In order to realize the seamless connection between superior and inferior medical institutions and simplify the process of patient referral to superior medical hospitals from the community medical institutions,Zhenjiang First People's Hospital designs a two-way referral platform for direct registration to Zhenjiang First People’s Hospital from community medical institutions.The paper introduces the design process,features and realization steps of this platform.The platform can realize the sharing of patient information between the community medical institutions and the hospital,facilitate patients' seeing a doctor and improve medical service level.

Objective:To analyze clinical and pathological features of Reed nevi (pigmented spindle cell nevi) .Methods:The clinical and pathological data were collected from 26 patients with Reed nevi, who visited Department of Dermatology of Xijing Hospital from January 2015 to June 2019, and analyzed retrospectively.Results:Among the 26 patients, 15 were males, and 11 were females. Their average age of onset was 17.35 years, and median age of onset was 13.85 years. Reed nevi occurred predominantly on the lower limbs (12 cases) , followed by the face (6 cases) , upper limbs (5 cases) and trunk (3 cases) . All the skin lesions were black in color, and 7 cases presented with maculae, 19 with flat papules, 22 with quasi-circular skin lesions, and 4 with irregular skin lesions. The diameter of skin lesions ranged from 2 to 10 mm, and 23 cases had skin lesions with a diameter of ≤ 5 mm. As histopathological examination showed, pathological subtypes included junctional nevus (15 cases) and compound nevus (11 cases) ; melanocytes were spindle-shaped with obvious cytochromes in 26 cases; nevus cell nests merged with the surrounding epidermis in 4 cases, and obvious fissures were formed between nevus cell nests and the surrounding epidermis in 22 cases; no obvious cell atypia or mitotic figure was observed in any of the 26 cases, and Kamino bodies were observed in 6 cases. All the skin lesions were resected by surgery, and no recurrence was observed during the follow-up of 1 - 5 years.Conclusion:Reed nevi can manifest as irregular lesions, pagetoid distribution of spindle cells of various sizes can be observed histopathologically, and they need to be differentiated from melanoma.

Siderophores were produced and secreted with marine microorganisms as the highly specific iron chelators. A method of liquid chromatography-tandem mass spectrometric detection coupled with solid phase extraction pretreatment was developed for the determination of siderophores in seawater. The samples were filtered through a 0. 22 μm membrane, extracted with an ENVI-18 cartridge and then eluted with methanol. The separation of the analytes was performed on a reversed phase SB-C18 column with a gradient elution program by using 0. 1% ( V/V) formic acid and methanol as the mobile phases. Qualitative analysis was performed in multiple-reaction monitoring mode. Good linearity (R2>0. 99) was obtained for Pyoverdines-Fe, Ferrichrome, Ferrioxamine E at the concentrations of 0. 001-3. 00 μg/mL, 0. 005-15. 00 μg/mL, 0. 001-3. 00 μg/mL, respectively. The instrumental detection limits and limits of quantification for the three analytes were 0. 08, 1. 76 and 1. 36 ng/mL; 0. 27, 5. 87 and 4. 53 ng/mL, respectively. The relative standard deviations were lower than 12%, while the recoveries were 12. 1%-18. 6% for Pyoverdines-Fe, 82. 0%-97. 7% for Ferrichrome, and 70. 0%-98. 3% for Ferrioxamine E.

OBJECTIVE:To synthesize the aryl-pyridazinone acid and curcumin ester. METHODS:With the raw material of 5-methyl-2-(3-chloro-4-fluorophenyl)-2-oxo-pyridazine acid (compound 1) and curcumin,there was ester-forming in the two sides of a phenolic hydroxyl and pyridazin-6-one carboxyl in curcumin by the catalysis of N,N-dicyclohexyl carbodiimide(DCC)/4- dimethylaminopyridine (DMAP). The targeted product,MS and NMR characterization of the structure were obtained through column chromatographic separation. Single factor was adopted to detect the effect of mixture ratio of curcumin and compound 1,re-action temperature and time and catalyst on the reactions. RESULTS:The productivity of targeted product (aryl-pyridazinone acid and curcumin ester)was 56.3%(in curcumin),the content by HPLC was 98.1%. The optimum conditions were as follows as the mixture ratio of curcumin and compound 1 was 1∶3,reaction temperature was 50 ℃,reaction time was 10 h and the catalyst was DCC/DMAP. CONCLUSIONS:The aryl-pyridazinone acid and curcumin ester is successfully synthesized with stable process.

Objective To determine relative risk factors for positive surgical margins in extraperitoneal laparoscopic radical prostatectomy(LRP). Methods From February 2004 to September 2007,33 patients(mean age 70 years old)with prostate cancers underwent extraperitoneal LRP.All patients were diagnosed by pathology preoperatively.Gleason score:3+3 14 cases(43%),3+4 11 cases(33%),4+3 6 cases(18%),4+4 2 cases(6%).Clinical stage:T1a-T1b 4 cases(12%),T1c 14 cases(43%),T2a-T2b 5 cases(15%),T2c10 cases(30%).Logistic regression analyses were performed. Results LRP was successfully performed on 31 cases.There were 2 cases converted to open surgery.Nine cases(27%)had PSMs.There were 6 cases(67%)and 4 cases(17%)of clinical stage T2c in PSM and negative surgical margin(NSM)groups respectively(P=0.010).There were 3 cases(33%)and 0(0)with high Gleason score(higher than 7)in PSM and NSM cases(P=0.015).There were 4 cases(44%)and 5 cases(21%)with t-PSA higher than 20dg/ml in PSM and NSM cases respectively(P=0.178).In these 9 cases,there were 4 cases(44%)positive with DRE.However there were 9 in the 24 NSM cases(38%)(P=0.509).Clinical stage T2c was independently positively correlated with PSM(OR=24.69).High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml were positively correlated with PSM. Conclusions Clinical stage is positively correlated with PSM.It is an independent factor.High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml mignt be the risk factors in predicting PSM and should be used together with clinical stage.Positive DRE findings may be also useful to predict PSM.

Objective To observe serum secreted protein acidic and rich in cysteine (SPARC) levels in normal subjects,obese subjects,patients with type 2 diabetes mellitus (T2DM),and obese patients with T2DM,as well as the difference of SPARC expression in mesenteric adipose tissue of subjects with and without T2DM.Methods Serum SPARC level was measured with the ELISA.RT-PCR,Western blot,and immunofluorescence were used to examine SPARC mRNA and protein expressions in mesenteric adipose tissue.Results (1) SPARC levels were higher in obesity,T2DM,and T2DM with obesity groups compared with normal group [(1 191.6 ± 718.91,1 223.81 ± 645.96,1 538.01 ± 757.95 vs 851.07 ± 280.21) ng/L,P＜0.05].(2) Pearson correlation analysis showed that SPARC level was positively correlated with homeostasis model assessment for insulin resistance index (r =0.205,P＜ 0.05).(3) The expression levels of SPARC mRNA and protein in mesenteric adipose tissue of T2DM patients were higher than those of control subjects (P ＜ 0.05).Conclusion SPARC is closely related to the development of obesity,insulin resistance,and type 2 diabetes mellitus.

Objective To evaluate the efficacy of percutaneouse trans-hepatic Cyanoacrylate (TH glue) embolization for gastric varices. Methods TH glue was injected into the gastric varices and its feeder veins in 30 patients. The endoscopy was performed at 1 week and every 3 months after the procedure, while the CT and portal vein angiography were performed at 3 months and every 6 months after the procedure to e-valuate the oblitazation results. Results The effective rate of treatment was 100%. A total of 21 patients were followed up in a mean period of 27.9 months (11-33 months) with a recurrence rate of varices at 14. 29% (3/21). Portal hypertensive gastropathy was observed in 17 patients (80. 95%), and to-bleeding occurred in 2 patients (9. 52%) due to portal hypertensive gastropathy. CT and portal vein angiography dis-played TH glue in fundic peripheral veins, perforating veins in the gastric wall and other feeding veins with-out re-ciroulation or new branches after embolization. Conclusion Peroutaneous trans-hepatic TH glue is a-ble to embolize the gastric varices and its feeding veins, which is feasible and effective in treatment of gastric varices.

OBJECTIVETo compare the effect and impact of holmium laser enucleation of the prostate (HoLEP) and 120-W thulium: YAG vapoenucleation of the prostate (ThuVEP) on erectile function in the treatment of benign prostatic hyperplasia (BPH).

METHODSWe retrospectively analyzed 93 cases of symptomatic BPH treated by HoLEP or 120 W ThuVEP. We made comparisons between the two groups of patients in the baseline and postoperative clinical and surgical indexes as well as their IPSS, quality of life (QOL), maximum flow rate (Qmax), postvoid residual urine volume (PVR), and IIEF-EF scores before surgery and during the 12-month follow-up.

RESULTSThuVEP, in comparison with HoLEP, achieved a significantly shorter operation time ([57.6 +/- 12. 8] vs. [70.4 +/- 21.8] min, P = 0.001) and a higher laser efficiency ([0.71 +/- 0.18] vs. [0.62 +/- 0.19] g/min, P = 0. 021). At 1, 6, or 12 months of follow-up, no significant differences were observed in IPSS, OOL, Omax, and PVR between the two groups (P > 0.05). Both the HoLEP and ThuVEP groups showed low incidences of complications and remarkably improved IIEF-EF scores at 12 months postoperatively, but with no significant differences (both P > 0.05). However, in those with relatively normal erectile functions before operation, the mean IIEF-EF score was reduced from 22.8 +/- 2.2 preoperatively to 21.0 +/- 2.7 after HoLEP, (P = 0.036).

CONCLUSIONBoth HoLEP and 120W ThuVEP are effective and safe in the treatment of BPH. Compared with HoLEP, 120 W ThuVEP has even a higher laser efficiency. However, neither can significantly improve erectile function, and HoLEP may have a short-term negative impact on the relatively normal erectile function of the patient.

Aged ; Holmium ; Humans ; Laser Therapy ; adverse effects ; methods ; Lasers, Solid-State ; therapeutic use ; Male ; Middle Aged ; Penile Erection ; Prostatectomy ; adverse effects ; methods ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Retrospective Studies ; Thulium ; Transurethral Resection of Prostate ; Treatment Outcome ; Urine

Objective To investigate the serum concentrations of secreted protein acidic and rich in cysteine (SPARC) in patients with diabetic nephropathy and SPARC mRNA and protein expressions in renal tissue of db/db mice.Methods Serum SPARC levels in normal subjects and patients with type 2 diabetes mellitus (without diabetic nephropathy),chronic renal failure (without diabetes mellitus),and diabetic nephropathy were determined with enzyme-linked immunosorbent assay.RT-PCR,Western blot,and immunofluorescence were used to detect the mRNA and protein expressions of SPARC in renal tissue of db/db mice.Results The serum level of SPARC in diabetic nephropathy group was significantly higher than those in normal group,type 2 diabetes mellitus,and chronic renal failure group [(5.78 ± 1.41 vs 3.58 ±0.41,4.51 ± 1.08,and 3.81 ± 1.16) μg/L,P＜0.05 or P＜0.01].The SPARC level in the type 2 diabetes mellitus group was higher than that in normal group (P＜0.05),but there was no difference between normal group and chronic renal failure.SPARC mRNA and protein levels in renal tissue of db/db mice were higher compared with the littermates (P ＜ 0.05).Conclusions The long term hyperglycemic state in patients with diabetic nephropathy causes pathological change of renal tissue.Simultaneously,increased secretion of SPARC from renal tissue results in elevation of serum SPARC level and may play a role in pathological change of diabetic nephropathy.

BACKGROUND:Simple spinal decompression for lumbar degeneration-induced lumbar scoliosis spinal stenosis is difficult to obtain long-term efficacy. Because simple decompression is considered an iatrogenic lumbar instability, and can aggravate lumbar deformity. Posterior lumbar pedicle screw fixation combined with decompression and fusion obtained good curative effects in patients.
OBJECTIVE:To investigate the clinical efficacy of posterior decompression, internal fixation, and bone graft fusion with posterior pedicle screw system in the treatment of degenerative lumbar scoliosis with stenosis.
METHODA retrospective analysis was performed in 18 patients with degenerative lumbar scoliosis with stenosis who received surgical treatment from February 2009 to November 2012. These patients consisted of 6 males and 12 females, with a mean age of 62.2 years (range, 48-80 years). They had lumbar scoliosis with a mean Cobb angle of 28.6° and underwent posterior decompression, internal fixation, and bone graft fusion.
RESULTS AND CONCLUSION:Al the 18 patients achieved satisfactory fol ow-up. The mean fol ow-up was 22 months. Al patients were satisfied with treatment outcomes and had improved quality of life. The mean correction angle was 13.7° (range, 6.0°-28.4°) after operation. There was no failure of internal fixation, and no infected cases were found. These data inducated that posterior decompression, internal fixation, and bone graft fusion is one of the effective methods for treating degenerative lumbar scoliosis with stenosis.