavior of pancreatic cell carcinoma, and to explore their clinical significance. Methods Immunohistochemical method was used to examine the expression of TLR9 protein in pancreatic cancer tissue and immunofluorescence staining was also performed to detect TLR9 protein expression in pancreatic carcinoma cells. In vitro cell adhesion, wound-healing scrape assay, transwell invasion assay and cell colony formation assay were performed to assess the effect of CPG ODN2216 on the invasive properties of Panc-1 cells. Results TLR9 were highly expressed in the pancreatic cancer tissue and pancreatic carcinoma cells. In vitro experiments as cell spreading assays, cell adhesion, colony formation assay and invasion assays showed the cell adhesion and cell motility properties of CPG ODN 2216 group to be apparently weakened compared with the control group. MTT assay showed cell proliferation ability in the CPG ODN group to be notably decreased, and CPG ODN2216 had inhibitive effects on the growth of panc-1 cells in a dose and time-dependent manner. Conclusions TLR9 gene was correlated with the invasive and metastatic potentials of pancreatic carcinoma. The used of CPG ODN2216 induced the inhibition of migration and invasion of the Panc-1 cell line.

Objective To evaluate the mechanism of external branch of the superior laryngeal nerve (EBSLN) injury during thyroid surgery as showed by intraoperative neuromonitoring.Methods 70 patients with 109 nerves at risk were enrolled in this study from March 2011 to October 2011.A positive signal is determined by observing contractions of the cricothyroid muscle.The relationship between EBSLN and the upper pole of the thyroid or the inferior constrictor muscle was studied.Results 108 nerves (99.1％) were located successfully,42 of which were visualized (38.9％).55 nerves (50.9％) crossed the superior thyroid artery more than 1 cm apart,while the other 53 nerves (49.1％) went less than 1 cm including 24 nerves(more than 0.5 cm,less than 1 cm) and 29 nerves (less than 0.5 cm) or coursed below the superior pole of the thyroid.The rate of the latter type was significantly elevated in patients with the top to botton diameter of the gland more than 5 cm.One patient suffered from impairing in the production of high tones postoperatively.Conclusions Intraoperative neuromonitoring is useful and helpful in providing instructive information for operations by locating EBSLN.

Objective: To establish an optimized path for health management of HBV infections among pregnant and lying-in women based on a Delphi method, so as to provide the evidence for intensifying the interruption of the mother-to-child transmission of HBV. Methods: Based on literature review and previous studies, the preliminary framework and contents of the optimized path for health management of HBV infections were constructed. Experts from epidemiology, clinical medicine and maternal and children healthcare were invited to participate in two-round Delphi consultations, and the preliminarily designed indicators were screened and revised. The score for feasibility of each indicator was calculated, and the weight of each indicator was estimated using a proportional distribution method. Results: Sixteen experts participated in the consultation, including 13 women. The participants had a mean age of (45.69±5.71) years, and a mean employment duration of (23.06±7.05) years. All participants had a degree of bachelor and above, and there were 14 experts with vice senior professional titles. The mean positive coefficient was 96.88% and the mean authority coefficient was 0.790 during the two-round expert consultations. There were significant differences in the coordination coefficient of importance, necessity and feasibility of indicators at all levels (P<0.05), and the coefficient of variation of the feasibility was all less than 0.250. The final optimized path for health management of HBV infections among pregnant and lying-in women included 6 primary indicators, 17 secondary indictors and 73 tertiary indicators. Among the primary indicators, delivery management (0.173 4), screening and evaluation (0.172 8) and pregnancy management (0.172 7) had a high weight. Conclusion A scientific and reliable optimized path is created for health management of HBV infections among pregnant and lying-in women, which has a potential value for improving the interruption of mother-to-child transmission of HBV.

Objective: To investigate the serum levels of anti-measles antibody among residents in Zhejiang Province in 2018, so as to provide insights into measles control. Methods: Permanent residents aged 0 to 59 years were recruited using the stratified multistage random sampling method in Zhejiang Province in 2018, and subjects' demographic features, medical history of measles and history of immunization with measles-containing vaccine (MCV) were collected using a questionnaire survey. The serum level of anti-measles IgG antibody was detected, and the geometric mean concentration (GMC) of anti-measles IgG antibody was estimated. The seroprevalence, protective rate and GMC of anti-measles IgG antibody were compared among residents at different age groups and regions. Results: A total of 4 189 residents were enrolled, including 1 939 males and 2 250 females, with a male to female ratio of 1∶1.16. There were 3 858 residents positive for anti-measles IgG antibody, with seroprevalence of 92.10%, and there were 2 072 residents with protective antibodies against measles, with a protective rate of 49.46%. The median GMC of anti-measles IgG antibody was 798.33 (interquartile range, 1 024.06) mIU/mL, and the protective rate of anti-measles IgG antibody appeared a tendency towards a decline with age ( χ2trend=18.067, P<0.001 ). There were significant differences in the seroprevalence ( χ2=45.090, P<0.001 ), protective rate ( χ2=57.432, P<0.001 ) and GMC of anti-measles IgG antibody (χ2=88.624, P<0.001 ) among residents at different regions, with the lowest seroprevalence of anti-measles IgG antibody in Ningbo City ( 85.19% ), the lowest antibody-protective rate (38.98%) and the lowest GMC [632.89 ( 909.04 ) mIU/mL] in Zhoushan City, the highest seroprevalence ( 95.16% ), antibody-protective rate (58.48%) and GMC [1 035.84 ( 1 301.77 ) mIU/mL] in Huzhou City. Conclusions The protective rate of anti-measles antibody was low and appeared a tendency towards a decline among residents in Zhejiang Province in 2018. There was a region-specific serum level of anti-measles antibody in Zhejiang Province in 2018.

Abstract Vaccine-hypervariable poliovirus type Ⅲ was detected in an acute flaccid paralysis infant at age of 6 months in Zhejiang Province in June, 2021, and the isolated and incubated virus had six nucleotide variations in the VP1 region as compared to the poliovirus Sabin vaccine strain. The infant had a history of three-dose poliovirus vaccination, and grade 2 muscle strength of the left upper limb upon onset. He was clinically diagnosed with cellulitis of the left shoulder, and recovered to normal following treatment. No abnormality was detected in the nervous system, and the infant was cured and discharged from hospital. No vaccine-hypervariable poliovirus was detected in subsequent infant' clinical samples or in close contacts, and no similar cases were identified during the active case detection by county/district medical institutions and among community populations. Since the infant did not present poliomyelitis-related clinical symptoms caused by vaccine-hypervariable poliovirus, poliomyelitis was excluded. The vaccine-hypervariable poliovirus was not spread because of timely identification and effective responses, suggesting the urgent need to maintain the sensitivity of the acute flaccid paralysis surveillance system and improve the coverage of poliovirus vaccination, so as to inhibit the transmission of poliovirus.