The auther Sum up clinical experience of hospice care and put forward. problem on Hospicecare.

Gastroenteropancreatic neuroendocrine neoplasms are a group of heterogeneous tumors originated from the gastrointestinal peptidergic neurons and neuroendocrine cells.Rectum is one of the major sites of gastroenteropancreatic neuroendocrine neoplasms.Although the progression of rectal neuroendocine neoplasms (rNENs) is relatively slow,metastasis could occurs and liver is the major target organ invaded by distant metastatic rNENs.Surgical operation can be used as the preferred method for the treatment of rNENs and its metastasis at present.If the clinical situations of tumors are not eligible for the operation,interventional treatment can be considered as an alternative treatment.The chemotherapies and molecule-targeted drugs for rNENs are primarily in the light of therapeutic methods for pancreatic neuroendocrine neoplasms,it may help patients achieve partial response or stable disease,and prolong patients survival time.However,there has been few clinical researches directed toward rNENs and no an extensive consensus for treatment of rNENs up to now,and more evidences of evidence-based medicine should be necessitated.This paper has discussed and summarized treatment progression of rNENs and its metastasis.

Objective To analyze the concentration of heavy metal elements, C, N and H in PM2.5 in the atmosphere in Hangzhou. Methods Midflow samplers were used to collect the samples in Hangzhou city, the element analyzer and microwave digestion ICP-MS were applied to test the samples. Results The average concentrations of N, C, H were 13.9-14.7, 30.3-30.8 and 7.9-8.9 ?g/m3 respectively in the central and northern east areas. The average mass percent values for the three elements(N、C、H) in the city were 12.8%, 27.8% and 8.1% respectively. The average ratios of total inorganic nitrogen to total organic nitrogen (IN/ON) and total organic hydrogen to total inorganic hydrogen (OH/IH) varied in the range of 2.2-3.5 and 3.5-3.6. Eleven elements showed a higher concentration in PM2.5, in which the values of Zn, Pb, Cu and Mn were all more than 200-11 500 mg/kg and the values of Cr, Ni, Se, Mo, Cd and Sb were 17-108 mg/kg, and that was only 6-8 mg/kg for Ag. The levels of average mass percent of all the metal elements were 1.7%-2.0%. Conclusion Carbon is one of important components in PM2.5 in Hangzhou. N and H exist mainly in the form of inorganic and organic compounds respectively. Zn, Pb, Cu, Mn are major heavy metal elements in PM2.5.

Studies were made on the effect of protoporphyrin in treating the acute liver injury induced by carbon tetrachloride ( CCl4 ) in rabbits and on the liver blood flow, biosynthesis of DNA and protein in liver of mice. The results showed that the protoporphy-rin was able to protect the liver remarkable as evidenced by his-tological studies. And it could inhibit the elevation of serum glut-amic-pyruvic transaminase ( SGPT ) , serum glutamic - oxaloacetic transaminase ( SGOT ) and serum ?-glutamyl- transpeptidase ( S?- GT)also. Protoporphyrin could regulate the metabolism of serum amino -acids in rabbits intoxicated by CCl4 as well. Furthermore,protoporphyrin can improve biosynthesis of DNA and liver protein and it may increase the blood flow in the liver of the mice.

In this study, a novel polyurethane membrane, modified by superfine silk-fibroin powder, was prepared for small-diameter vascular grafting. Scanning electron microscopy, transmission electron microscopy, and histological examination were applied to evaluate histocompatibility of this polyurethane membrane. The polyurethane membrane was compared with polytetrafluoroethylene material. A pseudomembrane and gap formed between polytetrafluoroethylene and the surrounding tissues, and no cells infiltrated or grew into the polytetrafluoroethylene material. On the contrary, superfine silk-fibroin powder/polyurethane blend membrane merged tightly with the surrounding tissues without gaps, and cells infiltrated and grew into the material. Moreover, the negative effects of superfine silk-fibroin powder/polyurethane blend membrane on cells were less than those of its polytetrafluoroethylene counterpart. Our findings indicated that the superfine silk-fibroin powder/polyurethane blend membrane has better histocompatibility than polytetrafluoroethylene membrane. It is concluded that the superfine silk-fibroin powder/polyurethane blend membrane is a promising biomaterial for small-diameter prosthesis.

Objective:To predict the basic physicochemical properties ,structure and function ,and linear B-cell epitopes of the capsid protein VP1 of coxsackievirus A6(CVA6).Methods: The amino acid sequence of the CVA6 VP1 was analyzed using Bioedit software and various online tools including SubLoc ,TargetP and the others from ExPASy Bioinformatics Resource Portal.Results: The CVA6 VP1 protein was a hydrophilic protein with a relative molecular weight of 33.6 kD and an isoelectric point of 7.92.This protein containsed 24 phosphorylation sites , but no signal peptide , transmembrane domains and possible fatty acylation sites.Its secondary structure was characterized by the richest random coils , and 48.52 percent of its amino acid residues exposed at the solution inter-face.Epitope prediction by Bepipred showed a number of potential B cell epitopes in the protein ,the highest antigenicity index among them located in the region of amino acids residue 155-165.Conclusion:The basic physicochemical properties ,structure and function characteristics ,and potential linear B-cell epitopes of CVA 6 VP1 were successfully predicted , which laid foundations for the further study on the protein and the preparation of vaccines and immunological diagnostic reagents for CVA 6 infection.

Objective To study the comprehensive hospital patients with psychological health department liaison consultation characteristics of the factors to cause delirium.Methods General hospital in 102 patients of psychological health department liaison consultation,this paper analyzed the factors which cause delirium.Results 102 cases(63 males and 39 females),the sex ratio was 1 :0.62;Men's and women's average age had no statistical difference(t =1.866,P =0.087 ).Age or age:70 ~ 79years,80 ~ 89 years of age to delirium patients were 39.26%,30.39% respectively.Delirium distribution respectively the main cause of the central nervous system disease,acute vascular disease,infection,disorder of digestion and absorption,anemia,endocrine metabolic disorders, acute metabolic disorders,trauma,surgery,spirit of active substances and non addictive drugs,etc.;Cause delirium in first place of the central nervous system disease,the etiology of acute vascular disease and infection of 29 cases respec-tively(28.43%),11 cases(10.78%),16 cases(15.69%).Additional surgery,spirit of active substances and non addictive drugs were 11 cases(10.78%),13 cases(12.75%),2 cases(1.96%).Many kinds of disease:102 patients with each with 1 ~7 kinds of diseases,the average (4.09 ±1.56)kinds.Share of drug species:102 patients in each oral 0 ~8 kinds of drugs,to average (5.86 ±1.52)kinds.Conclusion Comprehensive hospital patients with age or age group,the main factors to cause delirium etiology,patients with various diseases and share related species of drugs,disease complex,such as strengthening contact consultation for clinical sense.

Objective To evaluate the effect about medication compliance for patients with chronic heart failure in outpatients using nursing intervention model based on Omaha system.Methods 100 patients were randomly divided into observation group(50 patients)and control group(50 patients).The two groups of patients were given routine nursing intervention,the observation group also used the Omaha system to develop care programs on this basis, and was given the implementation about continuity of care.Results On the point of the two or three months after the patients were discharged,the AHFKT -V2 questionnaire scores in the observation group[(17.690 ±1.892)points, (20.900 ±2.052)points]were significantly higher than the control group[(14.080 ±2.374)points,(18.450 ± 1.781)points],the differences were statistically significant (t =-8.488,-6.442,all P <0.05).However,the same as the points after the patients were discharged,Morisky questionnaire scores in the observation group[(1.036 ± 0.780)points,(0.487 ±0.260)points]were significantly lower than the control group[(1.54 ±1.182)points, (0.920 ±0.804)points],the differences were statistically significant(t =3.420,4.965,all P <0.05).Conclusion The use of Omaha system to develop the targeted continuity of care,can improve the patients medication compliance.

The investigation on the chemical constituents of Anabasis aphylla L. was carried out by using various chromatographies, such as silica gel, Sephadex LH-20 and RP-C18 column chromatography. Further detailed investigation on the fraction of the ethanol extract of Anabasis aphylla L. yielded one new compound p-acetyl-phenol 1-O-beta-D-xylopyranosyl-(1-->2)-beta-D-glucopyranoside (1), together with five known compounds: piceine (2), isorhamnetin (3), quercetin (4), rutin (5) and isorhamnetin-3-rutinoside (6). Their structures were elucidated by spectral analysis such as NMR and MS. Among these compounds, compounds 2-6 were isolated from this plant for the first time.

Objective To screen and identify the predominant T-and B-cell ( T-B) combined an-tigenic epitopes on the outer membrane protein Loa22 of pathogenic Leptospira interrogans ( L.interrogans) stains and to further analyze their immunogenicity.Methods PCR analysis was used to detect loa22 gene in L.interrogans strains belonging to eight different serogroups or serovars prevalent in China.The PCR prod-ucts were sequenced after T-A cloning.A prokaryotic expression system for loa22 gene of L.interrogans sero-group Icterohaemorrhagiae serovar Lai strain Lai was constructed.The expressed recombinant protein rLoa22 was extracted by Ni-NTA affinity chromatography.The rabbit anti-rLoa22 serum samples and IgG were pre-pared.The T-B combined antigenic epitopes on Loa22 protein were predicted by using professional bioinfor-matic softwares.Phage display in combination with Western blot assay and ELISA were performed to identify the immunogenicity of the recombinant phage PⅢ protein-displayed and artificially-synthesized T-B com-bined antigenic epitopes, respectively.MTS assay and ELISA were performed to detect the activation of T cells and the expression of IL-2, IL-4 and IFN-γinduced by T-B combined antigenic epitopes, respectively. Results All of the tested pathogenic Leptospira strains were positive for loa22 gene, sharing 85.5%-99.8%homologies in nucleotide sequences and 93.9%-99.5%homologies in amino acid sequences.The construc-ted prokaryotic expression system for loa22 gene efficiently expressed the rLoa22 protein.Among four T-B combined antigenic epitopes (Loa22-77, Loa22-90, Loa22-125 and Loa22-157), only Loa22-90 epitope presented a strong positive band in Western blot analysis.The proliferation of CD4+T cells and the expres-sion of IL-2 ( Th1 ) and IL-4 ( Th2 ) were significantly enhanced by the stimulation with Loa22-90 epitope peptide (P<0.05).Conclusion Loa22 protein is a sequence-conserved genus-specific outer membrane protein of L.interrogans.The Loa22-90 epitope is the predominant T-B combined antigenic epitope of Loa22 protein, which might be used as a candidate antigenic epitope in the development of multiple antigenic pep-tide ( MAP) vaccines against Leptospira infection.