Objective To evaluate the effectiveness of nurse-led discharge planning for hospital inpatients with chronic disease.Methods The Cochrane Library,PubMed,Medline,EMBASE,Chinese Biomedical Literature Database Database(CBM),China National Kmowledge Infrastructure (CNKI),VIP Chinese full text database (VIP) and Wanfang Data were searched for randomized controlled trials assessing nurse-directed discharge planning for hospital inpatients with chronic disease.Two reviewers independently extracted data and assessed risk of bias.Meta-analysis was conducted for the eligible studies by RevMan 5.3.4.Results Seventeen randomized controlled trials and 5 331 participants were included.Meta-analysis demonstrated that,compared to standard care,nurse-led discharge planning were effective in reducing hospital readmission [risk radio (RR)=0.73,95％ confidence interval (CI) 0.64-0.84,P＜0.01],duration of inpatient readmissions [mean difference (MD)=-2.48,95％CI-3.68--1.29,P＜0.01],and all-cause mortality (RR=0.78,95％CI 0.62-0.97,P＜ 0.05).However,no reduction in the length of stay of the index admission (MD=-0.18,95％CI-0.64-0.27,P ＞ 0.05) was demonstrated.Conclusions Nurse-led discharge planning has a positive impact on several aspects of care for hospital inpatients with chronic disease,including reducing readmission,readmission length of stay,and all-cause mortality.It is worth being popularized.

Objective To explore the correlation between polymorphism of interleukin-28B(IL-28B) rs12979860 T/ C and susceptibility of hepatocellular carcinoma( HCC). Methods All eligible case-control studies published up to 2014-09-30 were identified by searching PubMed,EMBase,CNKI,CBM,VIP and WanFang databases. Two reviews independently identified the literature according to inclusion and exclusion criteria. Meta-analysis was performed using Rev Man 5. 2 and Stata 12. 0 software. Results A total of 6 stud-ies comprising 1 138 cases and 955 controls were finally included. Meta-analysis showed that IL-28B rs12979860 T/ C polymorphism was associated with the susceptibility of HCC. Compared with the genotype CC and CT + CC,genotype TT increased the risk of suffering from HCC(TT vs CC:OR = 2. 26,95% CI:1. 40-3. 64,Z = 3. 33,P = 0. 000 9;TT vs CT + CC:OR = 1. 90,95% CI:1. 23-2. 93,Z = 2. 89,P = 0. 004). In stratification analysis by ethnicity,we observed that the polymorphism of IL-28B rs12979860 T/ C was associat-ed with the susceptibility of HCC among Caucasian populations(TT vs CC:OR = 2. 06,95% CI:1. 22-3. 47, Z = 2. 70,P = 0. 007;TT vs CT + CC:OR = 1. 71,95% CI:1. 07-2. 72,Z = 2. 23,P = 0. 03). Conclusion The polymorphism of IL-28B rs12979860 T/ C is associated with the susceptibility of HCC,genotype TT may increase the susceptibility to HCC.

Objective To summarise the methods for a long segmental avulsed inj ury of ureter.Methods Ureteroscopies were performed on three male patients with upper ureteral calculi and one female patient with haematuria from upper urinary tract.Ureteral calculi caused small and middle hy-dronephrosis,obstruction wasn't seen on the upper urinary tract with haematuria.The kidney on the affected side showed normal founction on IVP.Four patients were suffered from a long segmental avulsed inj uries of full-thickness of ureter from ureteroscopy in a continuous epidural anesthesia.The injuries took place in UPJ and upper ureter.The length of avutsed ureters is 20-25 cm,mean length is 24 cm. Results The ureteroscopies were altered to open operations which were ileal ureteral substi-tutions on two patients,being anastomosed the avulsed ureter wrapped by caul on one patient and nc-phrectomy on one patient under general anesthesia in an emergercy.Two ileal ureteral substitutions had reached satisfied results that were no damaged renal functions,no metabolic acidosis,no repeatly U-rinary tract infections and no complains about micturition.One patient has maintained normal renal morphology and function after thirteen years followup,the other formed stricture in the anastomosis of the proximal piece of-ileum to the renal pelvis tWO years after operation,and then improved after ante-grade dilation.The patient with being replaced back and anastomosed the avulsed ureter had compli-cated with a renal atrophy on the affected side three months after the double-J was extracted.The kid-ney showed no function on isotop nephrogram and then was ablated.The last one with nephrectomy and the one before were followed up regularly,the renal functions and blood pressures remain normal.Conclusion Ileal ureteral substitution would be a good choice and has a stable curative effect and provide a good prognosis for treating long segmental avulsed injury of ureter suffered from ureterosco PY when no available urinary tract was utilized for reconstruction.

Objective:To study the clinical effect of early postoperative enteral nutrition and parenteral nutrition after radical ex-cision of gastric cancer to provide a better way of treating gastric cancers. Methods:Retrospective analysis of 140 gastric cancer pa-tients who were admitted to the PLA General Hospital between February 2009 and February 2011 was conducted. These patients were randomized into two groups based on the clinical trial, i.e., 70 in the control group received an intravenous parenteral nutrition for the treatment, and for the other 70 in the observation group, jejunostomy was done 1 to 5 days after the radical surgery by using Supportan as the enteral nutritional agent with a dose of at TPF-T 500 mL/d to 1 000 mL/d. The postoperative long-term survival rate of the pa-tients, the serum albumin, hemoglobin, alanine aminotransferase, aspartate aminotransferase levels before and after the treatment, as well as the situation of IgA, IgG, IgM and CD4+cells, NK cells, and B lymphocytes in the blood at the first and the seventh day after surgery were observed in the patients. Results:After the implementation of early enteral nutrition in the observation group, the 1-and 3-year survival rates were 84.29% (59/70) and 61.43% (43/70) respectively, whereas in the control group, the survival rates were 64.29% (45/70) and 47.143% (33/70) respectively, with statistically significant differences between the two groups (P<0.05). At the first and seventh day after surgery, the serum albumin, hemoglobin, alanine aminotransferase, and aspartate aminotransferase levels were significantly better in the observation group than in the control group, with statistically significant differences between the two (P<0.05). Compared with the parameters in the observation group at the first day after surgery and those in the control groups at the eighth day after surgery, the levels of IgA , IgG, IgM and CD42+cells, NK cells, and B lymphocytes were significantly increased in the obser-vation group at the seventh day after surgery. The differences among them were statistically significant (P<0.05). Conclusion: Early postoperative enteral nutrition for the gastric cancer patients undergoing radical surgery can be effective in improving the nutrition level of the patients and in enhancing their long-term survival rate, Thus, the treatment has value in clinical application.

Objective To study the protective effect of human urinary kallidinogenase (HUK) on focal cerebral ischemia-reperfusion injury in rats via phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway.Methods Eighty adult male SD rats were randomly divided into sham-operated group,model group,HUK group and LY294002 group (n=20).The rat focal cerebral ischemia-reperfusion models in the latter three groups were established by suture-occluded method;model group and HUK group were,respectively,injected with sterile saline or HUK 1.0 mL/kg via tail vein 3 h after reperfusion;rats in the LY294002 group accepted intraventricular injection of 10 nmol LY294002 before cerebral ischemia and caudal vein injection of 1.0 mL/kg HUK three h after reperfusion.Twenty-four h after reperfusion,Neurological Deficit Scale was performed,cerebral infarct volumes were detected by 2,3,5-triphenyltetrazolium chloride (TTC) staining,and protein expressions of Akt,phosphorylated (p)-Akt and Caspase-3 were assessed by Western blotting.Results As compared with those in the model group,the Neurological Deficit Scale scores were significantly lower,cerebral infarct volumes were significantly smaller,p-Akt expression was significantly increased,and Caspase-3 expression was significantly decreased in the HUK group (P＜0.05).As compared with those in the HUK group,Neurological Deficit Scale scores were significantly higher,infarction volumes were significantly increased,p-Akt expression was significantly decreased,and Caspase-3 expression was significantly increased in the LY294002 group (P＜0.05).Conclusion HUK has neuro-protective effect through up-regulating p-Akt expression in the PI3K/Akt signaling pathway and down-regulating Caspase-3 expression.

Objective To identify common allergens in patients with eczema or dermatitis by using serum IgE tests, and to explore their clinical significance. Methods A retrospective study was carried out on eczema or dermatitis patients with at least one positive serum IgE test result from 10 hospitals in China. Results Totally, 458 patients were included in this study with an average age of 28.13 ± 23.11 years. Of these patients, 209 (45.63%)were male, and 249 (54.37%)were female. The top three allergens were cockroaches(180/458, 39.30%), dust mite mix(152/458, 33.19%) and peanuts (116/458, 25.33%). Polysensitization (sensitization to more than one allergen)was observed in 89.66%(26/29)of patients with atopic dermatitis and 86.84%(33/38)of patients with facial eczema. Moreover, the rate of polysensitization was significantly higher in patients with generalized lesions than in those with circumscribed lesions (80%(88/110)vs. 70.40%(245/348),χ2=3.880, P=0.049). The positive rate of specific IgE against inhaled allergens was highest in the age group of 11-20 years(39/43, 90.70%), while the specific IgE against milk(26.53%, 26/98)and beef (19.39%, 19/98)was mainly observed in children aged less than 3 years. In addition, patients in northern areas showed increased positive rates of specific IgE to mugwort (10.35% vs. 1.61%,χ2= 4.917, P< 0.05), cockroaches (42.42%vs. 19.35%,χ2=11.959, P<0.05), milk (14.39%vs. 3.23%,χ2=5.958, P<0.05), soybeans (13.89%vs. 3.23%,χ2=5.594, P<0.05), beef(11.36%vs. 1.61%,χ2=5.641, P<0.05)and fresh-water fish(13.38%vs. 3.23%,χ2 = 5.235, P< 0.05)compared with those in southern areas. Conclusions Cockroaches are a common allergen in patients with eczema or dermatitis, and their clinical significance is worthy of further study. Polysensitization seems to be more frequent in patients with facial eczema or atopic dermatitis. Age is an important factor influencing allergen sensitization, and there is a regional difference in the distribution of common allergens.

Objective To investigate the internal quality control ( IQC ) on clinical chemistry , clinical immunology and clinical hematology in mutual recognition laboratories in medical institutions in Beijing.Methods By means of questionnaire survey and on -site investigation, fresh frozen serum and whole blood samples with assigned values by reference method were measured to investigate the status of IQC on clinical chemistry , clinical immunology and clinical hematology in 142 mutual recognition laboratories in medical institutions of Beijing,and results were analyzed.Results 142 copies of questionnaireson clinical chemistry, clinical immunology and clinical hematology were send out and 120, 97, and 101 laboratories returned the questionnaires respectively .The information feedback rate was 84.5%, 68.3% and 71.1%respectively .All the questionnaires were effective .Questionnaires survey results showed that more than 50%laboratories set up quality control goals and the most of the goals were probability for error detection ( Ped) 95%, probability for false rejection(Pfr)5%;About 70% laboratories usecd the same quality control plan for different tests ;The most frequently used quality control rules are 12s/13s/22s.On-site investigation showed that ,take the results of clinical chemistry for example , based on the desirable biological variation and WS/T 403 -2012 , most of the tests can't meet the quality control goalsunder the existing quality controlcondition.Conclusion Clinical laboratories should consider their actual situations , assess their own qualitylevels that they can reach , set reasonable quality standards for themselves , and make appropriateindividualized quality control plan.

As an important imaging marker of cerebral small vessel disease, white matter hyperintensity is closely associated with the clinical manifestations such as cognitive impairment, gait abnormalities, and urinary incontinence. Current studies have shown that the destruction of blood-brain barrier and inflammation response are the important pathophysiological mechanisms of white matter hyperintensity. As the most common immune cell in the inflammatory response of the central nervous system, microglia activation is the key to the occurrence and development of white matter hyperintensity. This article reviews the pathophysiological mechanisms of microglia involved in brain white matter hyperintensity.

Hedgehog (Hh) signaling pathway is present in many animals and plays an important role in regulating embryonic development and differentiation. Aberrant activation of Hh signaling contributes to the pathogenesis of many malignancies. Recent studies have shown that dysregulated Hh signaling pathway participates in the tumorigenesis, tumor invasion, and metastasis of hepatocellular carcinoma (HCC). Investigation of the relationship between Hh signaling pathway and HCC will help elucidate the molecular mechanism of pathogenesis of HCC and provide a new insight into the development of novel anticancer therapy and therapeutic target.

Objective:The extensive development of anatomical pulnonary segmentectomy requires thoracic surgeons to be familiar with the anatomical variations of the lung segment. The purpose of this study is to analyze the anatomical patterns of the right upper lobe lung segment using three-dimensional reconstruction, and to count rare variant types.Methods:From October 2017 to March 2020, 101 patients with small pulmonary nodules who were undergo segmental resection in our center were subjected to preoperative three-dimensional reconstruction of the lung structure, and the reconstruction data was retained for the statistics and analysis of the anatomical structure in the right upper lung lobe.Results:The right upper lobe bronchus is the most common with three branches(77/101), followed by two branches(16/101) and four branches(7/101). The two branches(70/101) of the right upper lobe pulmonary artery are the most common, followed by single branch(19/101) and three branches(11/101). In rare cases, four branches(1/101 cases) can be seen. The two branches(63/101) of the right upper pulmonary vein were the most common, followed by three branches(32/101) and single branch(6/101). In addition, a total of 12 rare mutations were counted. There were 2 variants in the bronchus, totaling 2 cases; 4 rare variants in the pulmonary artery, 13 cases total; 6 rare variants in the pulmonary vein, 10 cases total.Conclusion:The lung anatomy is complex and has many variations. The surgeon should fully grasp the anatomical structure of the lung segment of the patient's operating area before surgery, the data in this article will be a valuable reference for thoracic surgeons to carry out the upper right lobe segmentectomy.