ObjectiveTo understand the urban preference for outpatient pre-registration in large hospitals,and probe into the influencing factors,for recommendations to improve outpatient preregistration at the hospitals.Methods With Nanjing City as an example,the authors used tailoreddesigned questionnaire and qualitative interviews to investigate the preference of 1200 households of local residents regarding outpatient clinical pre-registration service at the tertiary hospitals.Results Age,education and economic factors are found to be the most important influential ones for urban preference in their outpatient pre-registration at large hospitals.Other factors include traditional approaches to outpatient clinic,inconvenience for outpatient pre-registration,and concerns for appointment breaking.Conclusion in order to increase their preference for outpatient pre-registration at large hospitals,hospitals should work to explore and improve approaches for outpatient pre-registration,and better their service quality,which will involve greater participation of both the hospital staff and residents.

Aim To evaluate the efficacy and safety of different routes for vinpocetine injection by intravenous or trans-angiographic catheter on cerebral vasospasm(CVS).Methods A total of 105 aneurysmal subarachnoid hemorrhage(aSAH)patients with CVS following intracranial aneurysm embolization were chosen and randomly divided into group C, B and A, with 35 cases in each group.Patients in group C were treated with 3H therapeutic regimen, while those in group B and A were with 3H therapeutic regimen plus vinpocetine by intravenous injection or trans-angiographic catheter, respectively.The index including middle cerebral artery(MCA) blood flow velocity, National Institutes of Health stroke scale(NIHSS) score, Glasgow outcome scale(GOS) grading, clinical efficacy, hypotension rate and rehaemorrhagia rate were detected and compared among three groups.Results After the 7 d and 14 d treatment, the MCA blood flow velocity of group A and B was observed to be significantly lower than that of group C(P<0.05), and the MCA blood flow velocity of group A was significantly lower than that of group B(P<0.05).The NIHSS score of group A and B was significantly lower than that of group A(P<0.05), and the score of group A was significantly lower than that of group B(P<0.05) following 28 d treatment.Moreover,the clinical efficacy of group A and B was significantly higher than that of group C(P<0.05), and the clinical efficacy of group A was significantly higher than that of group B(P<0.05).After the 28 d treatment, the hypotension rate of group B was found to be significantly higher than that of group C and A(P<0.05), while there was no statistical difference(P>0.05) observed in the hypotension rate between group A and C.Also, there was no statistical difference(P>0.05)found in the rehaemorrhagia rate among three groups.However, the GOS grading of group A and B was significantly better than that of group C(P<0.05), and the grading of group A was significantly better than that of group B(P<0.05)after 3 months treatment.Conclusions Using vinpocetine by intravascular injection or by trans-angiographic catheter could be the efficient treatment for the CVS after intracranial aneurysm embolization, and vinpocetine injection by trans-angiographic catheter is the better mode of administration with the consideration of efficacy and safety.

Objective To understand the status of knowledge,attitude and behavior on malaria of residents in endemic areas of Yunnan Province.so as to provide evidences for implementation of Global Fund MaIaIia Control Program.Methods The subjects were selected by the method of multi-level sampling in 47 countries and were investigated by questionnaire.Results A toatl of 40 940 households in 883 natural villages were investigated.39 234 questionnaires were effective with an effective rate of 95.83%.A total of 60.32%interviewees knew malaria symptom and signs,22.41%of them knew the route of transmission,17.65% knew the preventive measures.57.61% had the willing to use insecticide-treated bed nets(ITNs),and 8.68%of the households owned ITNs.Conclusion Health edueion and promotion regarding critical malria interventions should be strengthened in the following implementation.

Objective To investigate the mechanisms of Mieyou Decoction in the treatment of Hp-associated gastritis of spleen-stomach damp-heat syndrome. Methods Seventy BALB/c mice were randomly divided into control group, model group, high concentration of Mieyou Decoction group, low concentrations of Mieyou Decoction group, and gastric triad group, with 14 rats in each group. BALB/c mice of Hp-associated gastritis of spleen-stomach damp-heat syndrome models were established by composite factor. After the success of modeling and continuous 14-day administration, the expressions of TLR2, TLR4 protein, TLR2 mRNA, and TLR4 mRNA were detected by immunohistochemistry and qPCR. ELISA was used to detect the expressions of IL-6 and IL-8 in the serum. Results Compared with control group, the expressions of TLR2, TLR4 protein, mRNA, IL-6, and IL-8 in model group significantly increased (P<0.01);the expressions of TLR2, TLR4 protein, mRNA, IL-6, and IL-8 in high concentration of Mieyou Decoction group, low concentrations of Mieyou Decoction group, gastric triad group were lower than model group, with statistical significance (P<0.01);the expressions of TLR2, TLR4 protein, mRNA, IL-6, and IL-8 in high concentration of Mieyou Decoction group were higher than gastric triad group, but the differences were not statistically significant (P>0.05). Conclusion Mieyou Decoction may play a role in the treatment of Hp-associated gastritis of spleen-stomach damp-heat syndrome through intervention in the expressions of TLR2 and TLR4.

Objective To study the expressions of HSP70 and AQP4 in the H.Pylori-associated gastritis mice of Pi-Wei hygropyrexia syndrome;To investigate the mechanism of Mieyou Soup. Methods The mice were randomly divided into high concentration of Mieyou Soup group, low concentration of Mieyou Soup group, gastric triad group, model group and control group. BALB/c mice of H.Pylori-associated gastritis mice of Pi-Wei hygropyrexia syndrome model was established by composite factor. After modeling, the mice were administered for of continuous 14 days. The drug dosage of high concentration of Mieyou Soup group, low concentrations of Mieyou Soup group, and gastric triad group were 12.4, 6.2 g/kg, and 0.279 8 mg/kg, respectively. Western Blot was used to detect the expression of HSP70 protein, and immunohistochemistry was employed to detect the expression of AQP4 protein. Results Compared with control group, the expression of HSP70 and AQP4 in model group significantly increased (P<0.05);compared with the model group, the HSP70 in high concentration of Mieyou Soup group, low concentrations of Mieyou Soup group, gastric triad group increased, the AQP4 in high concentration of Mieyou Soup group, low concentrations of Mieyou Soup group, gastric triad group decreased, with statistical significance (P<0.01). Conclusion Mieyou Soup may play a role in treatment of H.Pylori-associated gastritis mice of Pi-Wei hygropyrexia syndrome by raising the expression of HSP70, and reducing the expression of AQP4 protein expression.

Objective To analyze the curative effect of simultaneous liver and kidney transplantation (SLKT) for patients with end-stage liver and kidney diseases and liver cirrhosis patients with hepatorenal syndrome.Methods All SLKTs (n=21) performed at our center from January 1999 to December 2010 were reviewed and SLKT outcomes were compared with those of kidney transplantation (KT) (n=609) and liver transplantation (LT) (n=133) performed during the same period.Results There were 3 deaths due to infection 2 weeks, 6 months and 5 years respectively after operation. One patient died due to multiple organ dysfunction syndrome 2 weeks after operation. One patient was dead 5 years after operation because of rejection. MELD level between SLKT and LT had no significant difference, but serum creatinine in SLKT group was significantly higher than in LT group (516.0±329.9 vs 111.4±138.1 mmol/L, P<0.01). The 1-year acute kidney rejection rate and rate of delayed graft function (DGF) of the kidney had no significant difference between SLKT group (0 vs 9.5 %) and KT group (6 % vs 17.3 %). There was no significant difference in one-, 3- and 5-year patient survival rate between SLKT group (87.7 %, 67.8 % and 67.8 %) and LT group (84.2 %, 73.5 % and 69.4 %).Conclusion SLKT is a safe and effective treatment for end-stage liver and kidney diseases.

ObjectiveTo investigate the variation of peripheral blood CD34+ cells during the hematopoietic stem cell mobilization,and its influence on the collecting timing and results.Methods Twenty-seven cases of peripheral blood hematopoietic stem cell mobilization and collection from April 2010 to December 2011 were analyzed,including 13 autologous cases mobilized with chemotherapy combined with granulocyte colony-stimulating factor (G-CSF,10 μg· kg-1 · d-1) and 14 cases of healthy donors mobilized with only G-SCF (7.5 μg · kg- 1 · d- 1 ).The number of peripheral blood CD34+ cells was counted,and its correlation with the yield of mononuclear cells (MNCs) and CD34+cells was analyzed.ResultsMNCs (5.84 ± 1.48) × 108/kg and CD34+ cells (3.93 ± 2.16) × 106/kg were obtained in healthy donors,and (6.58 ± 3.72) × 108/kg MNCs and (3.98 ± 3.06) × 106/kg CD34+ cells were obtained in autologous cases,respectively.There was only 1 failure in autologous cases.The peak of peripheral blood CD34+ cells in autologous cases appeared at day 4 after the treatment of G-CSF,and in healthy donors the number of peripheral blood CD34+ cells at day 5 was still in ascendant phase.The CD34+ cells/kg in the collection products were positively correlated with the percentage and absolute value of peripheral blood CD34+ cells.The cases ratio of CD34+ cells≥2× 106/kg in the products of single collection was up to 76.2％ (16/21) in the cases with peripheral blood CD34+ cells absolute value greater than 20/μl.ConclusionThe number of peripheral blood CD34+ cells was an important monitoring indicator in hematopoietic stem cell mobilization and collection,CD34+ cell absolute value ≥20/μl could be used as collection threshold.

Objective To investigate the strategies of reducing the incidence of missed diagnosis of severe traumatic brain injuries combined with multiple trauma. Methods Data of 432 patients with severe traumatic brain injuries and multiple trauma (ISS≥20) from January 2000 to August 2007 were analyzed retrospectively. All patients were divided into missed diagnosis group (MD group, n =54) and non-missed diagnosis group (NMD group, n =378) for correlation analysis on ISS, GCS, anatomical locations of the missed diagnosis, the time of delayed diagnosis and the prognosis. Results ISS was (42.97±10.94) points in MD group, with statistical difference compared with NMD group (P < 0.05). The patients with GCS≤8 in MD group was more than those in NMD group (P < 0.05). Conclusions It is effective to prevent missed diagnosis and improve the survival of patients with severe traumatic brain injuries combined with multiple trauma by judging injury severity quickly and precisely based on the principle of "life first" and repeated and systemic physical examination.

Objective To assess the value of preoperative neutrophil-lymphocyte ratio ( NLR) for predict the prognosis in patients with high grade T1 bladder.Methods From January 2004 to December 2014, the data of 307 patients diagnosed as bladder cancer of Stage 1 and high grade after undergoing TURBT were analyzed, including gender, age, smoking status, tumor number and size, hydronephrosis, intravesical instillations and preoperative blood transfusion of 307 patients diagnosed as bladder cancer of stage 1 and high grade after undergoing TURBT were analyzed retrospectively.All patients were primary urothelial carcinoma.According to preoperative NLR,patients were divided into the low NLR group( NLR≤2.42,n=197) and the high NLR group(NLR >2.42,n =110).Recurrence-free survival (RFS) and progression-free survival ( PFS) were calculated according to the Kaplan-Meier model and compared by the log-rank model.Cox regression models were used for multivariate analyses of the association between NLR and bladder cancer, then the prognostic factors affecting RFS and PFS were evaluated.Result of these 307 patients, the low NLR group accounted for 64.2%(197/307), and the high NLR group accounted for 35. 8%(110/307).The mean follow-up period was 71(range, 1-123)months.The recurrence rate in the low NLR group and the high NLR group recurrence rate were 19.2%( 38/197 ) and 34.5%( 38/110 ) respectively, RFS were 73.0(range, 2-123)months and 67.5(range, 1-122)months respectively.The progression rates were 4.1%(8/197) and 10.9%(12/110) respectively.The recurrence and progression rates in the high NLR group is higher than those in the low NLR group(P<0.01 and P=0.008), and RFS was shorter( P=0.002).Multivariable Cox regression analysis showed that NLR>2.42(P=0.007,HR=1.912)and hydronephrosis (P<0.01, HR =2.485 ) are associated with higher risk of recurrence.Conclusion Elevated preoperative NLR is an independent predictor of RFS and PFS in patients with high grade T1 bladder cancer.

Hepatitis B ; Humans ; Th17 Cells