Diverticulitis of colon,the inflammation of colonic diverticulars,is connected with dietary,age and disorder of colonic environment.Due to the different cultures between western contries and orient nations,the morbidity,predilection site,clinical manifestation and management are different in diverticulitis of colons.Computed tomography(CT)has been the key diagnosic method,and it is able to guide transfixion pins to treat diverticulitis of colon.After medical treatment,most of patients can be relaxed,and only someone need operations.

Objective To understand the status quo of work satisfaction of the graduates of GP vocational training program by Zhongshan hospital Fudan university,to provide bases for making best GP career development strategy by health authorities.Methods Using short form of the career orientation inventory to conduct career investigation of the 152 graduates of GP vocational training program by Zhongshan hospital,Fudan university.152 questionnaires were issued and the effective response rate was 100％.Results The top of GPs' career anchor is job security orientation (106,69.7％),followed by technical competence (28,18.4％),service (8,5.3 ％),managerial (5,3.3 ％),autonomy (3,1.9％),lifestyle (1,0.7 ％),entrepreneurship (1,0.7 ％),pure challenge (0,0) and geographic security orientation (0,0).We found that for male GPs,they displayed higher score for entrepreneurship orientation than female GPs (t =2.775,P =0.006).Those older than 35 displayed higher score for geographic security orientation than those younger than 35 (t =-2.154,P =0.033).GPs with at least 10 years' work experience displayed higher score for geographic security orientation than those with less than 10 years' work experience (t =-2.414,P =0.017).The distribution of all types of career orientations of GPs was the same no matter how different their degrees and professional titles were.Conclusions Job security orientation and technical competence are the major job orientations of GP vocational training program by Zhongshan hospital,some career anchor orientations are related to age,gender and duration of work experience.Effective career management should be conducted based on these characters of the graduates' career orientation.

The blood supply of metatarsuses and pha-langeals in 30 cases of fetuses and infants was ob-served by microangiographic methods. The resultsdemonstrated that diaphyses and cartilages of bothends of metatarsuses and phalangeals gradually in-creased in the fetal period and appeared nourishingartery and cartilage canal. Both ends of metatar-suses and phalangeals gradually decrea.ed in the. infant period and cartilage canals gradually disap-peared also. These implied that the appearance ofcartilage canals was related to the size of cartilageblocks. Cartilage Canals were temporary bloodsystem of fetal cartilage. Characteristics of bloodsupply of metatarsuses and phalangeals: 1. Asym-metrical distribution of blood supply on metatar-suses and phalangeal, that is the blood supply ofepiphyseal end is richer than one of non--epiphy-seal end, is adapted with the difference of growthability at both ends. 2. There is distribution ofcartilage canals at the epiphyseal end of the distalphalanx, and it is adapted with having growth a-bility at the proximal end. These show that bloodsupply of metatarsuses and phalangeals is closelyrelated to their growth and development.

Objective To investigate the application of the parenteral nutrition prescriptions for tumor patients in a tertiary hospital .Methods In this cross-sectional study , the parenteral nutrition prescriptions of all tumor inpatients in a tertiary hospital were collected from May to June in 2015 .The general data of patients who had used parenteral nutrition , the types of parenteral nutrition products , as well as the ratio of energy to ni-rogen ( E/N) , glucose/lipid ( G/L) ratio, non-protein energy to nitrogen ratio , and liquid volume were recor-ded and analyzed .Results Parenteral nutrition prescriptions were collected from 528 patients and showed high irrationality.The nutrient insufficiency rate was nearly 58.3%.The E/N (100:1 ~200:1) accounted for 32.3%and the G/L ( 1:1 ~2:1 ) 20.6%.Conclusions The rational application of parenteral nutrition should be a priority in clinical settings .A clinical nutrition supporting team may be established in tertiary hospi-tals to guide the appropriate use of parenteral nutrition .

Objective : To investigate the incidence of suspected adverse events following immunization(AEFI) in Chongchuan District, Nantong City, Jiangsu Province from 2008 to 2022, so as to provide insights into safety assessment of vaccines. Methods: The data on AEFI surveillance in Chongchuan District from 2008 to 2022 were collected through the National Immunization Program Information Management System of China, including demographics, history of vaccination, laboratory tests, incidence of AEFI and clinical characteristics. The epidemiological, clinical characteristics and reported incidence of AEFI were analyzed in Chongchuan District from 2008 to 2022 using a descriptive epidemiological method. Results: The reported incidence of AEFI in Chongchuan District from 2008 to 2022 appeared a tendency towards a decline (P<0.05), and the annual average reported incidence was 50.85/105. The incidence of AEFI associated with vaccines included in the national immunization program was significantly higher than that caused by vaccines that were not included in the national immunization program (74.67/105 vs. 20.35/105, P<0.05). General reaction was the predominant type of AEFI (1 937 cases, 44.21/105), and there were 274 cases with abnormal reactions (6.25/105) and 17 cases with coincident syndromes (0.39/105); however, no vaccine quality or vaccination accidents occurred. A high incidence rate was seen in AEFI associated with vaccines administered by subcutaneous (75.05/105) and intramuscular injection (47.40/105), and a low incidence rate was found in AEFI associated with vaccines administered orally (16.41/105). The five highest reported incidence rates of AEFI were found for the combined diphtheria, tetanus, acellular pertussis, poliovirus and Haemophilus influenzae type b vaccine (312.01/105), 7-valent pneumococcal polysaccharide-protein conjugate vaccine (292.14/105), inactivated Japanese encephalitis vaccine (248.37/105), Group ACYW135 meningococcal polysaccharide vaccine (240.67/105) and combined live vaccine for measles and rubella (229.31/105). The general reactions mainly included fever, redness and swelling and induration (1 878 cases, 96.95%), and abnormal reactions mainly included allergic skin rash (241 cases, 87.96%). In addition, 91.34% of AEFI occurred within 24 hours after vaccination, and 99.73% of cases with AEFI were cured during the 3-month follow-up. Conclusions The reported incidence of AEFI appeared a tendency towards a decline in Chongchuan District from 2008 to 2022. General reaction was the predominant type of AEFI, and all AEFI showed a good prognosis. The safety of vaccines was high in Chongchuan District from 2008 to 2022.

Objective: To evaluate the protective effect of influenza vaccine among people aged 70 years and older in Jiaxing City, Zhejiang Province, so as to provide a basis for formulating immunization strategies. Methods: The influenza-like illness (ILI) cases aged 70 years and older treated in influenza surveillance sentinel hospital in Jiaxing City from November 2022 to May 2023 were selected. The medical information and influenza vaccination information were collected by a questionnaire survey, and influenza virus was detected using the quantitative fluorescent real-time PCR assay. The test-negative design case-control study was used to analyze the influencing factors of influenza virus positive and evaluate vaccine effect (VE). Results: Totally 1 084 ILI cases were enrolled, including 535 males (49.35%) and 549 females (50.64%). There were 732 cases (67.53%) aged 70 to 79 years, and 352 cases (32.47%) aged 80 years and older. There were 689 cases with underlying diseases, accounting for 63.56%. A total of 224 influenza virus positive samples were detected, with a positive rate of 20.66%. Multivariable logistic regression analysis showed that a lower possibility of influenza virus positive was seen in ILI cases aged 80 years and older, with underlying diseases and with influenza vaccination in the current season (all P<0.05). A total of 345 cases were vaccinated against influenza in the current season, with a vaccination rate of 31.83%. The VE of influenza vaccine was 37.40% (95%CI: 12.40%-55.40%), of which the VE to A (H1N1) was 36.00% (95%CI: 7.50%-55.70%) and to A (H3N2) was 40.90% (95%CI: -26.00%-72.30%). The VE for ILI cases aged 70 to 79 years was 41.00% (95%CI: 13.90%-59.60%), and for ILI cases aged 80 years and older was 20.60% (95%CI: -64.60%-61.70%). Conclusions Influenza vaccine has a certain protective effect on cases aged 70 years and older. Free influenza vaccination for the elderly should be continuously promoted and the vaccination coverage should be increased.

Objective To explore indications for replantation and amputation of complex severed lower legs. Methods Fifteen lower legs in 25 cases with complex severed lower limbs were replanted including four finally amputated again, and other 10 legs were amputated directly after trauma. Those with successful replantation were repaired with microsurgical technology and limb lengthening procedure for complications such as soft tissue defect, bone defect and limb shortening. The amputated cases were fitted with prosthetic limb after wound healing. Results All cases were followed-up for three to 10 years (6.4 years in average), and 11 lower legs were survived in 15 replanted cases and other four were finally amputated and fitted with prosthetic replacement. The limbs of those with successfully replantation shortened to varied extent, and one can be categorized as grade Ⅰ, four as grade Ⅱ, four as grade Ⅲ and two as grade Ⅳ, according to Chen's classification of function evaluation for replanted limbs. Appearance of prosthetic limbs in 14 cases had no significant difference from the normal, and 12 of them could walk with load and two had slight claudication. Those with prosthetic limbs were more satisfactory than those with replantation of the limbs. Conclusion Replantation for complex severed lower legs should be comprehensively considered based on mangled extremity severity score (MESS), their local condition and function prognosis.

Objective To study the expression of NM-23 ,PCNA,p53 and S-100 in colorectal cancer tissues and their relationship.Methods Three hundred and seventy eases of elderly eolorectal cancer were labelled with NM-23,PCNA,p53 and S-100 and staged by pTNM classification.Results The positive rates of NM-23,PCNA,p53 and S-100 were 74.9% ,60.3% ,58.1% ,68.1% respectively.In elderly group,the expression of NM-23 had a neg-ative correlation with that of PCNA (r = -0.101 ,P = 0.026).However the expression of NM-23 had a positive corre-lation with that of p53 (r =0.111 ,P =0.016 ),the expression of S-100 had a positive correlation with that of p53 (r=0.112,P = 0.015 ),the expression of S-100 had a positive correlation with that of PCNA (r =-0.229,P =0.000).Conclusions In the elderly patients,NM-23,p53 and S-100 were significantly correlated with the inva-sion,metastasis and prognosis of eoloreetal cancer.PCNA may be a stimulative factor in the invasion and metastasis of colorectal cancer.NM-23 ,PCNA,p53 and S-100 can serve as effective markers in reflecting the invasion,metas-tasis and prognosis of colorectal carcinoma in the elderly.

Objective To investigate the effects of ghrelin on colonic motility in mice.Methods The eflfects of ghrelin on colonic propulsive movement were detected by charcoal suspension pushing test after injection of normal saline and different doses of ghrelin(20,50,100,200 ng/g).The effects of atropine,NG-nitro-L-arginine methylester hydrochloride(L-NAME)or D-Lys3-GHRP-6 on the changes of colonic propulsive movement caused by ghrelin(100 ng/g)were also investigated.In vitro,the effects of different doses of ghrelin(0.01,0.1,1,10μmol/L)on the spontaneous contraction amplitude of proximal colonic circular muscle strips were studied.Results Ghrelin significantly accelerated the colonic propulsive movement in dose-dependent manner,but the efiect was significantly inhibited in the presence of atropine,L-NAME or D-Lys3-GHRP-6(t=10.230,12.560,11.590,P＜0.05).Administration of ghrelin significantly increased the contraction amplitude of colonic circular muscle strips.but this effect was inhibited when the colonic circular muscle strips were pretreated by tetrodotoxin.ConclusionsGhrelin can accelerate colonic propulsive movement by activating growth hormone secretagogue receptor of cholinergic excitatory pathways and nitrergic nervous pathways in the enteric nervous system of colon.

Objective To study the MRI findings of HE and the pathological mechanism and to improve the diagnosis and differential diagnosis of HE. Methods Five patients of HE diagnosed by clinical and laboratory examination were examined with conventional MRI scan. Additional DWI, MRA and enhancement MRI scan were performed on 3 patients in which abnormal findings was detected on the conventional MRI. The distribution of lesions and signal characteristics were analyzed. The ADC values of the lesions and of the contralateral non-lesion area were measured. Moreover, the possible pathological mechanisms of HE were discussed on the basis of changes of clinical and imaging manifestations in the two cases with serial clinical and MRI data. Results Of 5 patients, brain abnormalities were found in 3 cases,which showed scattered spotted supratentorial white matter lesions of isointensity on T1 WI and DWI, and high signal intensity on T2WI and fluid-attenuated inversion recovery (FLAIR). Meanwhile, multiple plaque-like lesions involving both white matter and gray matter were found, mainly located at the basal ganglia nuclei, hippocampus and cingulate cortex. The lesions demonstrated iso-or hypo-intensity on T1 WI,and iso-or hyper-intensity on T2 WI, FIAIR and DWI at the initial stage. No enhancement was found in these lesions and MRA disclosed no remarkable findings. The ADC value of the lesions [ (0. 449 ± 0. 092) ×10-3 mm2/s] was decreased significantly compared with the contralateral noninvolved area [ (0. 838 ±0. 062) × 10-3 mm2/s] at the early onset. In 2 cases with glucocorticoid therapy, together with symptom relief, MRI follow-up scan demonstrated the reduction of lesion volume, the signal change to hyperintensity on T1 WI and hypo-intensity on DWL The ADC of the lesions increased significantly. Conclusion The MRI could be one of the effective tools for diagnosis, differential diagnosis, and judging the prognosis and therapeutic results of HE. Meanwhile, it may be a non-invasive method to study the pathological mechanism of HE.