Objective To explore the alteration of brain pain functional areas in patients with functional dyspepsia (FD) irritable bowel syndrome (IBS) overlap by rectal balloon volume stimulation and magnetic resonance imaging (MRI) and the differences with IBS alone patients and healthy individuals were compared.Methods A total of 11 IBS alone patients,16 IBS overlapped with FD patients (IBS-FD) and 10 healthy controls were recruited.Sensory thresholds and visual analogue scale (VAS) were recorded during the rectal balloon air injection process. The changes of brain activated areas were analyzed by functional MRI (fMRI) when the rectum was stimulated at the volume of 50,100 and 150 ml.The data were analyzed by least significant difference (LSD) test.Results Under rectal volumetric stimulation,the sensory thresholds of IBS-FD group and IBS alone group were (53.14 ± 16.05) ml and (59.20 ± 20.55) ml and the difference was not statistically significant (LSD test,P＞0.05).There was no significant difference in VAS score between IBS alone group and IBS-FD group (LSD test,P＞0.05).Rectal stimulated under different volume,the results of fMRI indicated the activation of anterior cingulated cortex, dorsolateral prefrontal cortex,postporietal cortex,thalamus and insular cortex in both IBS alone group and IBS-FD group.And there was no significant difference in activated areas and intensity between IBS alone group and IBS-FD group (LSD test,P＞0.05).Conclusions There was no significant difference in activations of brain areas between IBS alone and IBS-FD patients under rectal volumetric stimulation. Under rectal volumetric stimulation,although symptoms overlapped,there was no evidence of the overlap of braingut axis and visceral hypersensitivity between IBS alone and IBS-FD.

Internet medical services provide a more convenient communication channel between doctors and patients.Doctors can communicate with patients through online consultation,telephone and other ways to understand the patient's condition and provide treatment suggestions.This kind of communication mode can enable patients to trust doctors more and establish a good doctor-patient relationship.Therefore,this paper analyzes the development of Internet medical services in hospitals,analyzes the development of services from the perspective of pre diagnosis,in-process and post diagnosis services,and puts forward countermeas-ures for the development of Internet medical services from the perspective of patient satisfaction in view of the lack of perfect policy guarantees,the inability to effectively feedback the needs of patients,the lack of mature service models and other issues.

Objective To investigate the level of CD31 molecule expression on peripheral T lymphocytes of patients with chronic hepatitis B (CHB),and to study the relationship between the expression of CD31 molecule and serum ALT levels,serum levels of HBV DNA and HBeAg.Preliminarily explore the relationship between the expression frequency of CD31 molecule and patients CHB,in order to understand changes in different immune status when chronic HBV infecting.Methods A total of non-antiretroviral therapy 42 patients with CHB and 25 healthy volunteers were enrolled for the study.In peripheral blood,separated lymphocytes conventionally,the percentage of CD4 + 、CD8 + 、CD31 + 、CD31 + CD4 + 、CD31 + CD8 + 、CD31 + CD4 +/CD4 + 、CD31 + CD8 +/CD8 + cells were assessed by flow cytometry,serum ALT levels were tested by automatic biochemical analyzer,serum HBVDNA levels were determined by real-time fluorescent quantitative PCR,and the serological markers of HBV were examined through chemiluminescence simultaneously.Results The percentages of CD4 + 、CD31 + 、CD31 + CD4 + 、CD31 +CD4 +/CD4 + cells in patients with CHB were significantly less than the healthy(P ＜ 0.05);the percentages of CD31 + 、CD31 + CD4+ 、CD31 + CD8+ 、CD31 + CD4+/CD4+ cells in ALT ＜2ULN group of patients with CHB were significantly lower than ALT≥2ULN group(P ＜ 0.05);serum HBVDNA loads lower group (＞103-105copies/ml),middle group (＞ 105-107 copies/ml) and higher group of HBVDNA (＞ 107-109 copies/ml) CD31 molecule expression frequency were on the rise,but no statistically significant difference were observed in the comparison between groups (P ＞ 0.05);the percentages of CD31 + 、CD31 + CD8 + 、CD31 + CD4 +/CD4 + cells in the HBeAg-negative group were significantly lower than HBeAg-positive group (P ＜0.05).Conclusions The frequency of CD31 molecule expression on peripheral T lymphocytes of patients with CHB were declined;there is a certain relationship between the frequency of CD31 molecule expression and serum ALT levels,different loads of HBVDNA,HBeAg positive or negative in patients with CHB;chronic HBV infection of immune status may be associated with T cell surface expression of CD31 molecule frequency.

Objective To conduct a screening survey of glycophorin (GP) variants and observe the content changes of sialic acid (SA) and total sulfhydryl (SH) groups on the erythrocyte membranes among residents in a tertian malaria hyperendemic area of Guizhou Province.Methods GP variants were detected in the erythrocyte hemolysates of 173 local residents at two villages of Libo County by SDS-PAGE on 10% to 15% gradients gel and Western immunoblotting. Their SA and total SH group contents were estimated in erythrocyte membranes by spectrophotometric methods. 114 healthy subjects in Changsha and 49 individuals at a neighbouring village of the above area showing low morbidity of malaria served as normal and endemic controls respectively.Results Three distinct types of GP variants were found among 19 propositi in this hyperendemic area. The incidence of GP variants was 7.9% (8/101) at Yaolu Village whose population was mainly composed of Yao ethnic group;while that of Buyi ethnic group at Maolan Village was higher (15.3%; 11/72).The erythrocyte membrane contents of SA in residents at both villages exhibited a very significant tendency of decline (P<0.01), whereas those of total SH groups increased prominently in residents of Yaolu Village only (P<0.05).Conclusions The frequency of GP variants in this hyperendemic area does not depend upon the severity of malarial prevalence. The evident reduction of SA contents in the residents may be related to the breaking down of the SA residues on membrane GPs by the invasion of Plasmodium vivax.

Objective To explore the subtype,incidence and duration of delirium in intensive care unit(ICU).Methods From October 2015 to September 2017,we prospectively collected baseline information of 516 inpatients met the inclusion criteria of ICU in Jinhua Municipal Central Hospital of Zhejiang Province.We assessed patients with the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU),and analyzed subtype of delirium and compared the incidence and duration of delirium.Results Among 516 patients,there were 119 cases with delirium along with 23.06％for the incidence.There were 14 cases with delirium in the type of increased activities,61 cases with delirium in the type of decreased activities and 44 cases with delirium in the mixed type.Delirium of 79.83％of patients occurred for the first time when being admitted to ICU between the second day and fifth day with 63.87％for the incidence of delirium night.The duration of delirium was from two to three days accounting for 52.94％.There were statistical differences in the occurrence time of delirium with three subtypes(χ2=11.116,P=0.025).The differences in duration of delirium with three subtypes were also significant(H=24.728,P<0.001).Conclusions Patients' high-incidence period of delirium is from the second day to the fifth day after being admitted to ICU.The occurrence time of delirium has the volatility showing the characteristic of light daytime and heavy night.We should strengthen assessment for delirium of patients to identify and take steps early,so as to reduce the occurrence risk of ICU delirium and shorten the duration of delirium.

Objective The present study aimed to evaluate the expression and intratumoral heterogeneity of LN?5γ2 in esophageal squamous cell carcinoma ( ESCC) . Methods The expression of LN?5γ2 protein was examined in 135 ESCC cases by immunohistochemistry, and to analyze its relationship with the clinical relevance of patients. The protein expressions in different regions in the same tumor as well as different nests in the same region were compared. Results Moderate and high expression of LN?5γ2 protein was detected in 40.0% (54/135) of tumor tissues. Positive immunohistochemical staining was observed in 31.1% (23/74) of early stage (stages Ⅰ/Ⅱ) cases and 50.8% (31/61) of late stage (stage Ⅲ) cases, with a significant difference between these two groups (P=0.023). There was no statistical association of LN?5γ2 expression with age, sex of patients, PT sage, lymph node metastasis and degree of tumor differentiation ( P>0.05) . However, differential expression of LN?5γ2 protein was found at different sampling sites in the same tumor and the same sampling site in different carcinomas. Conclusion High expression of LN?5γ2 is positively correlated with tumor clinical stages and there existed intratumoral heterogeneity of LN?5γ2 expression in ESCC tissues.

Objective The present study aimed to evaluate the expression and intratumoral heterogeneity of LN?5γ2 in esophageal squamous cell carcinoma ( ESCC) . Methods The expression of LN?5γ2 protein was examined in 135 ESCC cases by immunohistochemistry, and to analyze its relationship with the clinical relevance of patients. The protein expressions in different regions in the same tumor as well as different nests in the same region were compared. Results Moderate and high expression of LN?5γ2 protein was detected in 40.0% (54/135) of tumor tissues. Positive immunohistochemical staining was observed in 31.1% (23/74) of early stage (stages Ⅰ/Ⅱ) cases and 50.8% (31/61) of late stage (stage Ⅲ) cases, with a significant difference between these two groups (P=0.023). There was no statistical association of LN?5γ2 expression with age, sex of patients, PT sage, lymph node metastasis and degree of tumor differentiation ( P>0.05) . However, differential expression of LN?5γ2 protein was found at different sampling sites in the same tumor and the same sampling site in different carcinomas. Conclusion High expression of LN?5γ2 is positively correlated with tumor clinical stages and there existed intratumoral heterogeneity of LN?5γ2 expression in ESCC tissues.