The paper covered dominant models and organization of healthcare alliances in Xinjiang, illustrating the hospital group model, synergy development model, focused partnership support model, three-level integration model, and other business models.As described by the authors, healthcare alliances in Xinjiang, thanks to telemedicine, have achieved initial success by means of disciplines support, primary care human resources, new technologies and new service spreading, and promotion of appropriate medical techniques, in such aspects as regional medical cooperation, population benefits and medical resources sharing.

Objective:To investigate effects of viola on macrophage TOLL-like receptor expression ,and tentatively explore the partial mechanism of viola intervention on macrophage function.Methods: Using viola water decoction lavage intervention in clean grade SD rats of conventional preparation containing serum ,In a certain concentration coculture with mouse peritoneal macrophages in 96-well plates.After 24 hours,cell phagocytosis activity was determined by neutral red uptake assay ,changes in expression levels of TLR-1,TLR-2,TLR-3,TLR-4,TLR-5 mRNAs were determined by RT-PCR.Results:Compared with the same concentration of normal serum group :(1 ) viola-containing serum group macrophage activity was significantly increased ( P<0.01 );( 2 ) Within certain concentration,viola containing serum group with increased or decreased expression levels of TLR -1,TLR-2,TLR-3 mRNA(P<0.05 or P<0.01 ) ,the expression level of TLR-4 was not significantly altered in each group ( P>0.05 ) ,and the expression level of TLR-5 was significantly increased in each group ( P<0.01 ).Conclusion:Viola-containing serum has obvious promoting effect on macrophage phag-ocytosis,the mechanism of which may be related to that this drug regulates and controls part of macrophage TOLL -like receptor expres-sion.

Objective To study the risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).Methods Between Ja(n)uary 1st 2013 and December 31st 2013,data from 196 consecutive patients who underwent PD at the Chinese PLA General Hospital were studied retrospectively.17 factors were examined.Univariate analysis and multivariate logistic regression analysis were used to determine the relative risks.Results DGE occurred in 71 patients (36.2％).The incidences of grade A,grade B and grade C DGE were 22.4％ (44/196),6.1％ (12/196) and 7.7％ (15/196) respectively.There were three postoperative deaths.The overall mortality rate was 1.5％.BMI,Braun anastomosis,clinically relevant postoperative pancreatic fistula (CR-POPF) and intra-abdominal collection were significantly correlated with DGE on univariate analyses.BMI ≥25 kg/m2,CR-POPF,and intra-abdominal collection were independent risk factors on univariate and multivariate regression analyses.Conclusions Post-operative complications were associated with DGE.Early diagnosis and timely treatment for pancreatic fistula and abdominal collection were helpful to decrease morbidity and to promote recovery of DGE.

Objective: The purpose of this study was to evaluate the safety and effectiveness of fast track surgery in laparoscopic gastrectomy for gastric cancer. Methods: All patients received elective gastric cancer resection, and were divided into three groups: group Ⅰ (open gastrecomy, n = 30) , group Ⅱ (open gastrecomy with fast track surgery, n = 30) , and group Ⅲ (laparoscopic gastrecomy with fast track surger-y ,n =30) . Clinical data and gut function were assessed in three groups. Results: There were no significant differences in postoperative complication and the number of lymph node harvest between 3 groups. Blood loss was less in group Ⅲ than group Ⅰ and group Ⅱ (P <0.01) ,but its operative time was longer and its cost was more than other two open surgery groups (P < 0. 01). Recovery of bowel function in group Ⅲ was faster,and postoperative hospital stay was shorter than group Ⅰ (P<0.01). However, recovery of bowel function and postoperative hospital stay in group Ⅲ was not different from group Ⅱ (P > 0. 05). Conclusion: Postoperative hospital stay can be shorter and recovery of bowel function can be faster in laparoscopic gastrectomy with fast track surgery plan compared to traditional care group. But when using fast track surgery plan, laparoscopic gastrectomy was not superior to open surgery.

Objective: To evaluate physical fitness status of medical college students using cluster analysis, to explore intercorrelations among of physical fitness indices, and to provide a theoretical basis for physical health training of medical colleges. Methods: Based on the 2014 revised Chinese National Student Physical Fitness Standard(CNSPFS), 10 431 undergraduates of Zhejiang Chinese Medical University in 2018 were recruited as participants, cluster analysis and category description were performed by using SPSS 21.0. Results: The two-step classification showed that medical college students were classified into three categories according to their physical fitness score: A, B, and C, which was 25.8%(1 165), 37.2%(1 169) and 37.0%(812) in male students and 32.4%(2 361), 50.8%(3 703) and 16.8%(1 221) in female students; the ranking of factors and based on specific contribution to physical fitness for males: BMI(1.00), standing long jump(0.98), pull-ups(0.88); females: BMI(1.00), 800 m(0.99), standing long jump(0.89). Conclusion Antropometric indicators play a key role in physical fitness among medical college students, and have a greater impact compared with other indicators; strength and endurance quality are the key factors to improve the performance of male and female physical fitness tests; It is of great significance for colleges and universities to carry out differentiated exercises plan for the rapid improvement of students’ physical fitness.

Objective: The aim of this study was to evaluate the impact of fast track surgery on host cell-mediated immunology and inflammatory responses in colorectal cancer patients.Methods: Sixty colorectal cancer patients were prospectively divided into fast track surgery(FTS)group(n=30)and conventional perioperative care group(n=30).In addition to clinical parameters(recovery of gastrointestinal function,complication rates and postoperative length of stay), the parameters of perioperative cell-mediated immunology function,and the serum level changes of CRP and IL-6 were determined.Results: FTS group was associated with a significantly shorter postoperative hospital stay compared with conventional care group(P<0.05).Serum concentration of CRP and IL-6 in FTS group were lower(P<0.05) than in the conventional care group on postoperative day(POD) 1 and POD 3(P<0.05).CD4/CD8 ratio in FTS group were higher(P<0.05) than in the conventional care group on postoperative day(POD)1 and POD 3(P<0.05).Conclusion: Fast track surgery for colorectal cancer patients can preserve cell-mediated immunity and control inflammatory responses when compared with conventional postoperative care.

Objective : To learn the preference and determinants for institute-based care of the elderly in Zhejiang Province. Methods : By multi-stage sampling and convenient sampling methods,three communities and three villages from Hangzhou,Jinhua and Yongkang as investigation spots,respondents who aged 60 years or above and lived for one year or more were selected for a questionnaire survey to learn their preference for institute-based care. Logistic regression analysis was used to explore the influencing factors for preference of institute-based care among the elderly. Results : A total of 390 valid questionnaires were collected,accounting for 91.76%. Among them,there were 219 men and 171 women, accounting for 56.15% and 43.85; 155 old people chose institute-based care,accounting for 39.74%. The results of multivariate logistic regression analysis illustrated that the elderly who had three children or more had less preference for institute-based care（OR=0.072,95%CI：0.007-0.742）;the elderly who lived with spouse（OR=0.395,95%CI：0.188-0.833）,with children（OR=0.323,95%CI：0.132-0.791）,with spouse and children（OR=0.305,95%CI：0.139-0.673）,compared with the elderly who lived alone,had less preference for institute-based care;the elderly who lived in rural areas,compard with the elderly who lived in urban areas had less preference for institute-based care（OR=0.404,95%CI：0.224-0.730）;the elderly without chronic diseases had less preference for institute-based care（OR=0.485,95%CI：0.292-0.805）. Conclusion Having three or more children,living with spouse,living with children,living with spouse and children,living in rural areas and living without chronic diseases are determinants for choosing institute-based care among the elderly.

Objective To construct a domain knowledge graph of dementia care,so as to provide the foundation and guarantee for the next intelligent application based on the knowledge graph.Methods A top-down approach was adopted to construct a domain knowledge graph of dementia care.Firstly,the ontology concept is constructed from the top level,namely the schema layer of knowledge graph.Then,instances are filled,and knowledge extraction is carried out from the existing data sources,and the extracted entities and relationships are filled into the pattern layer ontology database to complete the data layer construction of the knowledge graph.Finally,the"entity relationship entity"triplet data was input into the Neo4j graph database for storage.Results In this study,the personalized care plan set of 1 012 dementia cases was used as the corpus to construct a domain knowledge graph of dementia care.The knowledge graph takes people with dementia as the core,and unfolds,one by one,around basic characteristics,care problems,and care plans in a standardized"entity-relationship-entity"triplet format,forming a large knowledge network,which contains a total of 1 522 specific dementia care knowledge entities and 8 kinds of inter-entity relationships.Conclusion The domain knowledge graph of dementia care constructed in this study clearly and intuitively shows the global pedigree and logical path of knowledge,which provides an efficient and intelligent basic guarantee for the browsing,retrieval and application of dementia care knowledge,so as to realize personalized and intelligent management of people with dementia,break through the bottleneck of lack of professionals,improve the health outcomes of people with dementia,promote the implementation of inclusive pension services,and promote healthy aging.