Objectives To explore the relationship of orthostatic hypotension in elderly hypertensive patients with left ventricular structure and function.Methods 101 cases of elderly patients with hypertension were selected from July 2013 to June 2015.After blood pressure measurement in vertical and decubitus position,all patients were divided into non-orthostatic hypotension and orthostatic hypotension groups,received the echocardiography and the accurate calculation of left ventricular mass index.Results Compared with non-orthostatic hypotension,orthostatic hypotension in patients with left ventricular diastolic diameter,left ventricular posterior wall thinckness and interventricular septum thickness.Left ventricular mass index significantly increased(48.13±5.54)mm vs.(52.45 ± 1.48)mm in left ventricular diastolic diameter,(10.08± 1.87)mm vs.(11.29± 1.98)mm in left ventricular posterior wall thickness,(10.18± 1.88)mm vs.(11.61±1.66) mm in interventricular septum thickness,and (114.59 ± 22.72) g/m2 vs.(131.98 ± 23.43)g/m2 [t=4.386、2.985、4.397、8.672,in left ventricular mass index(BMI),all P＜0.05].Left heart ventricular ejection fraction and mitral peak early/late diastolic blood flow decreased [(60.81 ± 4.73)vs.(53.60±2.58)and(0.93±0.23)vs(0.76±0.26)t=4.298、3.654,all P＜0.05].Conclusions There is relationship of orthostatic hypotension with left ventricular structure and function in elderly hypertension patients,and it is essential not only to control blood pressure effectively,but also to focus on controlling orthostatic hypotension.

colon cancer and to find out treatment and prevention by using different gene changes.

Objective To investigate the efficacy and safety of endoscopic submucosal dissection (ESD) for removal of gastrointestinal stromal tumors (GISTs). Methods Data of 22 patients with GISTs,who underwent ESD, were reviewed in terms of personal situation, location and size of lesions, clinical manifestation, managements, pathology, complications and follow-up findings. Results The procedure was successfully performed in all patients and all lesions were removed by one procedure. The lesion size ranged from 0. 8 to 4. 0 cm and the operation time was 35-150 min ( mean 64. 5 min). Mild bleeding occurred in all cases, which was successfully managed by argon plasma coagulation, hot biopsy probe or endoclip. Perforation occurred in 4 patients (18. 1%), which were closed with endoclip. Abdominal distension was relieved with decompression, acid suppression with proton pump inhibitors and antibiotics in 3 cases, additional trans-abdominal puncture was needed in the other case. No severe hemorrhage occurred. The average length of hospitalization was 4. 5 days (3-10 d). The patients were followed up for 3 to 18 months, and no tumor residue or recurrence was observed. Conclusion ESD is an effective and safe endoscopic procedure to remove GISTs. The main complications are bleeding and perforation, which, however, can be cured.

Objective To detect the effect of cell density off both integrin αγβ6 expression and matrix metalloproteinase-9(MMP-9)secretion in colon cancer cells. Methods Flow cytometry was applied to analyze αγβ6 expression in human WiDr colon cancer cell lines and human HaCaT keratinocyte cells, respectively,at high-and low-cell density culture.The MMP-9 aetivity level for various coloIl cancer cell lines, WiDr and SW480 cells at high-and low-cell density culture was analyzed using Biotrak MMP-9 activity assay and Gelatin Zymography assay, respectively. Results High cell density significantly enhances integrin αγβ6 expression for WiDr cells expressing αγβ6 compared with low density,but no increase was observed for human keratinocyte HaCaT cells. Biotrak MMP-9 assay indicated that the amount of MMP-9 secreted per cell for WiDr and SW480 B6 cells at high cell density culture was(3.3±1.2)×10-7ng/cell and(27.2±3.0)× 10-7ng/cell respectively; However,at low cell density it was(1.8±0.7)× 10-7ng/cell and(10.9±2.0)×10-7 ng/cell,respectively. It was 2-3-fold higher for WiDr and SW480 β6 cells at high cell density compared with that at low cell density, but no density-dependent increase observed for SW480 wild cells lack αγβ6 expression(t=0.47,P＞0.05),MMP-9 secretion for SW480 wild cells was(3.9±1.7)× 10-7 ng/cell at hish cell density and(3.8 ±0.7)×10-7 ng/cell at low eell density(P＞0.05),respectively. Gelatin zymography assay also indicated that the level of MMP-9 in SW480 B6 cells expressing αγβ6 was evidently higher at high density than at low density, however no density-dependent increase observed for SW480 wild cells and HaCaT cells. Conclusions High cell density induces integrin αγβ6 expression and promotes MMP-9 secretion in colon cancer cells, which constitutes the basis for a self-perpetuating system of tumor infiltrating growth in colon cancer progression.

Objective To investigate the epidemiology of adults acute viral gastroenteritis in Shanghai Changning district. Methods All of 1 554 stool specimens of adults acute gastroenteritis in Shanghai Changning district from June 2010 to December 2013, and the enzyme-linked immunosorbent assay and multiple polymerase chain reaction was used to detecte different viruses. Results In all of 1 554 cases, the average age was (46.19 ± 15.59) years. Among them, 691 persons were male, 863 persons were female. Virus infection was detected in 407 cases, and the detection rate was 26.19%. Among them, 395 cases (97.05%) were single virus infection, and 12 cases (2.95%) were mixed infection. The peak of epidemic was from every November to next February. The incidence of watery diarrhea, vomiting and fever in virus positive group was significantly higher than that in virus negative group:95.09%(387/407) vs. 88.14%(1 011/1 147), 31.20%(127/407) vs. 18.83%(216/1 147), and 11.06%(45/407) vs. 7.59%(87/1147), P<0.01 or<0.05. Conclusions Rotavirus infection is common in adults with acute viral gastroenteritis. Patients with positive virus infection had a higher incidence of watery diarrhea, vomiting and fever. The peak of epidemic is winter.

Objective To investigate the surgical methods and clinical effect of repairing forefoot soft tissue defects with free peroneal artery perforator flap in elderly patients.Methods From June,2011 to April,2015,17 cases of forefoot soft tissue defects repaired with free peroneal artery perforator flap in elderly patients.There were 10 cases of male and female in 7 cases with an average age of 65.8 years old ranging from 60 to 74 years.Causes of injury:traffic accident in 7 cases,heavy crushing in 9 cases,electrical bums in 1 case.Injury part:6 cases on the left side and 11 cases on the right side.Metatarsus and phalanges fracture in 9 cases,tendon injury in 5 cases.Defect area:3.0 cm × 4.0 cm-6.3 cm × 11.2 cm.Results All flaps survived.All wounds were primary healing.Skin graft survived for the foot flap donor site,and no complicated with infection.All patients were followed up from 8 to 36 months with an average of 17.6 months.The appearance of flaps were good,slight bloated.The texture and color of the flaps were close to the recipient site.Flap feel were good.Accortling to (AOFAS)criteria system,the AOFAS score of last follow-up was (77.5±13.2).Excellent in 6 cases,good in 9 cases,fair in 2 cases.VAS score was (2.6±0.4).Conclusion The free peroneal artery perforator flap with the advantages of vascular anatomy constant,blood supply is reliable,thickness moderate,etc.It is a useful clinical method to repair forefoot soft tissue defects in elderly patients.

Background:Acute gastroenteritis is the second largest public health problem in the world. Rotavirus(RV)is one of the pathogens of acute gastroenteritis in adults,researches focusing on RV infection may provide the basis for prevention and control of the disease. Aims:To determine the epidemiological characteristics of RV infection in adults with acute gastroenteritis in Shanghai,China. Methods:From Jun. 2010 to Dec. 2013,stool samples and clinical data in adults with acute gastroenteritis in a designated hospital in Shanghai Changning District were collected. ELISA and PCR were used to detect RV infection and its genotypes. Results:A total of 1 554 eligible stool samples from acute gastroenteritis patients were recruited,of them 691 were males and 863 were females,the mean age was(46. 19 ± 15. 59)years old. RV was detected in 189 patients with a detection rate of 12. 2% ,163(10. 5% )were categorized as group A RV and 26(1. 7% ) were group B/ C RV;the most common genotypes in group A RV were G9(30. 1% )and G1(25. 2% ). Watery stool and vomiting were more prevalent in RV-positive patients than in RV-negative patients(P < 0. 05). The detection rates in years 2010,2011,2012 and 2013 were 12. 2% ,14. 9% ,6. 8% and 16. 3% ,respectively. When analyzed by age group,the detection rate was significantly lower in 18-39 years group than those in 40-59,60-79,and ≥80 years groups(8. 7% vs. 14. 8% ,14. 2% ,and 17. 1% ,P < 0. 05). The peak of epidemic was from Nov. to next Feb. Conclusions:RV infection in adults with acute gastroenteritis is more popular in middle aged and elderly people and shows a winter seasonality in Shanghai,China. The most common genotypes of group A RV are G9 and G1.

OBJECTIVETo analyze the diagnosis and treatment of autoimmune hemolytic anemia (AIHA) in liver transplant recipients.

METHODSA retrospective analysis was conducted of 3 patients who developed AIHA following orthotopic liver transplantation. The results of hemolysis tests and examinations of hemoglobin, white blood cells, platelets, total bilirubin, and alanine aminotransferase before and after treatments were reviewed.

RESULTSThese 3 patients developed AIHA following the transplantation possibly in association with the use of immunosuppressive agents, and the condition was effectively controlled after corresponding treatments.

CONCLUSIONAIHA is a uncommon complication after liver transplantation and can be cured after a definitive diagnosis with corresponding treatments.

Aged ; Anemia, Hemolytic, Autoimmune ; diagnosis ; etiology ; therapy ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Retrospective Studies

From March 2019 to May 2019, panel interviews were conducted with 39 representatives of 10 community health service centers in Shanghai Changning District, each took 30 to 90 min. The relevant information of interviews was coded, classified, streamlined, and the interview topics were sorted out. The interviews showed the following problems of continuing education in community health care setting currently: there were lack of updated disease-related clinical guidelines and other knowledge, lack of uniform regulations on rational drug use; the contents or forms of training did not match the needs of the community; and training in psychology and nutrition therapy could not be transformed into practical application. The participants made the following suggestions for continuing medical education: to build a database of clinical guidelines for diseases; to provide information-based support and guidance for rational drug use; to design training contents and training forms based on community needs; to provide training support in psychology, nutrition and other subjects; to increase trainings in research, teaching and health management and other aspects. Continuing medical education for community general practioners faces problems from knowledge users, knowledge providers, and the policy environment. The contents and forms of training needs should be optimized. These can be strengthened by communicating with the community and following up with the needs of the community in establishing diversified training forms, supporting assessment and incentive mechanisms for different types of training contents.

Based on literature analysis and conference discussion, the index system of the competence and performance of general practitioners (GPs) was developed, which consisted of 4 dimensions and 59 indicators. Based on the indicator system, the questionnaire was designed. From March 2019 to May 2019, a questionnaire survey on the ability, performance and training needs of GPs was conducted among the managers of 10 community health service centers in Shanghai Changning District. The dependent variables were analyzed through descriptive analysis, correlation analysis and quadrant mapping methods. The median of overall evaluation score of the performance of GPs in 10 community health service center was 2.7(2.4,2.9); and the mean of training demand score was (1.4±0.5). The performance scores was negatively correlated with the degree of training needs ( r=-0.654, P<0.01). Among the 59 capacity assessment indicators, there were 25 (42.4%) with poor performance but high training demand. The overall ability of general practitioners was common from the perspective of the community health service center managers, suggesting that it is important to strengthen the capacity development for community GPs, and those with poor performance and high training needs should be included in training priority, such as disease diagnosis and treatment, emergency management ability, rehabilitation service ability and medical law.