Objective To discuss the application effect of peer support education in improving theself-management ability of old patients with diabetes. Methods A total of 160 cases of old patients with type 2 diabetes who were treated and hospitalized from June 2014 to August 2015 were selected, then equally divided into observation group and control group through using random number method.Finally, 76 cases were studiedin observation group, while 75 cases in control group. The health education guidance of conventional diabetes had been used in two groups for six months, and the peer support education was also conducted for the patients in observation group on the basis of conventional education. The self-management ability, insulin standard injection knowledge-belief and attitude-behavior/practice (KAP) and glycosylated hemoglobin (HbA1c) value of old patients with diabetes were observed before intervention, 3 months and 6 months later, respectively. Also,the hypoglycemia frequency in two groups was compared during intervention. Results After three months of intervention, the score of diet, exercise management, glucose monitoring, foot care, pharmaceutical administration and smoke for self-management ability in observation group was 4.63 ± 0.92, 4.18 ± 0.97, 2.86 ± 0.96, 2.35 ± 0.59, 4.01 ± 1.43 and 0.62 ± 0.29, respectively, while that of these indicators in control group was 3.69 ± 0.83, 3.52 ± 0.67, 1.75 ± 0.67, 1.63 ± 0.72, 3.05 ± 1.39 and 0.59 ± 0.38. Except smoke (P > 0.05), the differences between two groups were statistically significant (t=2.987-5.965, P < 0.05). After six months of intervention, the score of diet, exercise management, glucose monitoring, foot care, pharmaceutical administration and smoke for self-management ability in observation group was 5.86±0.93, 5.37±0.61, 3.97±0.94, 5.06±0.92, 5.81±0.73 and 0.89 ± 0.31, respectively, while that of these indicators in control group was 3.68 ± 0.96, 3.65 ± 0.95, 1.86 ± 0.88, 2.65±0.88, 3.21±1.13 and 0.81±0.39. The difference was statistically significant (t=9.336-15.633, P<0.01), except smoke (P>0.05). Then, the insulin was normally injected in observation group after six months of intervention, the score of knowledge, attitude and behavior was 5.63 ± 1.87, 43.17 ± 6.03 and 16.57 ± 1.59, while that in control group was 3.76 ± 0.83, 23.71 ± 0.59 and 10.16 ± 0.95. The differences between two groups were statistically significant (t= 8.569, 15.623, 6.751, P<0.01). Also, the level of glycosylated hemoglobin was decreased from (8.17 ± 0.32) % to (7.16 ± 0.41) %, and the difference was statistically significant (t=-3.560, P=0.000). Conclusions Peer support education couldenhance the self-management consciousness of old patients with diabetes, standardize the insulin injection, improve the ability of self-management and improve glucose metabolism index so that it is worthy of being clinically popularized and applied.

Objective To explore the application effect of interactive health education in insulin injections of aged patients with type 2 diabetes in the incipient stage of diagnosis and treatment. Methods 100 cases of aged patients with type 2 diabetes were hospitalized into endocrinology department from January 2014 to December 2014, the pen insulin injections were conducted for them at the beginning. They were equally divided into experimental group and control group through random number method. And, the general education guidance was conducted in control group. Meanwhile, the diabetes health education team was established in observation group on the basis of control group. Then, it was educated through the interactive lectures, interviews, teaching, repeated teaching, psychological intervention and individual assessment. Before and after education, the KAP survey of standard insulin injections were used for the patients in two groups to evaluate their degree of proficiency in the knowledge and skills about insulin injections, and the incidence of glucose metabolism level and low blood sugar. Results After intervention, the insulin injection skill in observation group was better than that of in the control group, (64.6%,31/48 vs. 24.5%, 12/149,χ2=16.441, P<0.01), while the level of glycosylated hemoglobin was reduced from (7.95±0.65)%to (6.58±0.62)%(t=7.85, P<0.01). Conclusions In the incipient stage of diagnosis and treatment, the ability of aged patients with type 2 diabetes in learning new knowledge and technology was improved through interactive health education mode. Besides, the insulin injections were standardized. Also, the glucose metabolism was improved, and the incidence of hypoglycemia was significantly reduced to ensure the patients′safety when the insulin was injected outside hospital, which was worth being clinically applied and promoted.

Objective To investigate the clinicopathological features of early gastric cancer ( EGC) with micropapillary pattern. Methods In 447 consecutive EGC patients at Changzhou No. 2 People′s Hospital admitted from January 2006 to December 2016, 8 ( 1. 8％) with micropapillary adenocarcinoma (≥5％) were enrolled in the observation group and the remaining 439 were included in the control group. Clinicopathologic features including age, gender, gross pattern, tumor location, size, invasion depth, lymphovascular invasion, lymphatic metastasis and pathological stage were analyzed and compared between the two groups. Results There were no significant differences between the two groups in age, gender, gross pattern, tumor location or size (all P>0. 05). The observation group showed significantly more frequent submucosal invasion ( 100. 0％, 8/8 ) , lymphovascular invasion ( 62. 5％, 5/8 ) , lymphatic metastasis (62. 5％, 5/8), and higher pathological stage (Ⅱ+Ⅲ 25. 0％, 2/8) compared with those in the control group, which were 52. 4％ ( 230/439 ) , 9. 1％ ( 40/439 ) , 13. 9％ ( 61/439 ) , and 5. 9％ ( 26/439 ) , respectively ( all P<0. 05 ) . Conclusion EGC with micropapillary pattern is rare with a high liability to lymphovascular invasion, lymphatic metastasis, and higher pathological stage, compared to EGC without micropapillary pattern.

Objective: To investigate the clinical pathological feature of primary pulmonary sarcomatold carcinoma and to make a further understandine of the disease. Methods: Data including clinical manifesation, pathological findings, molecular detection and immunophenotyping with pathologically confirmed primary pulmonary sarcomatold carcinoma was retrospectively analyzed. Results: 15 patients with PPSC were identified(13 men and 2 women, age ranged 56-76 years, median age 66 years). The tumor were located in the left lobus superior(8 cases), lobus inferior(6 cases), and the right lobus medius(1 case). The main clinical symptoms was cough, sputum, bloody sputum, chest pain. Among the 13 males, 10 had smoking history of more than 30 years, and 2 females had no smoking history. All cases presented with a spheroid solid lung mass. All tumor showed mild enhancement similar to that of the surrounding musculature after contrast enhancement, and inhomogeneous central low-attenuation areas were seen in 15 patients. Pathological pattern: 6 cases spindle cell carcinoma, 4 cases pleomorphic carcinoma, 2 cases giant cells carcinoma, 2 cases carcinosarcoma, 1 case pulmonary blastoma. The tumors were composed of both carcinomatous and sarcomatous elements. Immunohistochemistry showed that CK was all positive, EMA was positive in 7, VIM was positive in 10 of 15 cases.10 patients were tested for common related genes of lung cancer, 4 patients had MET14 jump mutation, EGFR L858R gene mutation occurred in 3 cases, KARS G13D gene mutation in 2 cases, and BRAF V600E mutation in 1 case. All 15 patients underwent lobectomy, 13 underwent adjuvant chemotherapy, and 6 underwent local radiotherapy. Postoperative follow-up was 8 to 50 months, 3 cases were lost, and 4 cases were survival 3 years after the surgery. Conclusion Pulmonary sarcomatold carcinoma is a rare histologic subtype of non-small cell lung cancer. Compared with other NSCLC, there is no special clinical and imageing characteristics. Its definite diagnosis relies on postoperative pathological analysis and immunohistochemical staining, and PSC needs to be diatinguished from a variely of disease. PPSC is more aggressive and poor prognosis.

OBJECTIVEThis study aims to evaluate the efficacy and safety of crizotinib for advanced ALK-positive non-small cell lung cancer (NSCLC) patients.

METHODSTwenty-eight patients with advanced ALK-positive NSCLC were given orally crizotinib 250 mg b. i.d., and were followed up to evaluate the therapeutic efficacy and safety.

RESULTSAmong the 28 patients, the objective response rate (ORR) was 71.4% (20/28) and disease control rate (DCR) was 92.9% (26/28). Three patients achieved complete response. Seventeen patients had partial response. The most common drug-related adverse events were mild flickering vision and gastrointestinal reaction. Eleven patients experienced flickering vision. Nine patients had nausea and vomiting. Eight patients had diarrhea. They were all reversible and of grade I or II. Only one patient had grade III myelosuppression. Among the 28 patients, 16 cases were disease-free and 12 cases had progressive disease, with a progression-free survival of 8.2 months.

CONCLUSIONSCrizotinib is effective and tolerable in the treatment of advanced ALK-positive NSLCC. However, its long-term treatment efficacy requires to be further studied.

Antineoplastic Agents ; adverse effects ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; enzymology ; pathology ; Diarrhea ; chemically induced ; Disease-Free Survival ; Humans ; Lung Neoplasms ; drug therapy ; enzymology ; pathology ; Nausea ; chemically induced ; Protein Kinase Inhibitors ; adverse effects ; therapeutic use ; Pyrazoles ; adverse effects ; therapeutic use ; Pyridines ; adverse effects ; therapeutic use ; Receptor Protein-Tyrosine Kinases ; Vomiting ; chemically induced

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.

Objective: To investigate the clinicopathological characteristics of cardial mixed adenoneuroendocrine carcinoma (MANEC) and analyze its prognostic factors. Methods: The retrospective and descriptive study was conducted. The clinicopathological data of 34 patients with primary cardial MANEC who were admitted to the Changzhou No.2 People′s Hospital of Nangjing Medical University from January 2008 to January 2018 were collected. There were 20 males and 14 females, aged from 39 to 81 years, with an average age of 66 years. All the 34 patients underwent resection of cardia cancer and postoperative pathological examination. Observation indicators: (1) surgery and treatment; (2) clinical manifestations and pathological conditions; (3) pathological examination of surgical resection specimens; (4) follow-up and survival; (5) analysis of prognostic factors. Follow-up using outpatient examination and telephone interview was conducted to detect the survival of patients and tumor recurrence and metastasis up to December 2018. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers or percentages. Kaplan-Merier method was used to calculate the survival time and rate and draw the survival curve, and log-rank test was used for the survival analysis. Univariate and multivariate analyses were performed using the COX proportional risk model. Results: (1) Surgery and treatment: all the patients underwent surgery successfully and postoperative systemic chemotherapy based on cisplatin + etoposide. (2) Clinical manifestations and pathological conditions: patients had epigastric discomfort, abdominal pain and abdominal distension as the first symptoms. Of 34 patients, number of males, cases with age ≥60 years, cases with esophageal involvement, cases with stable microsatellite, cases with higher CA19-9, cases with elevated cancer embryonic antigen, cases of tumor pathologic TNM stage Ⅲ-Ⅳ, cases with tumor diameter ≥5 cm, cases with vascular tumor emboli, cases with positive lymph node metastasis, cases with nerve invasion were 20, 29, 31, 28, 4, 3, 29, 30, 27, 30, 29, respectively. (3) Pathological examination of surgical excision specimens: the masses of patients were mainly ulcer-type, with the diameter of 3.0-8.4 cm. Of the 34 patients, 1 had tumor infiltrated into submucosa, 5 infiltrated into muscle layer, 18 infiltrated into serosal layer, and 10 infiltrated into extra-serous fibrous adipose tissues. Microscopy examination showed that all tumors were composed of two components including adenocarcinoma and neuroendocrine carcinoma, and the two components accounted for more than 30%. Among adenocarcinoma components of the 34 patients, 14 were poorly differentiated tubular adenocarcinoma, 6 were mucinous adenocarcinoma, 6 were moderately differentiated tubular adenocarcinoma, 5 were low-adhesion carcinoma, 1 was highly differentiated tubular adenocarcinoma, and 2 were papillary adenocarcinoma. Among the neuroendocrine carcinoma components of the 34 patients, 10 were small cell type and 24 were large cell type. Of the 34 patients, 10 had adenocarcinoma and neuroendocrine carcinoma closely adjacent but not confused, and 24 had adenocarcinoma and neuroendocrine carcinoma cross-mixed. Immunohistochemistry examination of 34 patients showed that the components of neuroendocrine carcinoma were positive for synaptophysin, pheochromoin A and nerve cell adhesion molecule. The components of adenocarcinoma were positive for broad-spectrum cytokeratin, cytokeratin 8/18 and cytokeratin 7. (4) Follow-up and survival: 34 patients were followed up for 8.0-68.0 months, with a median time of 53.7 months. The 34 patients had survived for 21-49 months, with a median time of 35 months. The 1-, 3-, 5-year survival rates were 93.31%, 53.60%, and 20.62%. (5) Ananlysis of prognostic factors: results of univariate analysis showed that CA19-9, tumor diameter, intravascular tumor thrombus, tumor pathological TNM stage, lymph node metastasis, microsatellite detection, and histological classification were the related factors affecting the prognosis of patients with cardial MANEC (risk ratio =1.724, 0.327, 1.401, 1.612, 1.542, 1.876, 0.945, 95% confidence interval: 1.226-3.467, 0.218-0.776, 1.171-4.432, 0.694-4.054, 0.987-3.776, 1.217-4.341, 0.614-2.115, P<0.05). Results of multivariate analysis showed that the tumor pathological TNM stage Ⅲ-Ⅳ, positive lymph node metastasis, stable microsatellite, neuroendocrine carcinoma as the main histological classification were independent risk factors affecting the prognosis of patients with cardial MANEC (odds ratio=1.667, 1.441, 1.306, 3.501, 95% confidence interval: 1.013-4.915, 1.035-5.746, 1.006-6.213, 2.076-8.528, P<0.05). Conclusions Cardial MANEC is composed of two components including adenocarcinoma and neuroendocrine carcinoma, and the two components account for more than 30%. The tumors in the neuroendocrine cacinoma area present as solid nest-like pattern, rosettes-shaped or organ-like pattern, with high nuclear-to-plasma ratio and fine chromatin, and it is easy to see mitotic figures. Adenocarcinoma components are tubular adenocarcinoma, mucinous adenocarcinoma, papillary adenocarcinoma with various differentiation. The adenocarcinoma and neuroendocrine carcinoma components can be cross-mixed, and also can be closely adjacent but not confused. Tumor pathological TNM stage Ⅲ-Ⅳ, positive lymph node metastasis, stable microsatellite, neuroendocrine carcinoma as the main histological classification are independent risk factors affecting the prognosis of patients with cardial MANEC.