The occurrence and development of hepatocellular carcinoma （HCC） induced by chronic infection of hepatitis B virus （HBV） is a typical process of Cancer Evolution-development. Viral replication， viral mutation， and viral integration are three major mechanisms by which HBV promotes evolution of HCC. The replication of HBV induces and maintains chronic inflammatory microenvironment， that induces the generation of somatic mutation and viral mutation and provides selective pressure. HBV mutation helps cells to get stem-ness characteristics by activating key signaling pathways. HBV integration activates oncogenes， participates in the mechanism underlying the male predilection of HCC， and promotes the maintenance of chronic infection. Biomarkers related with HBV are effective predictive and prognostic markers of HCC. Anti-viral treatment significantly reduces the risk of HCC occurrence. High risk HBV mutations can be applied for predicting the effect of anti-viral treatment on improving HCC survival. Continuing to exploring mechanisms of HBV induced hepatocarcinogenesis can improve the specific prophylaxis of HCC by providing more effective biomarkers and therapeutic targets.

Objective To investigate the prevalence of iron deficiency(ID)and iron deficiency anemia (IDA) in pregnant women in urban areas of China. Methods The study was a national cross-sectional survey conducted from September 19th, 2016 to November 20th, 2016. According to the classification of the National Bureau of Statistics, all survey sites were set up in 6 regions of the country. Pregnant women were continuously selected using multistage stratified sampling. A total of 12 403 pregnant women were collected and examined for serum ferritin and hemoglobin levels. Results The median serum ferritin level during pregnancy was 20.60 μg/L(11.78-36.98 μg/L), the hemoglobin level was(118±12)g/L. With the progress of pregnancy, the levels of serum ferritin and hemoglobin decreased gradually. The median serum ferritin levels in the first, second trimester and third trimester were 54.30 μg/L(34.48-94.01 μg/L), 28.60 μg/L(16.40-50.52 μg/L), and 16.70 μg/L(10.20-27.00 μg/L)respectively(P<0.01). The mean hemoglobin levels were(127 ± 10)g/L,(119 ± 11)g/L and(117 ± 11)g/L respectively(P<0.01). The prevalence of ID in urban pregnant women was 48.16%(5 973/12 403), and IDA prevalence was 13.87% (1 720/12 403). The prevalence of IDA in the first, second trimester and third trimester were 1.96% (20/1 019), 8.40%(293/3 487)and 17.82%(1 407/7 897), respectively(P<0.01). The prevalence of standardized ID and IDA were significantly different in various regions of China(P<0.01). The standardized prevalence of ID were relatively higher in East China and Northeast China, 57.37% and 53.41% respectively, while it was the lowest in Southwest China, 30.51%. The standardized prevalence of IDA in South Central, Northwest, and East China were relatively high, 21.30%, 16.97% and 17.53% respectively, and the standardized prevalence of IDA in Southwest China was the lowest, 5.44%,the differents in various regions were significant(all P<0.01). Conclusion The current phenomenon of ID and IDA in pregnant women is still very common,and nutrition and health care during pregnancy should be strengthened.

Objective To investigate the changes of sex hormone levels in male patients with metabolic syndrome and its clinical significance.Methods From January 2012 to January 2016,a total of 186 male patients in the Integrated Chinese and Western Medicine Hospital Affliated to Nanjing University of Traditional Chinese Medicine were enrolled,and they were divided into MS group(n =112) and non-MS group(n =74) according to the definition of adult metabolic syndrome.All of patients were measured blood pressure,blood glucose,blood lipid,pancreas islet function and sex hormone,such as testosterone (TT),sex hormone binding globuli (SHBG),progestin (P),prolactin (PRL),luteinizing hormone (LH),follicle-stimulating hormone (FSH),estradiol (E2),dehydroepiandrosterone (DHEA).The sex hormone level and the correlation of components of metabolic syndrome between the two groups were compared.Results Compared with those in the non-MS group,the BMI,blood pressure,lipid levels in the MS group were significantly increased,the fasting blood glucose,HbA1c,FINS HOMA-IR in the MS group were significantly increased[(8.74 ± 1.93) mmol/L vs.(7.49 ± 2.39) mmol/L,(10.86 ±2.45)％ vs.(9.09 ±2.61)％,(13.62 ± 6.37) mIU/L vs.(6.88 ±5.05)mIU/L,(5.53 ±2.28) vs.(3.24 ±1.35),t=5.76,4.49,2.47,2.81,all P ＜ 0.05],and TT,SHBG in the MS group significantly decreased [(18.95 ± 9.51) nmol/L vs.(10.10 ±2.97)nmol/L,(35.86±27.93)nmol/Lvs.(25.56±19.90)nmol/L,t=3.18,5.46,allP＜0.05].Conclusion MS was associated with hypogonadism,and the more components of metabolic syndrome,the more hypogonadism.

Objective: To explore the entry points and monitoring points of individualized treatment for fracture surgery patients with ARDS.Methods: Clinical pharmacists comprehensively assessed the patient's conditions and looked up lots of literatures.Some suggestions on the anti-infection treatment efforts, glucocorticoid use dispute and rational use of ambroxol were offered.The efficacy and adverse reactions of drugs in the treatment process were monitored using some subjective and objective indicators.Results: The consensus about the pros and cons, dosages, as well as the possible dosage decrease of glucocorticoid therapy, the dosages of antimicrobial agents, and the dosages and treatment course of ambroxol was achieved between clinical pharmacists and doctors.As a result, the maximum benefits were obtained for the patient.Conclusion: Clinical pharmacists can explore the treatment and monitoring for specific diseases and find out intervention entry points of clinicians and patients to play a certain role in clinics, and accumulate treatment experience gradually.

TheMeridian and Acupoint Science is a basic course in the major of acupuncture-moxibustion and tuina. We applied target-guided teaching method in teaching this course to evoke student's interest in studyingMeridian and Acupoint Science through initiative guidance, and boost student's initiative and enthusiasm by exhibiting the teaching targets. During the practice, we emphasized the specification of each unit target, around which we adopted various methods; meanwhile, we also focused on prompt evaluation, based on which necessary adjustments would be made to approach the targets. Teachers should act as guider, maintainer and promoter in class, rather than transmitter, to help students to study positively rather than passively listen. Via this kind of teaching reform, students not only obtained knowledge, but also enhanced their capability and feelings.

With the advance of medicine and the extension of life expectancy,the proportion of elderly people is increasing around the world,so is the postmenopausal women in the world~ population.More and more women will be bothered by various perimenopausal problems.Vasomotor symptoms(VMS) and the genitourinary syndrome of menopause(GSM) are recognized as the most frequent symptoms associated with menopause.Menopausal hormone therapy (MHT) is the most effective intervention for management of these symptoms.However,the role of MHT in the prevention of cardiovascular disease,skeleton,urogenital systems remains controversial.New drugs such as selective estrogen receptor modulators are equivalent to MHT on the relief of VMS.In addition,it can also prevent bone loss,becoming a new research highlights.Nonhormonal management is an important consideration when hormone therapy is not an option because of medical contraindications or a woman's personal choice,like lifestyle changes,selective serotonin reuptake inhibitors,serotonin-norepinephrine reuptake inhibitors,vaginal laser and etc.

OBJECTIVETo explore the anti-inflammatory and analgesia mechanism of electroacupuncture (EA) device of point injection (PI) on rats of inflammatory pain.

METHODS48 Sprague Dawley (SD) rats were randomly assigned into a control group, a model group, an EA+PI group, an EA device of PI (EAPI) group, an EA group and a PI group, eight rats in each one. The rats in the control group were subcutaneously injected with 50 μL of liquid paraffin oil solvent into the dorsum of left hindpaw, while rats in the remaining groups were treated with 50 μL of complete freund's adjuvant (CFA) at identical location to induce the model of inflammatory pain. After model establishment, the rats in the EA+PI group, EAPI group, EA group and PI group were treated with EA+PI,EA device of PI, EA and PI, respectively, once every other day (the 2nd day, 4th day and 6th day). Each treatment was given for 30 min. The mechanical withdrawal threshold, thermal withdrawal threshold and foot swelling before and 1 d to 6 d after model establishment were observed; the western blotting method was applied to measure IL-1β expression in inflammatory tissue of skin.

RESULTSAfter model establishment, compared with the control group, the mechanical withdrawal threshold and thermal withdrawal threshold were reduced (all<0.05) and the foot swelling was increased in the rest groups (all<0.05). After treatment, the mechanical withdrawal threshold and thermal withdrawal threshold in the EAPI group were significantly increased compared with those in the EA+PI group, EA group and PI group (all<0.05), but the foot swelling was reduced (all<0.05). The IL-1β expression in the model group was higher than that in the control group (<0.05); after treatment, the IL-1β expression in the EAPI group was lower than that in the model group, EA group and PI group (all<0.05), but no significantly different from that in the EA+PI group (>0.05).

CONCLUSIONSThe efficacy of EA device of PI on inflammatory pain is superior to EA combined with PI, EA alone and PI alone, which is suitable for further popularization and application.

Objective To explore the application effects of specialized team building in intravenous infusion and its influences on job satisfaction of senior nurses. Methods A specialized team of intravenous infusion was built which was composed of 50 senior nurses selected in January 2014 from Hangzhou First People′s Hospital. The team was headed by nursing department and assisted by other medical departments. Senior nurses played the role of professional execution on the team. And then, were compared the patients′ satisfaction, incidence of nursing defect, errors, and accidents, job satisfaction of nurses before ( January 2012 to December 2013) and after ( January 2014 to December 2015 ) implementing team nursing. Results There was a statistically significant difference in patients′ satisfaction with nursing service before ( 90. 03%) and after (96.08%) implementation (χ2=140.412,P<0.01). The incidence of nursing defect, errors, and accidents was 1.02% before implementation and was 0.46% after implementation with a significant difference (χ2=10.748,P<0.01). After implementation, the job satisfaction of nurses increased from 12.0% (before implementation) to 82.0% with a significant difference (χ2 =49. 177, P<0. 01 ) . Conclusions Specialized team building can improve the quality of intravenous infusion and job satisfaction of senior nurses so as to enhance self efficacy, professional identity and stabilize nursing staff.

ObjectiveTo study the clinical application value of screening cervical precancerous lesions of high risk human papillomavirus(HPV) testing combined with thin-prep cell test(TCT) in prevention of cervical intraepithelial neoplasma (CIN) and cervical carcinoma. MethodsSeven hundred and sixty-three women were screened by high risk HPV test, TCT and pathology test of biopsy more. The positive coincident rate with the pathology test positive rate during the three technologies was compared.ResultsHigh risk HPV positive was 287 cases, the rate of infection was 37.61％(287/763), and pathology test positive was 82 cases, the coincident rate of which was 28.57％ ( 82/287 ) ; TCT positive was 78 cases, the rate of infection was 10.22％ (78/763), and pathology test positive was 50 cases, the coincident rate of which was 64.10％ (50/78) ; TCT + high risk HPV positive was 59 cases, pathology test positive was 47 cases, and the coincident rate of which was 79.66％ (47/59). Among each coincident rate,the differences were statistically significant (P＜ 0.05). The positive rate of high risk HPV infection CIN I was 32.26％( 10/31 ),CIN Ⅱ 41.38％ (12/29), CIN Ⅲ 93.55％ (29/31), squamous carcinoma of the cervix 96.88％ (31/32),respectively. ConclusionsThe positive rate of high risk HPV increases significantly with the grade of cervical precancerous lesions. It is of great significance to screen in the population for HPV and TCT in a regular time span,since it could not only decrease HPV infection rate and the incidence of cervical lesions,but also prevent the cervical cancer.

Aim To study the antitumor and immunological regulation effects of ardipusilloside-Ⅰ(ADS-Ⅰ) on tumor-bearing mice of S180, H22, EAC and L1210. Methods The tumor-bearing mouse model was made through injecting cancer cells in the right limb oxter(or in abdominal cavity), and the mice were administrated orally with ADS-Ⅰfor 8 days. Then we detached the tumor and counted the inhibition rate of tumor growth. Incorporation of ()~3H-TdR was used to assess the proliferation of T spleen lymphocyte cells; phagocytosis of abdominal cavity macrophage was measured with the method of chicken red blood cells. Results ADS-Ⅰ was proved to be effective on the tumor-bearing mice of S180, H22 and EAC, and the maximal inhibition rate of the dose of 100 mg?kg~(-1) was 38.7%, 48.6% and 50.0%, respectively;ADS-Ⅰ promoted the proliferation of T spleen lymphocyte cells,and strengthened the phagocytosis of macrophage in the tumor-bearing mice significantly. Conclusion ADS-Ⅰ can inhibit the growth of transplanted tumor,and improve the immunological function of tumor-bearing mice.