Objective To learn the medical experience of inpatients at public hospitals in Henan and the influencing factors.Methods Inpatient experience questionnaire (IPEQ) was customized for a random sampling of 500 inpatients at five tertiary public hospitals in Henan.Results Overall satisfaction of inpatients experience scored 8.48,of which the satisfaction for technical competence was the highest (4.19)and that for emotional support the lowest(3.31).The correlation analysis revealed that the doctors' technical competence score the highest correlation with the experiences (0.652).Conclusion Overall satisfaction of inpatients experience at public hospitals in Henan was found high in general,but humanistic care and service flow at the hospitals require further improvement.

BACKGROUNDTo investigate the diagnostic value of chest CT scan combined with telomerase activity and p16 gene methylation from exfoliated cells of sputum in 55 cases of solitary pulmonary nodules (SPN; ≤30 mm)suspected early peripheral lung cancer.

METHODSThe sputum specimens from 34 cases of cancer nodules and 21 cases of benign lesion were detected for telomerase activity by TRAP-PCR-ELISA and p16 gene methylation by PCR-based methylation analysis.

RESULTSThe qualitative diagnostic accuracy of CT scan was 61.8%(34/55) for SPN provided by pathology. Cytology analysis of sputum was positive in 13 cases (38.2%). Telomerase activity was positive in 29 cases: sensitivity was 79.4%, specificity was 90.5%, accuracy was 83.6%; p16 gene methylation was found in 11 cases: sensitivity was 32.4%, specificity was 100.0%, and accuracy was 58.2%. The sensitivity was increased to 86.1% by combination of telomerase activity and p16 gene methylation. Compared with nodules without malignant CT signs, expression of telomerase activity and p16 methylation of SPN with malignant CT signs (lobulation or spiculate protuberance or spicule sign) had a significant difference (P < 0.01).

CONCLUSIONSThe results suggest that chest CT scan combined with telomerase activity and p16 gene methylation detection in sputum for patients with peripheral lung cancer may enhance the diagnostic value of radiology and conventional cytology.

BACKGROUNDTo detect the micrometastases status in peripheral blood and regional lymph nodes of lung cancer patients by reverse transcription-polymerase chain reaction (RT-PCR).

METHODSCK19 mRNA expression in peripheral blood and regional lymph nodes was detected in 78 patients with lung cancer, and 30 patients with pulmonary benign lesions and 10 healthy volunteers as controls by RT-PCR. Meanwhile, all lymph nodes were also examined by traditional pathological method.

RESULTSThe positive rate of CK19 mRNA expression was 38.5% in peripheral blood of lung cancer patients, and 6.7% in patients with pulmonary benign lesions (6.7%) (Chi-square=10.505,P=0.001). No positive CK19 mRNA expression was found in peripheral blood of 10 healthy volunteers. The positive rates of CK19 mRNA of lymph nodes were 36.9% and 0 in lung cancer patients and pulmonary benign disease patients respectively (Fisher's exact=0.014). In lung cancer group, the metastatic rate of lymph nodes was 17.9% by traditional pathological examination, which was much lower than that by RT-PCR (Chi-square=7.664, P=0.006).

CONCLUSIONSRT-PCR amplification of CK19 mRNA is an sensitive method to detect early haematogenous and regional lymph nodes dissemination of cancer cells for patients with lung cancer. This method may lead to an earlier diagnosis and treatment of patients with subclinical metastasis in circulation and regional lymph nodes.

BACKGROUNDTo investigate the methylation and deletion of p16 gene and its diagnostic value in non-small cell lung cancer.

METHODSA total of 50 lung cancer tissues and 54 normal lung tissues were examined for p16 gene methylation in exon 1 and deletion in exon 2 by PCR based methylation analysis and duplex PCR respectively.

RESULTSOut of 50 lung cancer tissues, 16 were positive for the p16 gene exon 1 methylation (32.0%), and 14 for the p16 gene exon 2 deletion (28.0%). However, in 54 cases of normal lung tissues, only 2 showed the p16 gene exon 1 methylation(3.7%), and none showed the p16 gene exon 2 deletion. There were significant differences in methylation rate (Fisher's exact= 0.000 ) and deletion rate (Fisher's exact= 0.000) between the two groups.

CONCLUSIONSThe methylation and deletion may be important mechanisms for p16 gene inactivation in non-small cell lung cancer. The detection of p16 gene status may contribute to the diagnosis of lung cancer.

Objective: To propose a classification method and explore the indications and technical tips of the pedicled deep inferior epigastric artery perforator (DIEAP) flap. Methods: From July 2005 to December 2017, 18 patients underwent soft-tissue defect repairment using the pedicled DIEAP flap. The defect locations included abdomen (n=6), iliolumbar region (n=2), perineum (n=4), and proximal thigh (n=6). The flaps were divided into two types. The type Ⅰ flap were further subdivided into two subtypes. The type Ⅰa flap was solely based on the DIEAP. The type Ⅰb flap was also based on the DIEAP, however, the main trunk of the deep inferior epigastric vessels needs to be divided to further improve the pedicle length. The type Ⅱ flap was the traditional pedicled DIEAP flap. Results: Twenty flaps were included in this series. The mean flap size and pedicle length of the 4 flaps in type Ⅰa were 19.0 cm× 6.5 cm and 2.88 cm respectively. The rotation angles were 60 degrees (n=1), 120 degrees (n=1), and 180 degrees (n=2). The 3 flaps of type Ⅰb was 26 cm × 6 cm, 20 cm × 5 cm and 24 cm × 7 cm in size, and the pedicle lengths of them were 6 cm, 7 cm and 7 cm, respectively. All flaps in this subtype were rotated by 180 degrees. The mean flap size and pedicle length of the 13 type Ⅱ flaps were 21.46 cm × 9.38 cm and 11.08 cm. 17 flaps completely survived postoperatively. Small-sized necrosis of the distal portion of the flap occurred in 3 flaps. All patients were followed up for 6 months to 5 years, with the averaged 11 months follow-up time. All patients were satisfied with the final outcomes. Tumor recurrence was not noticed for the oncological patients. Conclusions The pedicled DIEAP flap has remarkable versatility in the defect repairment for the regions including abdomen, iliolumbar region, proximal thigh, and perineal region. Combining with the " propeller flap" concept, the clinical application of pedicled DIEAP flap could be further expanded. The pedicled DIEAP flap is a reliable reconstructive method for defect repairment in abdominal and iliolumbar regions.

Tertiary lymphoid structures (TLSs) is important channel for tumor immune cell infiltration. The existence of tumor TLSs is not only related to the prognosis of patients, but also to the efficacy of a variety of anti-tumor therapies. To explore the function and immunomodulatory mechanism of TLSs and its potential value as a tumor prognostic biomarker in comprehensive anti-tumor therapy will provide new ideas for follow-up research.

OBJECTIVE： To explore the current situation of service ability and pharmaceutical service construction of primary healthcare institutions in Jiangsu province. METHODS： Questionnaire survey was conducted among primary healthcare institutions of 13 prefecture level cities in Jiangsu province， involving basic service information （such as serving mode， medical departments）， resource allocation （such as hardware， human resource） and pharmaceutical care construction （such as the leaders of the drug procurement， pharmaceutical departments allocation， mediation safety management）. The current situation of service ability and pharmaceutical service construction was evaluated in primary healthcare institutions of Jiangsu province. RESULTS： A total of 579 primary healthcare institutions in Jiangsu province were investigated and 579 questionnaires were collected （some items in the questionnaires were not answered）. Outpatient service （543/555，97.8％） was the main mode of service provided by primary healthcare institutions in Jiangsu province， followed by emergency call （321/555，57.8％） and hospitalization （292/555，52.6％）； the frequently established department in primary healthcare institutions was the medical department for all （452/568，79.6％）， preventive healthcare department（401/568，70.6％）， internal medicine department （365/568，64.3％）； 16.1％ （93/533）of the primary healthcare institutions had no beds； 36.4％ （211/579）of the institutions had no chief physician； 20.9％ （111/532）of the primary healthcare institutions medicine procurement were managed by pharmacists； 42.5％ （212/499）of the institutions had no pharmaceutical departments； physicians were responsible for patients' medication safety in 43.9％ （236/537） of the primary healthcare institutions and pharmacists were responsible for patients' medication safety in only 16.2％ （87/537）of the institutions. CONCLUSIONS： Primary healthcare institutions in Jiangsu province have made some achievements in service capability building. Human resources， equipment and facilities， pharmaceutical care construction and other aspects still need to be improved.

OBJECTIVE：To provide reference for improving the level of pediatric pharmacoeconomic research in China. METHODS： Using “Pediatric”“Pharmacoeconomics”“Cost-effectiveness”“Cost-utility”“Cost-benefit”“Minimum cost ” as keywords，pediatric pharmacoeconomic research literatures published during Jan. 2009 to Dec. 2018 were retrieved from CNKI ， Wanfang，VIP and CBMdisc. The Pediatric Quality Appraisal Questionnaire was used to evaluate the quality of the literatures. The problems of these literatures were analyzed to put forward the suggestions. RESULTS & CONCLUSIONS ：Totally 140 literatures were eventually included. The number of published literatures was increasing and the distrubtion of journals was scattered. The first auther was mainly from medical institutions. Included literatures mainly involved respiratory disease and drug treatment ，etc. Among them ，15 literatures indicated the research angle ；research time limit of 109 literatures was equal to or less than one year ；6 literatures carried out sensitivity analysis. Most of them adopted cost-effectiveness analysis and decision analysis model. The results of quality evaluation showed that the economic evaluation ，camparators，target population ，outcomes，analysis and conclusions domains had high scores （0.62 to 1.00 score），time horizon and discounting domains had middle scroes （0.49 and 0.53 score respectively），but perspective ，costs and resource use ，incremental analysis ，sensitivity analysis and conflict of intrest domains had low scores （0.10 to 0.31 score）. The main problems of pediatric pharmacoeconomic literatures in China focused on selection of research perspective ，measurement of costs and clinical outcomes ，and selection of analytical methods. The quality of pediatric pharmacoeconomic evaluations in China need to improve. It is suggested to supplement the content of pediatric pharmacoeconomics in China Guidelines for Pharmacoeconomic Evaluations . It is also suggested for pediatric pharmacoeconomic evaluations to clarify the perspective ，standardize the cost identification ，reasonably select health outcome indicators and correctly apply analysis method in order to improve the quality.

Objective:To explore the risk factors involved in gastritis, gastric intraepithelial neoplasia (GIN) and gastric cancer in Shihezi area.Methods:A total of 7 110 Han nationality patients who underwent gastroscopy at the First Affiliated Hospital of Shihezi University School of Medicine from January 2012 to December 2016 were selected as the research subjects. The data of patients were obtained through medical records and questionnaires. After excluding diseases related to esophagus and duodenum, a total of 4 429 cases were included in the retrospective analysis. Of which, 4 249 were gastritis, 93 were GIN, and 87 were gastric cancer. χ2 test, rank-sum test or Fisher exact probability method were used to analyze the differences of various factors in gastritis, GIN and gastric cancer. Univariate and multivariate logistic regression analysis were used to screen the risk factors for gastritis progression to GIN and gastric cancer. Results:χ2 test and rank sum test showed that there were statistically significant differences in gender, age, history of digestive diseases and distribution of Helicobacter pylori ( HP) infection among the groups of gastritis, GIN and gastric cancer ( P<0.05). The proportion of HP infection decreased gradually with the disease severity. Multivariate logistic regression analysis showed that male ( P<0.001, OR=2.251, 95% CI: 1.461-3.470), elderly ( P<0.001, OR=4.829, 95% CI: 2.241-10.409), a family history of gastric cancer ( P=0.002, OR=3.227, 95% CI: 1.537-6.774) and a history of digestive diseases ( P=0.034, OR=1.644, 95% CI: 1.037-2.607) were independent risk factors for gastritis progression to GIN. Male ( P<0.001, OR=3.254, 95% CI: 2.026-5.225), middle-aged ( P=0.022, OR=2.688, 95% CI: 1.153-6.265) and elderly ( P=0.002, OR=4.734, 95% CI: 1.750-12.807) were independent risk factors for gastritis progression to gastric cancer. In stratified analysis to exclude age and gender, smoking ( P=0.028, OR=4.060, 95% CI: 1.160-14.202) was found to be a risk factor for gastritis progression to GIN in young adults, and obesity ( P=0.032, OR=3.869, 95% CI: 1.121-13.356) was found to be a risk factor for gastritis progression to gastric cancer in women. Conclusion:The degree of HP infection in gastric tissues is negatively correlated with the severity of gastric diseases, suggesting that HP infection may be an early event inducing gastric cancer. Male, the elderly, people with a family history of gastric cancer and a history of digestive diseases, and young smokers in Shihezi are more likely to develop GIN, and male, middle-aged, elderly, and obese women are at increased risk of gastric cancer.

Objective: To identify problems and demands for antenatal care (ANC) among pregnant women in different trimesters of pregnancy in Shanghai for optimizing ANC service during the epidemic of coronavirus disease 2019 (COVID-19). Methods: Organized by Maternal and Child Health Care institute in the 16 districts of Shanghai, a cross sectional study was conducted among pregnant women who came to pregnancy registration in the community health centers or attended ANC in maternity hospitals from February 7 to February 12, 2020. Consented participating women completed a semi-structured online questionnaire voluntarily. Data was analyzed using frequency and scoring, chi-square test. Results: A total of 2 002 valid questionnaires were collected from 183 community health centers and 67 midwifery hospitals. About 94.6% of the pregnant women worried about being infected during the COVID-19 epidemic, and 14.7% demanded for psychological consultation. Appointment ANC services were requested by 87.7% of the participants for avoiding presenting themselves in people-density places. Compared with other pregnancy trimesters, pregnant women in the second trimester were more willing to reduce the frequency of ANC (48.1% VS. 39.5% VS. 35.2%, P<0.01). Compared with multiparas, primiparas were more willing to have online consultation and guidance (63.8% VS. 49.2%, P<0.01). Regarding the needs for health knowledge on COVID-19, personal protection against 2019-nCoV was the most concerned for pregnant women, and 71.0% of them preferred to obtain knowledge through health applications, official Weibo and WeChat. Conclusions Pregnant women in Shanghai critically concern about the risk of 2019-nCoV infections, and highly demand knowledge and measures on prevention and protection from COVID-19. They ask for having time-lapse appointments for ANC and online access to health information and services. Maternal and Child Care institutes should understand the demands of pregnant women, optimize the means of ANC service, and provide tailored and accessible health education and service for the safety of mother and child.