Objective: To study the influence of community mental rehabilitation based on Deming Cycle(PDCA) management model on the quality of life of patients with chronic schizophrenia. Methods: From January 2016 to June 2017, 100 patients with chronic schizophrenia who agreed to community management in Wuxi were randomly divided into study group(n=50) and control group(n=50). Both two groups received traditional community mental health services, meanwhile, the study group was provided with community mental rehabilitation based on PDCA model.All the patients were followed up for 1 year.The quality of life scales(SQLS), social disability screening schedule(SDSS) and family care index(APGAR) were assessed before and after one-year intervention. Results: At the end of one year after intervention, the scores of total quality of life, psychosocial dimension, motive and energy dimension, symptom and side effects in the observation group were (41.27±10.54)points, (38.37±10.84)points, (35.43±7.46)points, (20.71±7.34)points, respectively, which were lower than those in the control group[(51.98±7.43)points, (48.73±8.72)points, (47.67±6.98)points, (29.79±8.64)points] and before intervention[(54.37±5.87)points, (49.78±4.73)points, (48.57±6.87)points, (33.17±10.42)points](t=5.87, 5.27, 8.47, 5.66, 7.68, 6.82, 9.16, 6.91, all P<0.05). At the end of one year after intervention, the social function score[(6.78±2.84)points] of the observation group was significantly lower than that of the control group[(8.83±2.73)points]and before intervention[(8.97±2.18)points](t=3.68, 4.33, all P<0.05), and the family social care index score[(8.75±2.04)points]was significantly higher than that of the control group[(7.04±2.36)points] and before intervention[(6.76±2.14)points](t=-3.88, -4.76, all P<0.05). There was a positive correlation between SDSS score and SQLS score(r=0.41, P<0.05). There was a negative correlation between SQLS score and SDSS score(r=-0.35, P<0.05). Conclusion The community mental rehabilitation strategy based on PDCA model can improve the social function and family social care, effectively improve the quality of life of schizophrenic patients, while positively promote the rehabilitation of patients.

Objective To review the experience of the clinical diagnosis and treatment of primary testicular diffuse large B-cell lymphoma.Methods A review was made who were treated in the Tumor Hospital of Zhengzhou University from January 2011 to November 2018.The average age of the patients was 58 years old,with 4 cases in left side and 8 cases in right side.All patients were admitted to hospital with painless testicle mass.Solid mass of testis were detected by ultrasound with no abnormality in tumor markers.All patients underwent orchiectomy and followed by chemotherapy.Results Twelve primary testicular lymphoma (PTL) were identified by pathology,with 8 cases in phase Ⅰ,2 cases in phase Ⅱ,1 case in phase Ⅲ,and 1 case in phase Ⅳ.The mean follow-up was 31 months.Inguinal orchiectomy was recommended as a diagnositc and initial therapy.All patients underwent R-CHOP/CHOP chemotherapy consisting of cyclophosphamide,doxorubicin,vincristine and prednisone with or without rituximab,including 6 cases with R-CHOP and 6 cases with CHOP.Nine of 12 patients underwent intrathecal prophylatic chemotherapy and 6 of 12 patients underwent contralateral testicle radiotherapy.Relapse occured in 2 patient with CHOP in central nervous system and died of the disease.One case with CHOP relapsed in abdominal cavity.No contralateral testicle relapse was observed.Conclusions PTL is a rare extranodal lymphoma.Painless testicle tumor in men over 50 years old should suspect of this disease.Inguinal orchiectomy is an important part of the treatment,which combines systemic chemotherapy and prophylactic modalities such as radiotherapy of contralateral testis and/or central nervous system (CNS) prophylaxis.

Objective: To summarize the clinical experience of primary bladder lymphoma. Methods: From September 2012 to May 2019, 8 cases of primary bladder lymphoma treated in our institute were analyzed retrospectively, including 4 males and 4 females. The mean age was 50.5 years old, ranged from 15 to 85. There were 3 cases of localized bladder lymphoma and 5 cases of metastatic bladder lymphoma. Three cases presented with painless gross hematuria primarily and 5 cases suffered from abdominal pain and bloating. Imaging examination showed the bladder tumor or pelvic mass with maximum diameter ranged from 3 to 22 cm, with 11.3 cm on average. Preoperative diagnosis of bladder tumor in 3 cases, and pelvic malignant tumor in 5 cases. Two patients underwent TURBT and 6 cases underwent pelvic mass resection and partial cystectomy. Results: Postoperative pathological diagnosis showed 6 cases of diffuse large B-cell lymphoma, 1 case of mucosa-associated lymphoid tissue lymphoma, 1 case of anaplastic large cell lymphoma. Follow-up after surgery ranged 3 to 60 months, with 28.1 months on average. Two patients can not tolerate radiotherapy or chemotherapy for postoperative complications of vesico-vaginal fistula and intestinal fistula, and both were alive at the last follow-up. Six patients underwent CHOP regimen (cyclophosphamide, doxorubicin, vincristine, prednisone), 3 cases were addd with rituximab. Three patients died during the follow-up. One 85-year-old patient died 10 months after surgery. Two cases of metastatic bladder lymphoma died 3 or 6 months after surgery respectively. Three cases were alive after chemotherapy, including 2 young patients undergoing chemotherapy with DICE regime and one patient undergoing pelvic radiotherapy. Conclusion The primary bladder lymphoma has no special clinical symptoms, and TURBT and needle biopsy are critical for the diagnosis, based on the pathological and immunohistochemical examination. The most common pathological type is diffuse large B-cell lymphoma. R-CHOP chemotherapy is recommended, which can be followed by DICE regime for young patients. Metastasis and aging predict poor prognosis.

Objective To compare the therapeutic results of photodynamic therapy (PDT) combined with biliary stenting versus biliary stenting alone in the treatment of nonresectable bile duct cholangiocarcinoma.Methods The PubMed,CBM,CNKI,VIP and WanFang Data were searched from January 1990 to December 2017.Two researchers independently screened the literatures,extracted the data and performed the quality evaluation.The meta-analysis was carried out using the RevMan software 5.3.0.Results Eleven controlled clinical trials were included in the meta-analysis.There were only two randomized controlled trials.The remaining studies were non-randomized controlled trials.Finally,659 patients were enrolled in this study.293 patients were treated with photodynamic therapy and biliary stenting while 366 patients were treated with stenting alone.Analysis showed that photodynamic therapy combined with stenting significantly extended the overall survival when compared with stenting alone (P＜0.01).There was no significant differences in the incidences of cholangitis (P＞0.05),but PDT and stenting had a significantly higher total complication rate (P＜0.05).Conclusions This meta-analysis showed that photodynamic therapy combined with stenting significantly improved the survival rate of patients with nonresectable ductal cholangiocarcinoma when compared with stenting alone.Photodynamic therapy did not increase the incidence of cholangitis.

Objective To evaluate the risk factors and prognosis of high risk bladder recurrence developing after radical nephroureterectomy(RNU) for upper tract urothelial carcinoma (UTUC).Methods The data of 148 UTUC patients who developed bladder tumor after RNU between January 2000 and December 2013 was retrospectively studied.There were 69 males and 79 females,aged from 34 to 82 years old (average 68 years old).83 patients were accompanied with hydronephrosis.80 patients were renal pelvic carcinoma.32 patients had the history of smoking.24 patients had the history of ureteroscope.68 patients had the tumor larger than 3 cm.Logistic regression model was used to analyze the risk factors of muscle invasive and high grade bladder recurrence lesions.We compared the clinocopathologic characteristics between primary UTUC and bladder cancer recurrence by using Fisher' s exact test.Cancer specific survival was analyzed using the Kaplan-Meier method,with the log-rank test used to assess significance.A Cox proportional hazard model was used for multivariate analysis.Results Of the 148 patients,non-muscle invasive (Tis、Ta and T1) tumors of primary UTUC and bladder recurrence were 51 (34.5％) and 119 (80.4％),respectively.High grade (G3) tumors of primary UTUC and bladder recurrence were 41 (27.7％) and 53(35.8％),respectively.During follow-up,94 (63.5％) experienced bladder recurrence once and 54 (36.5％) experienced multiple bladder recurrence.The median follow-up time was 59.5 (rang 8-142) months,48 (32.4％) patients died of UTUC.The grade of bladder cancer recurrence correlated with the grade (P =0.046),muscle-invasion (P =0.002) and tumor architecture (P =0.034) of the primary UTUC;muscle-invasive bladder cancer recurrence associated with that of the primary UTUC (P =0.009);bladder multiple recurrence related to gender (P =0.007).On multivariate logistic regression analysis,the muscle-invasion of primary UTUC was an independent risk factor for muscle-invasive (HR =5.512,95％ CI 1.654-18.37,P =0.004) and high grade (HR =3.948,95％ CI 1.589-9.813,P =0.004) bladder recurrence tumor.The muscle invasion of primary UTUC (HR =3.498,95％ CI 1.569-7.803,P =0.002) was a prognostic factor for cancer specific survival on multivariate Cox regression analysis.Conclusions Muscle-invasive UTUC tend to predict high risk bladder recurrence tumor,and the female could be more likely to appear multiple recurrence tumor.The muscle invasion of primary UTUC could be an independent prognostic factor for cancer specific survival.

Objective To explore a clean and efficient new method for extraction of Diosgenin. Methods Yield of the total saponins was evaluated to determine the optimal enzymolysis temperature,pH,solid to liquid ratio,dosage of enzyme and enzymolysis time.Using diosgenin yield as an index,solid to liquid ratio,concentration of sulfuric acid and hydrolysis time were optimized in the saponins hydrolysis process via orthogonal experiment. Results The best conditions for the enzyme pretreatment were as follows:the temperature for enzymolysis was 70℃,pH 5.5,solid to liquid ratio was 1:4,dosage of enzyme was 8 mL?kg-1,and extraction time was 24 h.The best conditions of total saponins hydrolysis were as follows:the solid to liquid ratio was 1:4,concentration of sulfuric acid was 2.0 mol?L-1 ,and hydrolysis time was 5 h. Conclusion The new method is environmental friendly and highly efficient,and expected to be applied in industrial production.

Dioscin chemical compositions are the main effective components in clinical commonly used Chinese medicines such as Diaoxinxuekang capsules and Xinnaoshutong capsules etc , which show distinct curative effect on cardiovascular and cerebrovascular diseases.Meanwhile, they are the important raw materials for the synthesis of steroid hormone drugs .The studies on the extraction technology exhibit important significance in the exploration of pharmacological activities of the components , which also are the external requirements for the growing demand of steroid hormone drugs market .In this paper , the relatively mature extraction methods re-searched in recent years were summarized ,and the advantages and disadvantages of the different processes were discussed in order to provide reference for the further studies and application .

Objective To analyze the 2015 IAAF World Athletics Championships victim of disease type and composition,investigate medical emergency services for major international sporting events.Methods The 2015 IAAF World Athletics Championships in Medical Encounter Forms records in 737 cases during the game (2015-8-21 to 2015-8-30) were retrospectively reviewed and analyzed.Results Total of 737 patients during the match,trauma 259 cases (35.1％),respiratory diseases 196 cases (26.6％),digestive diseases 77 cases (10.4％),heat-related illnesses 41 cases (5.6％).Athletes 170 cases (23.1％),174 cases of staff (23.6％),139 cases of the IAAF family members (18.9％),136 cases of spectators (18.4％),members of the media 56 cases (7.6％).Conclusions 2015 IAAF World Athletics Championships type of disease the treatment of patients with the most common sports injury,followed by respiratory diseases and common diseases in summer heat-related illnesses.Clinic staff personnel structure the most common,followed by extended family members as well as the IAAF athletes and spectators.Major sports events should develop reasonable security programs for priority diseases and key customer base,and to ensure a smooth operation.

Objective To evaluate the safety and therapeutic effect of covered expandable metallic stent placement combined with interventional chemotherapy in treating malignant esophago-tracheal fistulae. Methods A total of 60 patients with esophago-tracheal fistula were enrolled in this study. The patients were randomly divided into control group (n=28) and study group (n=32). Patients of the control group were treated with covered stent implantation only, while patients of the study group were treated with combination use of covered stent implantation and interventional chemotherapy. All the patients were followed up regularly, the short-term and long-term results were determined, and the effect rate, median survival time and complications were statistically analyzed. Results Among the 60 patients, successful obstruction of the fistula was obtained in 58 with a success rate of 96.7%. The median survival time of the 58 patients was 5.8 months. The median survival time of the control group and the study group was 3.6 months and 8.7 months respectively, the difference between the two groups was statistically significant (P<0.05). The one-month, 3-month and 6-month effect rates were 78.1%, 68.8% and 62.5% respectively. The incidence of esophageal stent re-stenosis in the study group was much lower than that in the control group. Conclusion The combination use of covered stent implantation and interventional chemotherapy can effectively improve the median survival time of patients with malignant esophago-tracheal fistula, and reduce the occurrence of stent-related complications. Therefore, covered expandable metallic stent placement combined with interventional chemotherapy is an effective and safe treatment for malignant esophago-tracheal fistulae.

Radix bupleuri is mainly used to treat cold fever and liver disease, and the curative effect is remarkable. The prepara-tions previously explored including bupleurum injection, tablets and capsules all show their own characters and different applicable peo-ple. Recently, many researchers carried out extensive research on its dosage forms. The early formulations have been improved as well, and successively developed dropping pill, nasal sprays, transdermal patches and the other new dosage forms. In the paper, the recent research progress in bupieurum preparations were summarized in order to provide reference for the improvement and application.