Objective · To understand the medical treatment willingness and place among migrant workers in Shanghai and relevant influencing factors. Methods · The questionnaire survey was used to investigate migrant workers in some areas of Shanghai and the data were analyzed with constituent ratio,χ2 test, and Logistic regression. Results · Regional differences in medical treatment willingness and place existed between migrant workers in surveyed areas and local workers. Differences between actual and intended medical treatment places existed among migrant workers. Main factors influencing the medical care seeking behavior of migrant workers were medical insurance, economic factors, and demographic factors. Conclusion · The medical security system and the accessibility of basic medical services for migrant workers should be further improved.

Background:Colonoscopy is considered as a standard method for detecting various kinds of colorectal polyps. However,conventional colonoscopy( CC)still has the chance to miss some lesions. Literatures have already reported that transparent hood assisted colonoscopy( THAC)can improve the detection of colorectal polyps. However,the effect of black hood assisted colonoscopy( BHAC)on detection of colorectal polyps is still unclear. Aims:To evaluate the effect of BHAC on detection of colorectal polyps. Methods:A total of 1 076 patients underwent CC and BHAC from Sept. 2014 to April 2015 at Huadong Hospital Affiliated to Fudan University were enrolled in this prospective randomized controlled study. Baseline characteristics,cecal intubation time,withdrawal time,number of polyps,detection rate of polyps,location, size,morphology and pathological diagnosis of polyps between two groups were compared. Results:Compared with CC group,cecal intubation time was significantly shorter in BHAC group than in CC group[(6. 31 ± 3. 51)min vs.(7. 05 ± 4. 15)min,P=0. 002]. No significant differences in withdrawal time and rate of cecal intubation were found between two groups(P>0. 05). Detection rate of polyps was significantly higher in BHAC group than in CC group(65. 4% vs. 48. 7%,P=0. 004). No significant differences in size,morphology of polyps were found between two groups(P>0. 05). Conclusions:Compared with CC,BHAC could significantly improve the detection of colorectal polyps,and shorten cecal intubation time.

Objective To determine risk factors for the miss rate of colorectal adenomas during colonoscopy.Methods A total of 981 patients,diagnosed as having at least one polyp in colonoscopy,received a second colonoscopy in 6 months from November 2012 to March 2016.All polyps were removed in the second colonoscopy.Bio-information of patients such as sex,age,surveillance interval and features of polyps such as number,size,shape,location,pathology,withdrawal time,bowel preparation was retrospectively analyzed.Factors associated with the miss rates in these patients were analyzed with Chisquare and was also analyzed with Logistic regression model for multiple factors.Results A total of 981 patients were selected according to the inclusion and exclusion criteria,including 604 males and 377 females.Miss rates of males and females were 38.9％ (235/604) and 27.9％ (105/377) (P＜0.01)respectively.Age ranged from 25 to 87 years with mean age being 61.0±9.7 years.Miss rates of senior patients ＜65 and ≥65 years were 31.5％(195/619) and 40.1％(145/362) respectively (P＜0.01).A total of 1 728 adenomas were found in first colonoscopy.A total of 2 267 adenomas were found in the second colonoscopy.The adenoma miss rate was 23.8％ (539/2 267).The miss rate of adenoma whose size ≤ 5 mm was 42.5％ (311/732);and that of larger size of 6 to 9 mm was 17.8％ (194/1 090);that of even larger size,i.e.,≥10 mm,was 7.6％(34/445)(P＜0.01).Miss rates of Is,Isp,Ip,LST and Ⅱ adenomas in shape were 28.4％(489/1 720),9.3％(24/235),6.6％ (12/182),9.0％(6/67) 20.5％ (8/39) respectively (P＞0.05).Location with highest adenoma miss rate were descending colon,ascending colon and transverse colon,27.8％(64/230),25.5％(120/470),25.5％ (161/632) respectively.Miss rates of high and low risk adenoma were 44.8％ (277/618) and 17.4％ (63/363) (P＜0.01).The highest adenoma miss rate of all the pathology type was tubular adenoma.The adenoma miss rate was 26.9％ (449/1 671) (P＜0.01).Miss rates of good and poor bowel preparation were 30.2％ (271/897) and 82.1％ (69/84) (P＜0.01).Miss rates of adequate and inadequate withdrawal time were 24.3％ (174/717) and 62.9％ (166/264) (P＜0.01).Conclusion Male,old-age,diameter ≤ 5 mm,poor bowel preparation and inadequate withdrawal time,high risk adenoma are the risk factors for missed adenoma.But the shape and location of adenoma are not the risk factors.

Objective: To compare the efficacy of endoscopic treatment with surgical treatment for early gastric cancer accorded with expanded indications of endoscopic submucosal dissection (ESD). Methods: A total of 165 patients (167 lesions) with early gastric cancer underwent ESD (ESD group, 77 cases) or surgery (surgery group, 88 cases) from January 2011 to December 2016. The lesions fulfilled expanded indications of ESD, and were pathologically identified as differentiated or undifferentiated adenocarcinoma. Chi-square test, continuity-adjusted Chi square test, and Fisher exact test were used to analyze the incidence of lesion residual, local recurrence, metachronous recurrence, short-term complications and long-term complications. The 3-year overall survival rate and 3-year disease-free survival rate of the two groups were analyzed by Kaplan-Meier method. Results: There were no differences on the incidence of lesion residual (P=0.473), local recurrence (P=1.000) and metachronous recurrence (P=1.000) between the ESD group and the surgery group. The 3-year overall survival rate (100.0% VS 98.3%, P=0.343) and the 3-year disease-free survival rate (98.1% VS 96.7%, P=0.655) were not significantly different between the two groups. There was no significant difference on the incidence of short-term complications between the two groups [7.8% (6/77) VS 5.7% (5/88), χ²=0.294, P=0.588]. The incidence of long-term complications in the ESD group was lower than that in the surgery group [0 (0/77) VS 8.0% (7/88), continuity-adjusted χ²=4.588, P=0.032]. Conclusion For patients with early gastric cancer fulfilled expanded indications of ESD, ESD has a lower incidence of long-term complications with similar efficacy compared to surgery.

Objective To evaluate the value of near focus narrow-band imaging ( NF-NBI ) in differentiating hyperplastic polyp ( HP ) and sessile serrated adenomas/polyp ( SSA/P ) . Methods Data of 65 cases of pathologically confirmed HP or SSA/P with clear NF-NBI images in Huadong Hospital Affiliated to Fudan University from October 2017 to September 2018 were retrospectively analyzed. Three senior doctors observed the images of NF-NBI, including expanded crypt opening ( ECO ) and thick & branched vessel ( TBV) . The results were compared with pathological results in order to analyze differential diagnostic value of ECO and TBV for HP and SSA/P. Results Among 65 lesions, 44 were SSA/P and 21 were HP. The sensitivity, specificity, and accuracy of ECO, TBV, and ECO combined with TBV for differential diagnosis between HP and SSA/P were 80. 3％( 106/132 ) , 85. 7％( 54/63 ) and 82. 1％( 160/195 ); 38. 6％( 51/132) , 82. 5％( 52/63 ) , and 52. 8％( 103/195 ); and 84. 8％( 112/132 ) , 73. 0％( 46/63 ) , and 81. 0％(158/195), respectively. Conclusion ECO under NF-NBI has a high sensitivity for diagnosis of SSA/P . ECO combined with TBV is helpful for differential diagnosis between HP and SSA/P .

Objective To observe the restoration of structure and function of auto-transplanted lymph nodes.Methods Inguinal lymph nodes in Spregue-Dawley (SD) rats were auto-transplanted by free implantation, or with an intact vascular pedicle, or by free transplantation with microvascular anastomosis, to the popliteal fossa where lymph nodes were removed. The observation methods included emission computerized tomographic (ECT) scanning, staining of China ink and methylthionine chloride to observe the histological changes.Results After four weeks, these vascularized nodes showed normal histological appearances and spontaneously reestablished afferent and efferent lymphatic reconnection with the surrounding lymphatic vessels. ECT lymphoscintigraphy with 99mTc-Dx showed that vascularized lymph nodes had restored their normal function.Conclusion Vascularized lymph node transplantation is a useful method for draining extremity lymph edema.

Objective To observe the influence of chemotherapy on the changes of tumor markers levels in patients with advanced lung cancer.Methods A total of 75 patients with advanced lung cancer were selected amd treated with the combination of two drugs based on platinum.The therapeutic effect was judged by the changes of solid tumor according to medical image.The levels of tumor markers before and after the treatment were tested by chemiluminescence immunoassay,and tumor markers including cancer embryonic antigen(CEA),neuron specific enolase(NSE),carbohydrate antigen 125(CA125),cytokeratin(CYFRA211),squamous cell cancer antigen(SCC).Results The levels of tumor markers were significantly lower after the treatment than those before the treatment(P<0.05).The decreased level of patients with CR and PR were significantly lower than those with SD and PD(P<0.05).There was significant difference in the changes of tumor markers levels before and after treatment between the patients with different tumor types.Conclusion Effective chemotherapy can significantly decrease the levels of tumor markers in patients with advanced lung cancer.

Objective To observe the influence of chemotherapy on the changes of tumor markers levels in patients with advanced lung cancer.Methods A total of 75 patients with advanced lung cancer were selected amd treated with the combination of two drugs based on platinum.The therapeutic effect was judged by the changes of solid tumor according to medical image.The levels of tumor markers before and after the treatment were tested by chemiluminescence immunoassay,and tumor markers including cancer embryonic antigen(CEA),neuron specific enolase(NSE),carbohydrate antigen 125(CA125),cytokeratin(CYFRA211),squamous cell cancer antigen(SCC).Results The levels of tumor markers were significantly lower after the treatment than those before the treatment(P<0.05).The decreased level of patients with CR and PR were significantly lower than those with SD and PD(P<0.05).There was significant difference in the changes of tumor markers levels before and after treatment between the patients with different tumor types.Conclusion Effective chemotherapy can significantly decrease the levels of tumor markers in patients with advanced lung cancer.

Objective:To analyze the predictive value of P504S for pathological upgrading of gastric low-grade intraepithelial neoplasia (LGIN) after endoscopic submucosal dissection (ESD).Methods:Data of 117 patients (119 lesions) who underwent ESD for LGIN at Huadong Hospital from January 2015 to March 2019 were analyzed retrospectively. Biopsy and ESD specimens were collected. According to pathology, specimens were divided into the LGIN group (postoperative pathology of non-upgrade) and the upgrade group (postoperative pathology of upgrade). The positive rates of P504S were compared between biopsy and postoperative specimens of the LGIN group, and between biopsy and postoperative specimens of the upgrade group. The consistency of the expression of P504S was examined between the biopsy specimens and the postoperative specimens in the LGIN group and the upgrade group. Receiver operator characteristic (ROC) curve of the prediction of pathological upgrading was drawn by the results of P504S in biopsy, and the cutoff value of immunohistochemical staining score was calculated.Results:The positive rate of P504S in the biopsy specimens of the LGIN group (46.8%, 36/77) was lower than that in the biopsy specimens of the upgrade group (73.2%, 30/41) with significant difference ( P=0.006). The positive rate of P504S in the postoperative specimens of the LGIN group (51.9%, 40/77) was lower than that in the postoperative specimens of the upgrade group (82.9%, 34/41) with significant difference ( P=0.001). In the LGIN group, the positive rate of P504S in biopsy specimens (46.8%, 36/77) was lower than that in postoperative specimens (51.9%, 40/77) without significant difference ( P=0.289). The expression of P504S was consistent between biopsy specimens and postoperative specimens with good consistency( K=0.793, P<0.001). In the upgrade group, the positive rate of P504S in biopsy specimens (73.2%, 30/41) was lower than that in the postoperative specimens (82.9%, 34/41) without significant difference ( P=0.219). The expression of P504S was consistent between biopsy and postoperative specimens, and the consistency was general ( K=0.579, P<0.001). ROC curve was drawn for the prediction of pathological upgrading by the results of P504S in biopsy, and the cutoff value of immunohistochemical staining score was 100. The sensitivity and specificity of pathological upgrading for positive result were 0.659 and 0.740, respectively. Conclusion:P504S staining of the postoperative specimens facilitates identification of the degree of gastric mucosal neoplasia. When the cutoff value of staining score is 100, the staining of P504S in biopsy tissue plays a role in predicting the pathological upgrading.

Objective : To analyze the status and influencing factors of the intention of people aged 18 to 25 years to primary medical institutions and their satisfaction for health services in Zhejiang Province, so as to provide basis for the improvement of health services in primary medical institutions. Methods: During November and December in 2019,the 18-25 year-old people in Zhejiang Province were recruited to investigate the general information, intention to seek medical advice and satisfaction for health services in primary medical institutions through WeChat. Logistic regression was performed to analyze the influencing factors of the intention and the satisfaction. Importance matrix was used to analyze the key drivers of the satisfaction. Results: Among the 620 people surveyed, with a response rate of 93.37%, 142 (22.90%) chose primary medical institutions for advice. Actually 516 (83.23%) people went to primary medical institutions last year, and 384 ( 74.42% ) of them were satisfied with the health services. The results of multivariate logistic regression analysis showed that the people aged 18-25 years who were under the new rural cooperative medical care system ( OR=3.062, 95%CI: 1.745-5.373 ) and who had records in community health centers ( OR=0.547, 95%CI: 0.308-0.970 ) were more likely to go to primary medical institutions for medical advice; the ability of doctors ( OR=1.478, 95%CI:1.168-1.871 ) ,the drug notification by medical staff ( OR=1.308, 95%CI: 1.065-1.606 ) , routine examination items ( OR=1.523, 95%CI: 1.227-1.889 ) , the ways of payment ( OR=1.168, 95%CI: 1.017-1.340 ) , the comfort of environment ( OR=1.785, 95%CI: 1.437-2.219 ) and the bulletin boards of health knowledge ( OR=1.302, 95%CI: 1.086-1.561 ) were associated with the satisfaction. The results of importance matrix analysis showed that the ability of doctors and routine examination items were the priorities to improve, followed by the drug notification by medical staff; the comfort of environment had competitive advantages; the ways of payment and the bulletin boards of health knowledge needed to be further analyzed. Conclusions The 18-25-year-old people in Zhejiang Province were less intended to seek medical advice in primary medical institutions, which was associated with the type of medical insurance and records in community health centers. They were satisfied with the health services, the ability of doctors and routine examination items were the key drivers.