Objective To establish a duplex fluorescence PCR for detection of HIV proviral DNA and to evaluate its application for early diagnosis of HIV infection in infants .Methods A duplex fluores-cence PCR system was set up based on TaqMan technology for detection of human ribonuclease P ( RNase P) gene and long terminal repeat ( LTR) region of HIV.A recombinant plasmid containing the targeted gene fragment , pTG19-T, was constructed by TA cloning technique and used as the template for evaluation of sen -sitivity of the assay .Blood samples from 11 healthy individuals and 98 HIV-infected patients were collected and detected to validate the assay specificity .The assay of duplex fluorescence PCR was then carried out to detect 96 infant blood samples collected from several maternal and child health hospitals in Zhejiang province from January 2011 to September 2012 for early diagnosis of HIV infection .The results were compared with those by using the Roche HIV DNA qualitative detection kit .Results The established duplex fluorescence PCR could specifically detect HIV proviral DNA with a specificity of 100%and a detection sensitivity of 100 cps per reaction .The coincidence rate between the established assay and the Roche HIV DNA qualitative de -tection kit was 100%in the detection of 96 blood samples .Conclusion The duplex fluorescence PCR as-say showed advantages of cost-effectiveness , convenience , good specificity and accuracy with high sensitivi-ty.It could be used for early diagnosis of HIV infection in infants and also as a general technical platform for the detection of HIV proviral DNA .

Objective To study the clinical features bone marrow biopsy of secondary myelofibrosis(SMF).Methods 69 patients with secondary myelofibrosis were analyzed retrospectively,and the relationship between myelofibrosis degree and megakaryocyte count was analyzed. Results Analysis of 69 cases of patients with SMF, the original incidence included 20 cases (29.0 ％)of chronic myeloid leukemia (CML),14 (20.3 ％) cases of lymphoma,10 (14.5 ％) cases of acute myeloid leukemia (AML),10 (14.5 ％) cases of myelodysplastic syndrome (MDS),6 cases(8.7 ％)of acute lymphoblastic leukemia (ALL),4 cases of multiple myeloma (MM),3 cases of myeloproliferative neoplasms (MPN),2 cases of chronic lymphocytic leukemia (CLL).There was no significant difference of the mygakaryocytes’ count and association of myelofibrosis with it was found (r=0.024,P=0.848). Conclusion Various clinical diseases of blood system may associated with secondary myelofibrosis. Bone marrow biopsy can be used to initial diagnostics of malignant disease of hematological system patients.When cellular examination of bone marrow is dry tap or dilution, which means higher incidence of SMF. Bone marrow biopsy plays an important role in diagnosis of SMF.

Objective To assess the effects of QRS duration on left ventricular systolic synchronicity in patients with heart failure by real-time three-dimensional echocardiography(RT-3DE).Methods Thirty-four patients with heart failure(LVEF≤35%)were selected and divided into two groups.Group A consisted of 20 patients with normal QRS duration,and group B included 14 patients with long ORS duration.All the patients underwent two-dimensional echocardiography(2DE)and RT-3DE respectively.Parameters including left ventricular inlernal diameter(LVIDd),left ventricular ejection fraction(LVEF)of 2DE,and left ventricular endsystolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),LVEF,the time to minimal systolic volume of 16-segmental standard deviation as a ratio of R-R interval(Tmsv16-sd/RR)of RT-3DE were obtained and analyzed between the two groups.Results There were no significant differences of LVIDd,LVEF acquired by 2DE between the two groups(P＞0.05);LVESV,LVEDV,Tmsv16-sd/RR of RT-3DE were slightly higher in group B than those in group A,but didn't reach the significant difference between the two groups(P＞0.05).The mechanical dyssynchrony maybe related to the severity of heart failure.Conclusions RT-3DE can quantify global left ventricular systolic synchronicity.QRS duration has no significant effect on left ventricular systolic synchronicity in patients with heart failure.

Objective To investigate left ventricular(LV) systolic dyssynchrony in heart failure of different etiology which caused respectively by ischemic heart disease and dilated cardiomyopathy and analyse the correlation between the systolic dyssynchrony index(SDI) and the LV ejection fraction(LVEF). Methods Forty-three subjects were divided into two groups. Group A consisted of 17 heart failure patients which caused by ischemic heart disease and group B included 26 heart failure patients which caused by dilated cardiomyopathy. Three-dimensional datum of left ventricle were obtained using real-time three-dimensional echocardiography (RT-3DE) in full volume mode. Post-processing software Qlab was used for advanced analysis. The end-diastolic volume (EDV), end-systolic volume (ESV), LVEF and bull eye graph of seventeen segments were obtained. Standard deviation of time-to-minimal-systolic-volume of 16-LV segments corrected by R-R interval was calculated as SDI of LV. Results There was no statistical difference in age, heart rate, LVEF and EDV between the two groups (P >0.05). SDI of group A was lower than that of group B,but there was no statistical difference between them (P>0.05). Bull eye graph of seventeen segments revealed that the distribution of delayed systolic segments were different between the two groups. SDI of two groups appeared negative correlation with LVEF(r = -0.83, r = -0.71, P-< 0.01). Conclusions LV systolic dyssynchrony existed in heart failure which caused by ischemic heart disease and dilated cardiomyopathy,but the distribution of delayed systolic segments were different between them. SDI increased with worsening LV systolic function.

Objective To detect the content of plasma ctDNA and the mutation rate of BRAF V600E in plasma of patients with thyroid carcinoma ,and to explore its clinical significance. Methods Plasma ctDNA was extracted from 16 patients with thyroid carcinoma and 59 patients with benign thyroid nodules by using the blood genomic DNA Extraction Kit. The ctDNA content was detected by fluorescence quantitative PCR ,and the mutation of circulating BRAF V600E was detected by PCR and sequencing. Then the clinical significance was analyzed by combined detection analysis. Results The content of ctDNA in thyroid cancer group was significantly higher than that in benign nodule group (P < 0.01). BRAF V600E mutation detection showed that the mutation rate was 43.75%,but benign nodules had no mutation. Parallel combined detection improved the sensitivity and the specific-ity of the combined detection was higher. Conclusion Combined detection of ctDNA and BRAF V600E in plasma is helpful for differential diagnosis of benign and malignant thyroid nodules.

Objective To analyze and summarize the efficacy and the experience in the application of type Ⅰ and type Ⅱ bundled pancreaticojejunostomy in pancreaticoduodenectomy. Methods Between Jan.2005 and Dec. 2009, a total of 38 patients who underwent bundled pancreaticojejunostomy was enrolled, and their clinical data were retrospectively analyzed. 20 patients received type Ⅰ bundled pancreaticojejunostomy and 18 patients received type Ⅱ bundled pancreaticojejunostomy. The operative time, postoperative hospital stay, mortality and complications were compared. Results The operative time of type Ⅰ bundled pancreaticojejunostomy was (91 ± 20) min, and it was (63 ± 21) min in type Ⅱ procedure, and the difference was statistically significant (P ＜ 0. 05). The mortality and complications, postoperative hospital stay were 10.0%(2/20), 45.0% (9/20) and (20 ±2)d in type Ⅰ procedure, while they were 5.6% (1/18),38.9% (7/18) and(23 ±2)d in type Ⅱ procedure, and the difference was not statistically significant.Conclusions There was no significant difference in the effects between type Ⅰ and type Ⅱ bundled pancreaticojejunostomy. Carefully selective application of type Ⅰ and type Ⅱ bundled pancreaticojejunostomy helps complete these procedures.

Objective To investigate the effect of erythropoietin(EPO)on the expression of aquaporin - 2 (AQP2)in the kidney of young SD rats after release of bilateral ureter obstruction(BUO - R). Methods Thirty - two young SD rats were equally divided into 4 groups randomly(BUO group,BUO - R group,BUO - R ﹢ EPO group and Sham group,8 rats in each group). The BUO model was built through bilateral ureteral ligation. EPO(500 U/ kg)was given to BUO - R ﹢ EPO rats at 2 h after release of BUO,and then repeated 6 h,12 h,24 h and 36 h thereafter and the same volume of 9 g/ L saline was simultaneously given to BUO - R rats. The Sham group was prepared in parallel by laparotomy and free dissection of bilateral ureters but not ligated. Both side kidneys were harvested 48 h(72 h for Sham group)after release of BUO to examine the effect of EPO on the expression of AQP2 in inner medulla by immunohisto-chemistry,Real - time PCR and Western blot. The urine samples were collected by using metabolic cage before death. Results The osmotic pressure of BUO - R ﹢ EPO group was higher than that of BUO - R group,but lower than that of Sham group(P ﹤ 0. 05). Immunohistochemistry showed that the collecting duct wall thinned and lumen enlarged. After the pictures were analysized by using Image - Pro Plus software,it showed that the expression of AQP2 in collecting duct in BUO group was significantly down - regulated compared with that in Sham group,whereas,it was slightly weaker in BUO - R group and BUO - R ﹢ EPO group than Sham group(P ﹤ 0. 05). These results were further confirmed by a-dopting Western blot,and the relative quantity of AQP2 in BUO group was also the lowest of the four groups(P ﹤0. 05). Real - time PCR showed that the level of AQP2 mRNA in Sham group was(24. 30 ± 1. 03)folds of BUO group,(10. 60 ± 1. 05)folds of BUO - R group and(5. 70 ± 1. 01)folds of BUO - R ﹢ EPO group,respectively. Conclusion EPO could promote not only the recovery of AQP2 mRNA and protein expression but also the recovery of AQP2 function in young BUO - R rats.

PURPOSE: Maintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs. METHODS: A cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education. RESULTS: The nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor's degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents. CONCLUSION: Health-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.
Asian Continental Ancestry Group* ; China ; Cross-Sectional Studies ; Dronabinol ; Education ; Emergency Medicine ; General Practice ; Health Occupations ; Health Policy ; Hospitals, County ; Hospitals, Urban ; Humans ; Models, Theoretical ; Needs Assessment ; Rural Nursing ; Surveys and Questionnaires

OBJECTIVETo investigate the surgical and oncological outcomes after laparoscopic pancreaticoduodenectomy (LPD), and compare its efficacy with open pancreaticoduodenectomy (OPD).

METHODSClinical data of 40 patients with malignant tumor undergoing pancreaticoduodenectomy between January 2012 and January 2013 in our department were retrospectively analyzed. Patients were divided into LPD and OPD group according to operative procedure. Operative time, blood loss, harvested lymph nodes, drainage on first postoperative day (POD1), first flatus day, time to liquid diet, postoperative period of fever, postoperative hospital stay, postoperative complications, and 1-year cumulative survival rate and recurrence rate were compared between the two groups.

RESULTSThere were no significant differences between the two groups in operative time, harvested lymph nodes, TNM stages, postoperative period of fever, time to drain removal, postoperative complications, 1-year cumulative survival rate and recurrence rate (all P>0.05). As compared to OPD group, LPD group showed less blood loss [(168.2±87.4) ml vs.(353.5±140.1) ml, P<0.001], drainage on POD1 [(157.7±69.7) ml vs. (289.1±197.0) ml, P=0.039], earlier flatus [(4.1±0.9) d vs. (6.6±3.4) d, P=0.024], shorter time to liquid diet [(5.8±1.3) d vs. (8.2±3.5) d, P=0.040], earlier ambulation [(3.6±1.4) d vs.(6.2±1.5) d, P<0.001], and shorter postoperative hospital stay [(17.0±2.2) d vs.(25.7±13.8) d, P=0.047].

CONCLUSIONLPD confers similar surgical and oncological outcomes and is superior to OPD in terms of decreased blood loss and rapid postoperative recovery.

Aged ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Laparotomy ; Male ; Middle Aged ; Pancreaticoduodenectomy ; methods ; Retrospective Studies

Objective:To investigate the teaching mode of laparoscopic surgery skills for medical interns and its effect.Method:s New interns were randomly divided into experimental group and control group. The experimental group received the laparoscopic surgery skill training by learning Pick and Place (PP), Scrip Shear (SS), Suture and Knot tying (SK) and Tissue Isolation (TI), and they also received additional training of basic surgery skills before the training of laparoscopic surgery skills, while the control group did not receive the pre-training. Examines and questionnaires were conducted after the training.Result:s There were no significant differences in laparoscopic skills between the two groups at the beginning of the training, but they all had obvious improvement after training ( P<0.01). Compared with the control group, the experimental group did better in PP and SK ( P<0.01), but no differences in SS and TI. The satisfaction rate of training model and skill improvement was 95% and 85% in the experimental group and control group. Conclusion:Short-term program of laparoscopic surgery skill training could effectively improve intern's laparoscopic surgery skills, and the master of basic surgery skills is conducive to the learning of laparoscopic surgery skills.