Objective:To understand the satisfaction evaluation of contracted residents with " Internet plus" family doctor services and to explore its influencing factors.Methods:From November to December 2021, a stratified random sampling method was used to select 360 contracted residents who had utilized " Internet plus" family doctor services from community health service centers or township health clinics in various counties, cities, or districts of a city in Shandong Province for on-site questionnaire surveys. The purpose was to understand their awareness and satisfaction with the " Internet plus" family doctor services. At the same time, key informant interviews were conducted with contracted residents according to the principle of intensity sampling and information saturation, to collect their opinions and suggestions on the implementation process and model construction of " Internet plus" family doctor services. Descriptive analysis was performed on the data, and a binary logistic regression model was used to analyze the factors affecting the satisfaction of contracted residents with " Internet plus" family doctor services.Results:352 valid questionnaires were obtained. Among the respondents, 108 (30.6%) were very familiar or relatively familiar with the " Internet plus" family doctor service policy, and 251 (71.3%) expressed a high level of satisfaction with the overall " Internet plus" family doctor service. Gender, monthly income status, frequency of participation in health education activities, and satisfaction with the doctor′s daily service attitude, medical technical level, medical service charge level, and the level of communication between the service team and family members were factors affecting the satisfaction of contracted residents with " Internet plus" family doctor services ( P<0.05). Interview results showed that 38 people (95.0%) believed that there were issues with the current implementation of " Internet plus" family doctor services in China, such as the lack of an effective policy support environment, the need to improve the publicity and mobilization effects of contracting institutions, poor service cognition levels among the population, concerns about service quality, misunderstandings about internet-related concepts, network " panic" caused by electronic fraud phenomena, and cultural level differences among the elderly that limited the use of services. Conclusions:The overall satisfaction of contracted residents with the " Internet plus" family doctor services was relatively good. Various factors affected the satisfaction evaluation of contracted residents. It is important to focus on the differences in service psychological perception among contracted residents with different demographic characteristics, strengthen the construction of service teams and service platforms, and improve the public′s cognition and participation in " Internet plus" family doctor services to promote the continuous development of " Internet plus" family doctor services.

Objective To investigate the effect of Liu-Shen-Wan on transplanted tumors in mice with colon cancer based on the polarization of M2 macrophages in the tumor microenvironment. Methods We established a subcutaneous transplantation tumor model of mice with CT26 colon cancer. Mice were randomly divided into vehicle, oxaliplatin, and oxaliplatin combined with Liu-Shen-Wan groups. Treatment was administered for three weeks, and tumor volume was measured. All mice were weighed during the administration. After the end of the treatment, the mice were dissected and tumors were photographed and weighed. Spleen index was calculated. The expression levels of IFN-γ and IL-12P40 in serum and related blood biochemical indices were measured. The expression levels of M2 macrophage polarization indices, namely, IL-10 and TGF-β, in serum and tumor tissues were detected. The infiltration degree of M2 macrophages in each group was observed by immunohistochemical experiments. Results The tumor volume and mouse weight in the oxaliplatin combined with Liu-Shen-Wan group significantly decreased compared with those in the vehicle group. The spleen index increased, and the expression levels of IFN-γ and IL-12P40 in serum also significantly increased. The mice had no obvious side effects after the drug treatment. In addition, the expression levels of IL-10 and TGF-β in the serum and tissues of mice in the oxaliplatin combined with Liu-Shen-Wan group significantly decreased. The expression levels of CD68 and CD206 in tumor tissues also decreased. Conclusion The anti-tumor effect of Liu-Shen-Wan on the transplanted tumors of mice with colon cancer is related to the inhibition of M2 macrophage polarization in the tumor microenvironment.

Objective:To investigate the predictive value of 18F-FDG PET-CT in the conversion from thoracoscopic lobectomy to thoracotomy for non-small cell lung cancer (NSCLC). Methods:The clinical data, CT and PET-CT images of 193 patients with primary NSCLC undergoing thoracoscopic surgery from January 2014 to June 2021 at China-Japan Friendship Hospital were retrospectively analyzed. All patients were divided into 45 cases who were converted to thoracotomy (the conversional group) and 148 cases who were not converted to thoracotomy (the non-conversional group). Univariate analysis was performed on clinicopathological characteristics and image parameters. Multivariate logistic regression was used to analyze the factors affecting the conversion to thoracotomy. Taking the final conversion to thoracotomy or not as the gold standard, the predictive effect of variables in the conversion to thoracotomy was analyzed through the receiver operating characteristic (ROC) curve. Delong test was used to compare the area under the curve (AUC) predicted by all variables.Results:In the conversional group, the proportion of peribronchial lymph node (PLN), peribronchial cuffs of soft (PCS), pleural calcification, pulmonary nodule calcification, PLN or PCS calcification or increased density on chest CT was higher than that in the non-conversional group (all P<0.05); and the maximum standardized uptake value (SUV max) of PET in the conversional group was higher compared with that in the non-conversional group ( P<0.001). Univariate logistic regression analysis suggested age ( OR = 4.663,95% CI 2.191- 9.923, P < 0.001) and PLN or PCS density of chest CT scan ( OR = 2.824, 95% CI 1.791-7.303, P < 0.001) were independent influencing factors of the conversion from thoracoscopic lobectomy to thoracotomy. ROC analysis showed that the effect of the conversion to thoracotomy predicted by the combination of 18F-FDG PET and chest CT [AUC = 0.891 (95% CI 0.831-0.951); the optimal cut-off value of SUV max and CT was 3.45, 70 Hu: the sensitivity was 84.4%, the specificity was 83.8%] was better than that by chest CT alone [AUC = 0.678 (95% CI 0.591-0.766); the optimal cut-off value of CT was 70 Hu: the sensitivity was 62.2%, the specificity was 62.8%; P < 0.001] and by age [AUC = 0.625 (95% CI 0.532-0.719); the optimal cut-off value was 65.5 years: the sensitivity was 75.6%, the specificity was 60.1%; P < 0.001]. Conclusions:PLN or PCS density on chest scan and age are valuable in predicting the conversion from thoracoscopic lobectomy to thoracotomy for NSCLC patients. The combination of PET and CT has an additional role in predicting the conversion to thoracotomy during thoracoscopic lobectomy.

Background: Thyroid diseases are highly prevalent worldwide, but their diagnosis remains a challenge. We established reference intervals (RIs) for thyroid-associated hormones and evaluated the prevalence of thyroid diseases in China. Methods: After excluding outliers based on the results of ultrasound screening, thyroid antibody tests, and the Tukey method, the medical records of 20,303 euthyroid adults, who visited the Department of Health Care at Peking Union Medical College Hospital from January 2014 to December 2018, were analyzed. Thyroid-associated hormones were measured by the Siemens Advia Centaur XP analyzer. The RIs for thyroid-associated hormones were calculated according to the CLSI C28-A3 guidelines, and were compared with the RIs provided by Siemens. The prevalence of thyroid diseases over the five years was evaluated and compared using the chi-square test. Results: The RIs for thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), and total triiodothyronine (TT3) were 0.71–4.92 mIU/L, 12.2–20.1 pmol/L, 3.9–6.0 pmol/L, 65.6–135.1 nmol/L, and 1.2–2.2 nmol/L, respectively. The RIs of all hormones except TT4 differed significantly between males and females. The RIs of TSH increased with increasing age. The prevalence of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was 0.5% and 0.8%, 0.2% and 0.6%, 3.8% and 6.1%, and 3.3% and 4.7% in males and females, respectively, which differed from those provided by Siemens. Conclusions Sex-specific RIs were established for thyroid-associated hormones, and the prevalence of thyroid diseases was determined in the Chinese population.

Objective:To report our experience in diagnosis and treatment of posterior atlantoaxial dislocation with odontoid retrolisthesis.Methods:A retrospective study was conducted of the 5 patients who had been treated from July 2012 to August 2018 at Department of Orthopaedics, General Hospital of Southern Theater Command for posterior atlantoaxial dislocation. They were 4 men and one woman, aged from 34 to 67 years (average, 47 years). All of them had a history of trauma. Of them, 4 were complicated with odontoid fracture and one with congenital free os odontoideum. Their posterior atlantoaxial dislocation ranged from 3 to 9 mm (average, 6 mm). By the American Spinal Injury Association (ASIA) grading system, their preoperative spinal injury was rated as grade B in one, as grade C in 3 cases and as grade D in one. All the 5 patients underwent skull traction at 10° flexion. Surgical trans-oralpharyngeal atlantoaxial reduction and internal fixation was performed for the one patient whose reduction had not been achieved by traction while posterior atlantoaxial screw-rod fixation or anterior odontoid screwing was conducted for the 4 patients whose reduction had been achieved by traction. The distance of posterior atlantoaxial dislocation was measured to evaluate their reduction and ASIA grade system was used to assess their spinal function after operation.Results:The postoperative distance of posterior atlantoaxial dislocation was 0 mm, showing a reduction rate of 100%. The 5 patients were followed up for 6 to 36 months (average, 15 months). By the ASIA grade system, the postoperative functional recovery of the spine was grade D in 4 cases and grade C in one. No implant loosening or breakage occurred.Conclusion:As a kind of high-energy hyperextension injury, posterior atlantoaxial dislocation is rare in clinic, but an appropriate treatment can be adopted to deal with its different clinical types to achieve good outcomes.

Objective To investigate the metastasis and the prognosis of the axillary lymph nodes in triple-negative and invasive ductal breast cancer patients of different ages.Methods 321 female breast cancer patients diagnosed as triple-negative and invasive ductal carcinoma from Jan.1,2008 to Dec.31,2017 were selected as the samples,all of whom were treated with regular surgical treatment and postoperative radiotherapy and chemotherapy,and were divided into three groups according to their ages,including the younger group(＜40 years old),the middle age group (40 to 60 years old),and the elder group(≥60 years).We compared the metastasis of axillary lymph node,the disease-free survival rate after 1 to 5 years of the operations and the prognostic factors of the three groups.Results Among the 321 patients,there were 94 young patients,151 middle-aged patients and 76 elder patients.Among the three groups,the rate of axillary lymph nodes metastasis was the lowest in the elderly group(11.8％),the highest in the middle-aged group(17.2％)and middle in the young group(13.8％).The patients were followed up for 1 to 5 years.The recurrence rate of the young,middle-aged and elder groups was 56.4％,53.6％ and 17.1％ respectively.There was a significant difference between the three groups (P＜0.05).Conclusion ①he frequency of LN transfer in patients of TNBC is lower in the younger and the elder patients than in the middle-aged patients.②The younger patients of TNBC have a higher recurrence rate and poor prognosis,while the elder patients of TNBC have the lowest recurrence rate and good prognosis.(③The prognosis of TNBC may be related to metabolism,which,of course,needs to be further verified with the proof of blood and cell test.(④The younger patients of TNBC are more likely to suffer blood metastasis,and adjuvant systemic therapy in early period may be more beneficial than local radiotherapy and early axillary dissection.

Objective To investigate the changes of prevalence of hyperuricemia ( HUA) and its correlations with blood glucose and lipid in healthy adults receiving physical examination at Peking Union Medical College Hospital (PUMCH) from 2012 to 2017. Meth-ods An observational approach was adopted for the data analysis.The test results of uric acid (UA),fasting blood glucose (FBG),to-tal cholesterol (TC),triacylglycerol (TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C), creatinine (Cr) and Urea of 399 089 cases (206 881 males and 192 208 females) at PUMCH from January 2012 to December 2017 were collected and statistically analyzed.Results The total prevalence of HUA was 17.4% in which the prevalence of males was signif-icantly higher than that of females (25.6% vs 8.5%,χ2＝20 234.850,P＜0.01).During the years of 2012 to 2017,the prevalence of HUA was 26.5%,24.7%,28.6%,23.9%,24.8% and 24.5% in males,and 13.8%,6.3%,7.9%,6.1%,6.2% and 6.8% in females for each year respectively.The prevalence of HUA in males aged 18 to 64 years old was significantly higher than that in the age-matched fe-males (all P＜0.05).However, the prevalence of HUA in males aged≥65 years old was similar to the age-matched females.There was no statistically significant difference of HUA prevalence between males and females aged ≥65 in 2013,2015,2016 and 2017 ( χ2＝1.792,0.017,1.440 and 0.205 respectively;all P＞0.05).The percentages of hyperlipidemia in both males and females of HUA group were higher than those of non-HUA group respectively (all P＜0.01).The percentage of hyperglycemia in males of non-HUA group was higher than that of HUA group,but the percentage of hyperglycemia in females of non-HUA group was lower than that of HUA group ( all P＜0.01).High levels of TC,TG and FBG were risk factors of HUA with increased OR values in increased concentrations of TC,TG and FBG,respectively.Conclusion During the recent 6 years, in healthy adults receiving physiced examination at PVMCH, the preva-lence of male HUA diagnosed was at overall high level,but the prevalence of female HUA was in decreasing and relatively stable trend. Hyperlipidemia and hyperglycemia should be the risk factors of HUA.

Objective To evaluate the analytical performance of four lipoprotein associated phospholipase A2(Lp-PLA2)activity reagents on Beckman AU5800 automatic biochemical analyzer. Methods The remaining serum samples of 214 patients and 140 apparently healthy individuals were collected from March to July 2017 in Peking Union Medical College Hospital.These samples were used for method comparison and reference interval evaluation.According to the guidelines of EP15-A,EP6-A,EP-17 and EP7-P from Clinical and Laboratory Standards Institute(CLSI)standards,the precision, linearity, sensitivity and common interferences(e.g free bilirubin, conjunct bilirubin, hemoglobin and chyle)were assessed.According to EP9-A2,method comparisons of differents regents(Evermed,DiaSys,Hengxiao and Zhongyuan were labeled as A,B,C and D,respectively)were conducted and the differences were estimated at medical decision levels(328U/L,391U/L and 485U/L).Results The precision of four reagents were acceptable.The repeatability(CV%)of A to D were 0.5%-1.7%, 0.7%-3.0%, 0.9%-2.0% and 0.5%-3.3%,respectively.The reproducibility(CV%)were 0.7%-2.9%, 1.4%-3.2%, 1.3%-1.9%and 0.8%-4.1%,respectively.Both of those achievedlaboratory defined quality objective(<5%).The linearity of A to D were 44 -1 992 U/L,39 -1 798 U/L,13 -540 U/L and 75-1 717U/L,respectively.The regression coefficient R2 was between 0.997 and 1.000, and the correlation coefficient(r)was between 0.998 and 1.000.The interference of chyle were acceptable among these four reagents andmet the manufacturer′s requirementsor clinical needs.In a low level of Lp-PLA2,bilirubin had an obvious interferenceonreagent C;B and C were negatively affected when the hemoglobin was 4.5 g/L; and D was positively affected when the hemoglobin was 2.45 g/L.The regression coefficients R2 of A,C,D compared with B were between 0.978 and 0.995,and the correlation coefficients(r)were between 0.989 and 0.998. The expected differences at medical decision levels ranged from -240 U/L to 113 U/L.For A to D,the Lp-PLA2 activity results of 131(93.6%), 140(100%), 82(58.6%), and 128(91.4%)cases were analysed within the manufacturer′s claimed reference intervals.Conclusion The precision and linearity of the four Lp-PLA2 activity detection reagents used in automatic biochemical analyzer are good, but the anti-interference ability needs to be improved.

Objective To validate the performance of six enzymatic glycated albumin reagents and evaluate their clinical application.Methods The performance of six enzymatic glycated albumin reagents(labled as A,B,C,D,E,F) from Beijing Jiuqiang Co, Beijing Lideman Co,Ningbomeikang Co, Beijing Haomai Co, Sichuan Maike Co and Asahi Kasei Co were assessed on Olympus AU5800 automatic biochemistry analyzer.According to the standard of CLSI,the precision,interference and linear correlation of these reagents were assessed.To assess the accuracy of GA% ,we used GA standard material whose value had been assigned using ID-LC/MS method provided by ReCCS.To do the method comparison and determine the consistency of assay, 50 fresh serum samples of T2DM outpatient and 80 fresh serum samples of apparently healthy people in Jan 2016 were tested using six kits.According to the EP28-A3C protocol, the reference range for GA%was validated in 122 apparently healthy individuals undertaking medical examination from January to February 2016 in PUMC.Results The precision,and the ability of anti-interference of the six reagents were good.The accuracy percentage deviation of six reagents was-19.3%-9.2%.The correlation coefficient of domestic reagents A to E and imported reagents F in the determination of GA% was 0.966-0.999, the average absolute bias was 7.0%-10.4%.The coincidence rate of A-E and F in determining abnormal GA% was between 88.5% and 96.9%.The coincidence rate was increased after switching to the reference range for preliminary clinical evaluation.Conclusion Six GA enzymatic kits used in automatic biochemical analyzer have high precision and strong anti-interference ability.Accuracy still needs to be improved.

Objective To evaluate the influence of dosage,operation method,adverse reaction of endoscopic photodynamic therapy (EPDT) on its therapeutic efficacy in rabbit models of in-situ rectal cancer,so as to provide preclinical basis of photodynamic therapy for rectal cancer.Methods 20 rabbits with in-situ VX2 rectal cancer were randomly divided into control group,PDT low dose group,intermediate dose group,and high dose group.At 24 h before PDT,photosensitizer (hermimether) was intravenously injected into rabbits.630 nm semiconductor laser was used as light source.The growth of the tumor was observed by conventional endoscopy and endoscopic ultrasonography,and the survival time,general conditions and adverse reactions were recorded.The histopathological changes were observed by hematoxylin-eosin staining.Results At 7 d after PDT,the total response rates of low dose,intermediate dose and high dose group respectively were 40％ (slight),80％ (60％ remarkable and 20％ slight),100％ (20％ remarkable and 80％ slight).The average survival times of the three groups were 14 d,10 d and 5 d,respectively.The main adverse reactions were inflammation,intestinal obstruction,intestinal peristalsis loss and death.Conclusions The dosage of PDT is an important factor to influence the curative effect.The appropriate dose of PDT will have a better effect on the treatment of rectal cancer.A thorough study of these problems is helpful to the clinical application of PDT in the treatment of rectal cancer.