OBJECTIVE:To provide experience and reference for the reform ofintegration of medicine and nursingunder the strategy ofHealth China 2030. METHODS:By literature analysis,the demand characteristics and supply situation ofinte-gration of medicine and nursingservice model in China were analyzed. The development bottleneck ofintegration of medicine and nursingservice model in China was discussed to put forward countermeasures and suggestions. RESULTS&CONCLUSIONS:Integration of medicine and nursingis a new model of the development of pension services in China. Throughout whole country, it is still in the stage of exploration and practice. There are some problems,such as serious inadequate beds,low participation of private pension institutions,pension service quality ofintegration of medicine and nursinghaving to be improved,weak market competition of pension institutions,social forces participation having to be improved,big demand gap of medical and nursing staff,inadequate high-quality medical and nursing talent. A clear positioning ofintegration of medicine and nursingservice model in China should be put forward andintegration of medicine and nursingmonitoring system should be improved. It is suggested to establish service complaint mechanism of pension institutions,encourage the active participation of diverse social forces,broaden the financing channels ofintegration of medicine and nursing,build service information sharing platform ofintegration of medi-cine and nursing,establish electronic health records for the elderly and set up maintenance personnel training mechanism so as to promote the rapid development of the reform ofintegration of medicine and nursing.

Rituximab in the combination of CHOP regimen has been widely used as the standard treatment of several kinds of B cell non-Hodgkin lymphoma (B-NHL),but there are still about 1/3 of the late B-NHL patients become primary and secondary resistant to the drug.Recently,many translational research progress in malignant lymphoma promoted the development of promising candidate drugs for the treatment of lymphoma.The advances in translational research field were summarized in this manuscript.

Advances in clinical transformation research has facilitated discovery of a number of novel somatic mutations and aberrant intracellular signaling pathways involved in malignant proliferative B-cell lymphoma.Meanwhile,small molecular inhibitors targeting those mutation genes or signaling pathways have also been shown to be effective in treating relapsed and refractory B-cell non-Hodgkin lymphoma.This paper reviewed important discoveries in clinical transformation research in lymphoma field in 2013.

Objective To investigate the related factors and preventive measures of nasopharyngeal massive hemorrhage in patients with nasopharyngeal carcinoma after radiotherapy. Methods Clinical data of 43 nasopharyngeal massive hemorrhage patients with nasopharyngeal carcinoma after radiotherapy were analyzed retrospectively. Results Thirty-nine cases(90.7 %) had abroad skull base invasion due to tumor, 36 cases (83.7%) received high dose of radiation, and 13 cases (30.2 %) were accompanied by diabetes. Conclusion Tumor location is the major factor for nasopharyngeal massive hemorrhage, while radiation dosage, fractionation patterns and diabetes are the secondary factors. The measures in cluding hyperfractionation, overall dose control and blood sugar regulation should be taken for the high risk patients. Prevention is more important than salvage.

Objective To observe the treatment and outcomes of gastric stump cancer(GSC) after subtotal gastrectomy,and to analyse the possible related factors for the development of GSC. Methods The clinical data of 693 patients with subtotal gastrectomy were retrospectively analysed.The development,treatment and outcomes of GSC were observed,and the possible factors associated with the development of GSC were analysed. Results Seventy-six cases of GSC emerged in the 693 patients with subtotal gastrectomy.Fifty-one of the 76 cases were perfomed radical operations(n=36) or palliative resection(n=15).No death was found during the perioperative period,and the median survival time was 32.7 and 14.2 months,respectively.Those 25 without surgical management died 3 to 11 months after the development of GSC.Among the 76 cases with GSC,stomach was found as the original site of ulcer in 59(22.3%,59/259),and duodenal bulb in the other 17(3.9%,17/434)(P

Objective To observe the bone mineral density(BMD)in type 2 diabetic women and discuss the methods for evaluation of BMD.Methods BMD was measured by dual-energy X-ray absorptiometry(DEXA)at skeletal regions of supine and lateral spine,left femur neck and left hip in 484 type 2 diabetic women and 868 healthy women.The relation of BMD of healthy women in skeletal regions with age changes was found to fit a cubic regression model.Results The peak BMD of lateral spine and hip appeared at 25-34 and 35-44 years old respectively.BMD in diabetic women was not different from age-matched healthy women.The BMD values of the different age stages in diabetic women showed no difference(P>0.05)as compared with healthy women,and decreased with the age increase.The numbers of damaged bone sites were increased with the age increase.The BMD difference values between peak value and values of different age stages showed no difference between diabetic and healthy women groups(P>0.05).Conclusion The changes of BMD in type 2 diabetic women show no difference from age-matched healthy women.And in both diabetic and healthy women,BMD decreases with age increasing.

Objective To investigate the effect of sevoflurane pretreatment on the expression of tight junction protein Occludin and ZO-1 in the lung following ischemia-reperfusion (I/R) injury in rats. Methods Ninty-six adult male Wistar rats weighing 250-350 g were randomly divided into 4 groups ( n = 24 each): group Ⅰ sham operation (group S);group Ⅱ I/R; group Ⅲ sevoflurane (group Sevo) and group Ⅳ Sevo + I/R. The animals were anesthetized, tracheostomized and mechanically ventilated. Right femoral vein and left carotid artery were cannulated for BP monitoring, blood sampling and drug and fluid administration. Lung I/R was induced by clamping left pulmonary hilum for 45 min followed by 120 min reperfusion in group Ⅱ and Ⅳ. In group Ⅲ the animals inhaled 2.2 % sevoflurane for 30 min. In group Ⅳ the animals inhaled 2.2 % sevoflurane for 30 min before lung ischemia. Six animals were killed at the end of 45 min ischemia (T1), and 60 and 120 min of reperfusion (T2, T3 ). The lungs were immediately removed for determination of W/D lung weight ratio and the expression of Occludin and ZO-1 protein (by Western blot). Tissues of lung were obtained for observation of histopathology with light microscope. Lung permeability index (LPI) was calculated. Another 6 animals were killed at 120 min of reperfusion for lung lavage. Results I/R significantly increased W/D ratio and LPI and significantly reduced Occludin and ZO-1 protein expression in the lung tissue as compared with group C and Sev. Sevoflurane pretreatment significantly attenuated the I/R-induced changes. The pathological damage to the lung tissue was significantly less in group SP than in I/R. Conclusion Sevoflurane pretreatment may protect the lungs from I/R injury by up-regulating the expression of Occludin and ZO-1.

Objective To study pathological diagnostic value of forceps and brush biopsy cytological examination by percutaneous transhepatic cholangiodrainage(PTCD) for malignant obstructive jaundice.Methods From April 2005 to April 2006,24 cases of obstructive jaundice underwent PTCD and stent insertion in biliary tract.Tissue pathological examination by forceps and brush was done during PTCD.Results 24 cases received forceps biopsy,of whom,14 cases received brush cytological examination at the same time.All of the 24 cases of forceps biopsy obtained pathological tissue and the pathological results as follows: adencarcinoma in 15 cases,4 cases had allotype cells,regarded as positive results;inflammation tissue in 1 case,which was restenosis after stent insertion;fibrous tissue in 1 case;tissue obtained was cholangioepithelia in 3 cases,in which 1 case was diagnosed as lymph node metastasis of peripheral head of pancreas after gastric cancer operation,2 cases were diagnosed as cholangiocarcinoma,the positive rate of forceps biopsy being 79.2%(19/24).4 cases of cytological examinations by brush showed tumor cells in 2 cases,allotype cells in 2 cases,regarded as positive results,the positive rate being 28.6%(4/14),and others were negative results.Conclusions Intracholangio-biopsy by PTCD offers the advantages of simplicity,safety,higher accuracy and less complications.Pathological diagnosis can be obtained at the same time during reducing-jaundice therapy by PTCD.

Objective To construct the expression vector of siRNA targeting the human protection of telomeres (hPOT1) gene for the observation of the inhibitory effect of the vector on hPOT1 gene expression in gastric cancer cell line SGC-7901, and to offer a ground work for further study on the roles of hPOT1 in growth and proliferation of gastric cancer cells. Methods 64 base-pair oligonucleotide for small interfering RNA expression targeting hPOT1 gene was designed and chemically synthesized. After annealing, double oligonucleotides were inserted into the downstream of H1 RNA promoter of pSUPER to recombine psiRNA-hPOT1 plasmids, and transiently transfected into gastric cancer cell line SGC-7901 with liposome-mediated transfection after restriction enzyme and sequencing analysis. Semi-quantitative RT-PCR was used to detect the expression levels of hPOT1 gene. Result Recombinant psiRNA-hPOT1 vector was confirmed by sequencing analysis. The results demonstrated that 64nt had been inserted into the expected site. Furthermore, the inserted sequence was exactly correct. The recombinant psiRNA-hPOT1 vector could significantly suppress the hPOT1 expression in gastric cancer cell line SGC-7901. Conclusion The constructed siRNA expression vector of hPOT1 gene psiRNA-hPOT1 recombinant plasmid can block the expression of hPOT1 gene in gastric cancer cell line SGC-7901.

Triple-negative breast cancer (TNBC) is a subgroup of breast cancers defined by a lack of the expressions of estrogen,progesterone and HER2 receptors,with more aggressive biological and clinicopathological characteristics and a close relationship with basal-like and breast cancer susceptibility gene-1 (BRCA1)-related breast cancers.TNBC is insensitive to most available hormonal or standard therapeutic agents,associated with increased risk for distant metastases and with poorer prognosis than other types of breast cancer.A deeper insight into the biology of TNBC may lead to improved therapies and better clinical outcomes of the disease.